WSJ article: "Med School Needs an Overhaul"

[finn_]

And it is hard to disagree with you. However, the question remains the same – to what extent it is a society's failure and to what your parents' and yours?

Sure, and depending on your situation it could be due to your parents. Maybe they made some bad choices and now you have to pay the price. Is that fair? I guess that’s up for debate. But maybe certain groups have been systematically discriminated against for decades and even centuries and these disadvantages also get passed down.

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[Mkif586]

Sure, and depending on your situation it could be due to your parents. Maybe they made some bad choices and now you have to pay the price. Is that fair? I guess that’s up for debate. But maybe certain groups have been systematically discriminated against for decades and even centuries and these disadvantages also get passed down.

Again, I can't agree more. The question is how to draw the line between the two? And here is where big politics come into play and given the extreme left lean of academia I really doubt it will not be skewed toward progressive agenda instead of systematically approaching the situation. Nobody wants to leave any patients group without best possible comprehensive care. But we must understand what is a patient failure that we can address or take into account and where there is nothing we can do about the patient's life situation, but you need to complexly approach the problem not just by pointing to one side based on one's political affiliation.

 

[dr_kateb]

to what extent it is a society's failure and to what your parents' and yours?

If the sociology courses I was forced to take are right, 100% society’s fault.

 

[deleted621740]

I think this topic is one of the most sensitive in todays media, you make an excellent point but you only cover one side of a problem by completely forgetting about individual choices which seems to be a taboo in academia. And I am 100% sure that if the class would be added to the curriculum it will make same mistakes. By the way it is already taught in HS and college, the classes are called American history and sociology.

This is exactly correct. The reasons @LizzyM stated that lead to racial disparities are correct, but @LizzyM fails to even touch on personal choice. And the fact that an anonymous faculty member on here neglected to include perhaps one of the biggest contributors to the variance in income between races, we can be pretty sure that these causes won't be discussed in a medical school classroom in one of these courses. @LizzyM also fails to list how differences in culture contribute. For example, it has been shown that lower income African-Americans are more likely to own luxury items (shoes, clothes, vehicles, etc) than their white counterparts in similar and even some higher income brackets. So, if we really care about fixing disparities, why not address things like this as well? Why only the racism that exists out in the ether and which is very hard to pinpoint? Choice and culture between groups make a difference, but of course, that does not mean that racism, and poor policy don't also have a substantial impact, which they absolutely do. My point is just that @LizzyM is lending credence to the idea that these classes and the discussions that occur in them may be one-sided.

 

[deleted480308]

One group tends to have less money but why? Blacks have lower income than any other racial or ethnic group, why? Let's look at the systems that keep them poor: educational spending in this country is based on real estate taxes and thus there is less money for education in areas that are predominately lower income. Some communities keep lower income people out through zoning and other regulations on housing stock (minimum lot size, bans on multi-family units, etc) , and blacks have been segregated and redlined and zoned out of some communities. There is far less intergenerational wealth and I could go on and on but I'll recommend this article:

Examining the Black-white wealth gap | Brookings

A close examination of wealth in the U.S. finds evidence of staggering racial disparities.

www.brookings.edu

So if people have less money for expensive services, and they are more likely to die because of the absence of a service, we need to ask why that is happening in one of the richest countries in the world.

It should be taught somewhere, don't you think? College, High School, medical school?
Why do health disparities exist? is there something docs can do about it? Is it a bigger social issue that needs to be addressed systemically by all of society? Do we need to be woke? When? Where?

That’s politics, not medicine

 

[Mkif586]

Also, there are few other serious questions, one of which is why this class is needed after all? What does it cover beyond what was covered in history, sociology, mandatory public health lectures and liberal news every single day? The answer "to get a deeper understanding of [issue]" is not going to work. How deep is enough? How to determine it? Who is going to take the responsibility of deciding that, "totally unbiased" dean? Given that the lectures will be extremely one sided, what benefit would it serve by cutting time devoted for something more practical? What to do with this information at the end of the day? Advocating for change? But people spend years studying one particular problem before they make suggestions or consult politicians, you really think that one class in med school that covers only a tiny portion and is extremely one sided will make doctors enough savvy to advocate for something? It is nothing more than an idea to use a huge halo effect against society "if even doctors said that, it means this is important". When you advocate for something you advocate for a particular political and a particular program, when there are 10 different people with 10 different programs how would you pick the right one after one short class many years ago? Just advocating to "fight poverty and injustice" is nothing more than just words. If you made it to medical school then you probably already know how society works and what issues it has, what secret but extremely important information could be taught during that class to make you go and say – "we have a very serious problem that nobody besides us know about and we have no idea how to fix but something needs to be done". Indeed, there are so many secret and untold issues in America that general public had never heard of before and never attempted to fix. But one short course in medical school will dramatically change the situation. Are there any scientific evidence to support the claim “Problem X exists. Adding a few-week class to medical schools’ curriculum leads to improving the situation”?
Go on twitter and find a whole bunch of physicians from many countries advocating for particular politicians, companies, bashing other countries and their population, and of course using mantra "I am a doctor, I know better" though it is not within one's scope of practice. If someone took intro to macroeconomic back in freshman year of college, should we now contact that person to consult fed? Imagine how it would like – what makes you an expert in that topic? – Well, I am zoology major who works at Mesa Verde National Park but I took 16-week introductory class 15 years ago and I now ask to make a minimum wage $100 to fight poverty because poverty is bad. Does public have a huge respect for park rangers? No, but it does have it when it comes to doctors. Now the exact same situation but when it comes to physicians advocating for a change in socio-economic area. What makes an expert in the field to advocate for a particular reform? I am a dermatologist who took a mandatory 5-week course in medical school 20 years ago, trust me, I know what I am talking about. How does that work for you? In some countries doctors study theology, history of local communist party, and then go in public to advocate for that. 100% unbiased innit?
And another serious issue it trying to pull whatever one can by pretending it is important to know. How about astronomy? What, you think it is unrelated to medicine? Did you know that some people have sensitive eyes to sunlight and knowing what is sun is very important. Did you know that there are people who like to look in the sky while driving at night and people do get into car accidents because of that? I can give more ridicules examples that, however, clearly show that if one has a goal to include something into the curriculum, it is always possible to justify it.

How urban design can impact mental health

A great deal of work has been done on how urban design can improve physical health: reducing obesity, or lung diseases, for example. But in the proliferation of research and guidelines for the...

www.urbandesignmentalhealth.com

Could bad buildings damage your mental health?

Research has shown city dwellers are more likely to suffer from anxiety and depression – but could individual buildings have a negative impact on wellbeing?

www.theguardian.com

You got me right, urban and building designs are now should be taught in medical schools! Screw architects and urban planners, it is doctors' job to do it. You think this is it? How about divorce related suicides and mental disorders? You think we have therapists for that? Screw this, if it affects patients life situation, we need to teach that in medical school, now doctors are responsible for studying family psychology and advocating for family policies. And there are could be many more examples of what affects patients lives.
My overall point is that, we only have 4 years to become as good physicians as we can, and what is taught is a zero sum game. If you add something, you now have to remove something. There are enormous amount of things that affect people health, but doctors are not responsible for learning everything about the world around us, and should instead focus on something more practical and within scope of practice. We cannot add everything to the curriculum and one 5-week class will not make anyone an expert in a particular issue. It would look like a 5 year old kid asking "if there are so many poor people why can't government just print money and it give to everyone?". It will be exactly the same but with doctors "I am a doctor, I see poverty is bad, I have no education in economics besides some class many ears ago, but I will go and advocate for any policy that promises to fix inequality. How do I know that it will not inflict any further damage, I don't, but I am a doctor and that white coat means I am cool enough to advocate for that".

 

[LizzyM]

My overall point is that, we only have 4 years to become as good physicians as we can, and what is taught is a zero sum game.

Nope. Life-long learning. What goes before medical school is important. What comes after is important. Yes, personal choice is important and learning to talk about personal choices with patients and to help people engage in behavior change is also part of the curriculum but it has not been part of the conversation this week which has focused on social justice issues in the curiculum.

 

[deleted1005514]

Nope. Life-long learning. What goes before medical school is important. What comes after is important. Yes, personal choice is important and learning to talk about personal choices with patients and to help people engage in behavior change is also part of the curriculum but it has not been part of the conversation this week which has focused on social justice issues in the curiculum.

I think this leans towards why med schools try to build more diverse classes than in the past. Not just ethnic diversity, but also religious, socioeconomic, etc diversity too. It’s good to have 30 & 40 somethings in a class...they remind the younger students that there’s more to life than studying, test taking, and hustling. Young students remind the older ones that they were young and clueless and scared once too, and to be kind. Those from small towns offer perspective that big city kids have rarely seen. All these different points of view offer a glimpse at medicine from so many angles, I don’t think that could be replicated in a formal curriculum.

 

[Mkif586]

Nope. Life-long learning. What goes before medical school is important. What comes after is important.

100% true. So, why can't we learn socio-political stuff on our own before or after medical school? And if we speak more practically, we pay huge amount of money, take insane loans (in most countries you can buy few houses for that price) to actually get the degree, pass boards and obtain residency. It may sound that "no, no, you pay money to become well rounded physician etc". But there are many people who hold different views and yes, they pay money to just move on to the next step which is best possible residency, what is beyond that is not their business, if something doesn't help me to get into the most competitive program, then I don't care how important someone thinks it is. Don't get me wrong, I am not saying that I or majority of (pre)medical students hold this view but a lot of people do.

 

[HopeP]

Also, it seems like this guy wrote an article with similar themes last year:

Opinion | Take Two Aspirin and Call Me by My Pronouns

Can't wait for next year's article: "Racism in medicine will go away if we just ignore it!"

No wonder it has big time push back An Open Letter to Our Former Dean From 150+ Penn Alums
Next article should be upcoming September, based on biannual series so far.

 

[Maimonides1]

Cultural diversity in any classroom.., more so in medical schools is a critical factor to establish the better understandings needed to bring down any barriers wether in social or political sciences.., but more importantly so in the medical sciences in order to curb health disparities and its social determinants!!

 

[Maimonides1]

No wonder it has big time push back An Open Letter to Our Former Dean From 150+ Penn Alums
Next article should be upcoming September, based on biannual series so far.

Kudos to you ALL..!

 

[LizzyM]

One thing that PBL makes possible is to bring social determinants of health into a case in addition to pathophysiology, immunology, etc. There are ways of bringing this material into a medical school curriculum without it being a discrete course.

 

[HopeP]

One group tends to have less money but why? Blacks have lower income than any other racial or ethnic group, why? Let's look at the systems that keep them poor: educational spending in this country is based on real estate taxes and thus there is less money for education in areas that are predominately lower income. Some communities keep lower income people out through zoning and other regulations on housing stock (minimum lot size, bans on multi-family units, etc) , and blacks have been segregated and redlined and zoned out of some communities. There is far less intergenerational wealth and I could go on and on but I'll recommend this article:

Examining the Black-white wealth gap | Brookings

A close examination of wealth in the U.S. finds evidence of staggering racial disparities.

www.brookings.edu

So if people have less money for expensive services, and they are more likely to die because of the absence of a service, we need to ask why that is happening in one of the richest countries in the world.

Even though I am a typical ORM naturalized citizen parent, understanding the systematic racism and issues even never study US history in my life. All I can do as a parent is educate my son about it and hopefully he makes right decisions for his life. He amazed me when he decided to spend last summer (yes good 2+ months) in an African country at host family w/o any of home luxuries. I will say that experience has profound impact on his thought process that I won't be ever able to influence.

 

[Maimonides1]

One thing that PBL makes possible is to bring social determinants of health into a case in addition to pathophysiology, immunology, etc. There are ways of bringing this material into a medical school curriculum without it being a discrete course.

Wisely said @LizzyM
We don’t have to create discrete separate course for this in our curriculum, rather emphasize the importance of social and family history/background into disease presentation and medical management discussion within a prevailing culture of sensitivity to health disparity between faculty and students, while doing all this without falling in the trap of politicizing medicine “The Noble profession” compare to what the legal profession failed to do..!!