Posted by: bkivey | 5 September 2010

Caring, sensitive, . . . and competent?

On 1 August a news story appeared in the local paper describing the Humanities and Medicine Program at Mt. Sinai Medical School. Under this program the medical school accepts 35 students annually who have majored in a humanity or social science rather than obtain the usual biological or physical science degree. Students accepted under this program take abbreviated courses in organic chemistry and physics the summer prior to the start of medical school. Otherwise, they aren’t required to take the usual courses in biology, chemistry, and mathematics that make up the majority of a pre-med academic program.

The stated goal of the program is to allow access to a medical education for students who are more interested in the ‘care’ part of healthcare. The theory is that such students will focus more on the patient and less on the technical aspects, thus providing a more well-rounded physician. As someone who has had a fair amount of contact with the medical community, usually in the emergency room, I can say that I care a lot less about a physician’s bed-side manner than whether they can correctly diagnose and fix whatever it is that ails me. A couple of anecdotes may serve to illustrate this.

In one year I managed to break my left forearm in five places on two separate occasions within six months of each other. The first time I stiff-armed the ground while falling off my bike; three breaks including one that had it’s own medical name. The second time I got hit by car, also while on my bike; two more breaks in different places. I had the same orthopaedic surgeon both times. His bedside manner was pretty much non-existent: a visit would consist of him entering the room, looking at my arm, writing in the chart, and leaving. No hello, no how-are-you-doing, nothing. Did I feel slighted or ignored? Not in the least. He fixed my arm. Twice. I have 100% functionality, due to his skill and ability, in a limb that was seriously abused . Sure, it would have been nice if he had stopped to chat for a bit, but his skills in the social graces weren’t my primary concern at the time; his skills in the surgical arts were, and he delivered.

 On another occasion I managed to contract Hepatitis-A (Note: you do not want to get this disease). I also came down with the flu and pneumonia, probably due to my weakened immune system. A physician prescribed a medicine for the pneumonia, and when I got home I took the recommended dose. After I took the medicine I started reading the drug information and warnings and saw that that particular medicine was specifically contraindicated for patients with hepatitis. I know the guy knew I had hepatitis because he had diagnosed me. What followed was the worst night of my life where I would black out as my body went into convulsions and then wake up bathed in sweat and with sore muscles from the convulsions. I was so weakened from my various ailments that I couldn’t get to the phone to call 911. This went on for hours, and I was never sure when I blacked out if I would wake up again. That particular physician was a nicer guy than the surgeon, but he damn near killed me.

The point is that in many jobs personality counts for a lot less than competence, and in the medical profession, as in many other fields, the nature of the work requires that it’s practitioners possess certain abilities. Dr. Nathan Kase, the founder of the Mt. Sinai program, is quoted in the article as calling the science requirement for medical school an ‘obstacle’. I would say that isn’t a bad thing.

A person drawn to the hard sciences, or at least willing to take a heavy rotation of college-level work in them, is likely to be inquisitive, intelligent, logical, and able to concentrate. All qualities I would like to see in someone who may well have my life in their hands. The requirements select for people who are good at things that most folks expect their physicians to be good at.

When I was a child I entertained thoughts of entering the medical profession, specifically as an orthopaedic surgeon (this was before I had broken any bones) because I thought it would be cool to put people back together. When I got to 7th grade biology, I knew that medicine was not for me. I just couldn’t get interested in the subject matter. This feeling was reinforced during my college chemistry classes. The only part of those classes I liked was at the end of Chem II where the final lab exam consisted of discovering the constituent parts of an unknown compound. Finding stuff out, that was  cool. The rest of it, not so much.

The Mt. Sinai program has been in place since 1987, so one might expect that at least one study has been done to evaluate how students admitted under its auspices have done in the medical profession vis-a-vis their more traditionally prepared colleagues. The only peer-reviewed study that has been done evaluated the students academic rather than their clinical performance. If the program is to provide insight into the efficacy of a non-traditional medical school preparation, then I would think that the program administrator’s would be anxious to quantify the results.

I have some concern about the motivation of people who do not have to endure the rigor of the usual pre-med education. One of the students interviewed in the story, a development studies major at Brown,  is quoted as saying:

‘I didn’t want to waste a class on physics or waste a class on orgo. The social determinants of health care are so much more pervasive than the immediate biology of it.”

If you want to change the world, I’m sure the Poli Sci or Journalism schools will be happy to have you. If I’m wheeled into the ER at 2:00 AM, I hope the resident physician ‘wasted’ a class on organic chemistry, and is concerned about the immediate biology.

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