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If we reexamined the antiquated educational requirements currently needed to
practice medicine, we could have a plentiful supply of creative, compassionate,
and reasonably priced physicians.
If we reexamined the antiquated educational requirements currently needed to practice medicine, we could have a plentiful supply of creative, compassionate, and reasonably priced physicians.PPO's, socialized medicine, rationing treatment, or legalistic approaches do not solve the problem.
Most Pre-Medical Education is
The Problem with
The biggest problem, however, is that doctors
frequently cannot diagnose or treat a patient's illness. Suppose you go to your
doctor because you have been feeling tired. He does a physical exam and
orders some seemingly high tech lab tests. The results are normal, and
you are led to believe that there is nothing physically wrong. After all,
modern medicine is very advanced, isn't it? The Health-Care System Is Far More Primitive Than
The Health-Care System Is Far More Primitive Than
Biological Warfare Is An
Imminent Threat For Which We are Unprepared:
It's not the fault of doctors. The system is in terrible disarray.
The microorganism mycoplasma is one of a myriad of pathogens that can reside in the body undetected for years. It can disrupt biochemical functioning, leading to fatigue and other symptoms. Dr. Garth Nicholson is one of many researchers working on the detection and treatment of this and other diseases.
Dr. John Martin is investigating what he terms "stealth viruses." Knowing these doctors first-hand, and having tested positive for both of these debilitating illnesses, my stake in this matter is highly personal.
The System Could Be Drastically
Let's compare Microsoft
with the medical system. The requirement to work at Microsoft is simply
the ability to do one's job. The requirement to be a medical doctor,
however, is to spend valuable years in an irrelevant, expensive, academic
setting followed by several more years of incomplete training. After
enduring more than a decade of this insanity, of course doctors will charge
more money for their time.
Shame: A Major
Reason Why Most Medical Doctors Don't Change Their Views
The obvious response from the medical profession should have been gratitude: here was an important way to improve the safety of clinical practice. But in fact the response was doubt, outrage, even legal proceedings against the investigators; the controversy went on for years. Why?
An important clue surfaced at the
annual meeting of the American Diabetes Association soon after the study was
published. During the discussion a practitioner stood up and said he
simply could not, and would not, accept the findings, because admitting to his
patients that he had been using an unsafe treatment would shame him in their
eyes. Other examples of such reactions to improvement efforts are not
hard to find.
Indeed, much of the extreme
distress of doctors who are sued for malpractice appears to be attributable to
the shame rather than to the financial losses. Also, who can doubt that a
major concern underlying the controversy currently raging over mandatory
reporting of medical errors
Doctors may, in fact, be particularly vulnerable to shame, since they are self-selected for perfectionism when they choose to enter the profession. Moreover, the use of shaming as punishment for shortcomings and "moral errors" committed by medical students and trainees such as lack of sufficient dedication, hard work, and a proper reverence for role obligations probably contributes further to the extreme sensitivity of doctors to shaming.
What are the lessons here for
those working to improve the quality and safety of medical care? Firstly,
we should recognize that shame is a powerful force in slowing or preventing
improvement and that unless it is confronted and dealt with progress in
improvement will be slow. Secondly, we should also recognize that shame
is a fundamental human emotion and not about to go away. Once these ideas
are understood, the work of mitigating and managing shame can flourish.
But quality improvement has another powerful tool for managing shame. Bringing issues of quality and safety out of the shadows can, by itself, remove some of the sting associated with improvement. After all, how shameful can these issues be if they are being widely shared and openly discussed?
Here is where reports by public
bodies and journals like Quality and Safety in Health Care come in. More
specifically, such a journal supports three major elements: autonomy, mastery,
and connectedness. These motivate people to learn and improve, bolstering
their competence and their sense of self worth, and thus serving as antidotes
American Healthcare System is the Third Leading Cause of Death
This Journal of the American Medical Association article illuminates the failure of the U.S. medical system in providing decent medical care for Americans.
In spite of the rising health care costs that provide the illusion of improving health care, the American people do not enjoy good health, compared with their counterparts in the industrialized nations. Among thirteen countries including Japan, Sweden, France and Canada, the U.S. was ranked 12th, based on the measurement of 16 health indicators such as life expectancy, low-birth-weight averages and infant mortality. In another comparison reported by the World Health Organization that used a different set of health indicators, the U.S. also fared poorly with a ranking of 15 among 25 industrialized nations.
Although many people attribute poor health to the bad habits of the American public, Starfield (2000) points out that the Americans do not lead an unhealthy lifestyle compared to their counterparts. For example, only 28 percent of the male population in the U.S. smoked, thus making it the third best nation in the category of smoking among the 13 industrialized nations. The U.S. population also achieved a high ranking (5th best) for alcohol consumption. In the category of men aged 50 to 70 years, the U.S. had the third lowest mean cholesterol concentrations among 13 industrialized nations. Therefore, the perception that the American publicís poor health is a result of their negative health habits is false.
Even more significantly, the medical system has played a large role in undermining the health of Americans. According to several research studies in the last decade, a total of 225,000 Americans per year have died as a result of their medical treatments:
ē 12,000 deaths per year due to unnecessary surgery
ē 7000 deaths per year due to medication errors in hospitals
ē 20,000 deaths per year due to other errors in hospitals
ē 80,000 deaths per year due to infections in hospitals
ē 106,000 deaths per year due to negative effects of drugs
Thus, doctor-induced deaths are the third leading cause of the death in the U.S., after heart disease and cancer.
One of the key problems of the U.S. health system is that as many as 40 million people in the U.S. do not have access to health care. The social and economic inequalities that are an integral part of American society are mirrored in the inequality of access to the healthcare system. Essentially, families of low socioeconomic status are cut off from receiving a decent level of treatment.
By citing these statistics, Starfield (2000) highlights the need to examine the type of health care provided to the U.S. population. The traditional medical paradigm that emphasizes the use of prescription medicine and medical treatment has not only failed to improve the health of Americans, but also led to the decline in the overall well-being of Americans. Starfieldís (2000) comparison of the medical systems of Japan and the U.S. captures the fundamental differences in the treatment approach. Unlike the U.S., Japan has the healthiest population among the industrialized nations. Instead of relying on sophisticated technology and professional personnel for medical treatment as in the U.S., Japan uses its technology solely for diagnostic purposes. Furthermore, in Japan, family members, rather than hospital staff, are involved in caring for the patients.
The success of the
Japanese medical system testifies to the dire need for Americans to alter their
philosophical approach towards health and treatment. In the blind
reliance on drugs, surgery, technology and medical establishments, the American
has inflicted more harm than good on the U.S. population. Starfieldís (2000) article is
invaluable in unveiling the catastrophic effects of the medical treatments
provided to the American people. In order to improve the medical system,
American policymakers and the medical establishment need to adopt a
comprehensive approach and critically examine the failure of the richest
country in the world to provide decent health care for its people.
We are in an age of information explosion, made possible largely by the internet. The problem, however, is that most of this information does not filter into the rigid institutional curriculum of our universities. Required medical education today consists of four years of high school, four years of college, and four years of medical school. Throughout these twelve years, a common pattern emerges: memorize data, pass a test, and forget what was learned. This pattern runs counter to lasting learning and inhibits the development of creativity. If one has a bad product, one must examine the way in which it is manufactured.
A Plan for Functional, Fast-Paced, and Enjoyable Medical Education
This would be available to the student at his own pace, allowing the most intelligent, self motivated students to complete this phase of their training in a short period of time.
Real Medical Education Begins with Patient Interface
When the student felt ready, he would contact an available doctor of his choice, either directly, or through an internet matching program. While providing a free service to the doctor by taking time consuming medical histories, the student would learn first-hand about diseases and their symptoms. Actual person-to-person contact would create a lasting a vivid learning experience.
Students would have 'apprenticeships' with a great many doctors, working in various styles of practices, and lasting up to six months. If, on a given day, the student deals with patients for four hours, he would spend the rest of the day immersed in the study of medicine through the internet, meeting with his peers, or in discussion groups.
REFORM: A Vision of the Future
The only question is: "How long will it take?" This depends primarily upon the efficiency of our educational and governmental systems and our ability to communicate these ideas to the public.
Nanotechnology (link) is the science of building tiny machines; machines that could enter the human body and act as single-cell laboratories to detect and repair any problems. For example, Swedish scientists Edwin W.H. Jager and Olle Inganšs are developing nanostructures called actuators - mechanical devices that can move or control things - to handle biological materials such as single cells, bacteria, or molecules in liquids like blood plasma, and cell culture medium.
The tiny machines - extremely durable and capable of a wide variety of tasks - are being developed and studied in scores of laboratories all over the world. This is critically important, because at present we don't have the capability to measure many of the microbiological processes in the body.
Lyme disease, for example, is a chronic and crippling disease caused by several types of bacteria. At present, there is no reliable test for this illness, and no cure. We must develop tools that can decipher the vast array of events that occur within our bodies on a molecular level, and nanotechnology offers very promising assistance.
technology doubles every eighteen months:
In light of the technology discussed above, a blood pressure instrument seems a very primitive tool, most commonly used as ritual, rather than to gain useful information on the patient's condition. We have proven that we have the capacity to work miracles, and yet for the most part, our methods are clumsy and ineffectual.
According to one survey, for every dollar that the medical student pays, there are four dollars that come from other sources of funding. Most people don't realize that 90% or more of the M.D. faculty members are volunteers.
They aren't paid. I find that incredible to contemplate. The real heart, the essence, of medical school is provided free of charge. It is the institution itself - the rigidity - that is so expensive.
Conservatively speaking, there are thousands of people with chronic illnesses who have educated themselves about their conditions via the internet. They quickly managed to become more familiar with their diseases than the physicians who treat them.
There is a wealth of non-profit web sites dedicated to medical subjects and authored by non-physicians. Though often extremely information rich, they typically post a disclaimer stating that their information should not be considered medical advice, and that the reader should always consult a physician.
Such a disclaimer is appropriate for legal reasons, but usually ludicrous, because these sites are often generally more substantive and accurate than the information provided by most licensed doctors.
This is not a criticism of physicians, but of the medical system. When doctors are seeing thirty patients a day, they have little remaining time for researching new medical developments.
After having been programmed by years of education to practice with a particular style, their potential for creativity and growth is severely hindered.
Traditional institutional education is rigid and non-creative, directed toward learning information that is mostly irrelevant and obsolete. Replacing the current structure with a system that focuses on live patients and allows ample time for the student to devise creative solutions via internet information resources, technical support, and a worldwide communication network would greatly improve the quality of healthcare.
The role of the teacher is not to lecture, but to be available when the student is having difficulty or requires advice. Lectures can be conducted via the internet. Today's doctors tend to use ritualistic, formulaic approaches: weigh, measure, take blood pressure, conduct a superficial examination, write a prescription, and then move to the next patient. Good medicine is a creative process; a process which must be developed from the beginning.
Reform And Medical Education
Many students intent upon becoming a physician will major in biology or chemistry, but medical schools do not hesitate to accept applicants who have excelled in any other academic area of study. Regardless, a majority of things learned at the undergraduate level has no relevance to the practice of medicine.
After college and upon acceptance to a program, the would-be doctor enrolls at a four-year medical school. Upon graduation, he is awarded the doctor of medicine degree: the M.D.
In the first year of medical school, students cover the basic sciences, including anatomy, biochemistry, and physiology. For students who have studied science at the undergraduate level, these courses are largely a duplication of material already covered, however, much of what was learned in college is no longer remembered. There is a huge amount of factual information to be memorized, and as a result, most of it is soon forgotten - much like in college - after the tests.
The second year of medical school - containing a similarly large volume of factual information - is devoted to the study of disease and medication. Practically the entire focus of the curriculum is dedicated to life threatening diseases, with essentially no emphasis on either nutrition or many of the seriously debilitating 'garden variety' illnesses frequently encountered by doctors.
Like all other medical students, I spent my third year of school at a teaching hospital. Approximately 65% of the diseases that I saw were severe liver and lung conditions; the result of smoking and alcohol abuse. Students assisted in surgery, delivered babies, and managed out-of-control cases of diabetes. The most common conditions that cause people to seek medical attention, however, were neglected.
The fourth year is a continuation of the hospital clinical experience, and includes work in orthopedics and pediatrics at other specialty hospitals. After graduation, most doctors complete their residency, which is an additional four years spent in the supervised practice of their medical specialty at a hospital.
By today's standards, the educational process of becoming a physician is extremely arduous and expensive, taking twelve or more years, and costing in the hundreds of thousands of dollars. Although the student is taught by literally hundreds of physicians, most of whom freely donate their time as a purely charitable gesture, the majority of the student's medical studies take the familiar form: memorize, pass-the-test, and forget. The process is so inefficient that most of what is learned - even relevant information - is forgotten by the time it is over.
The universe contains an inexhaustible volume of information, and to attempt rote memorization of even a small fraction of that volume is an extremely burdensome task. Furthermore, it is impossible to predict what one will need to know in the future. Granted, we need to have a general understanding of how the real world works.
If handled properly, without the dry details, students - seeing the relevance of such information - will be far more likely to retain what they are learning. Beyond this general understanding, students should be given the freedom to explore their own interests without the constraint of rigid requirements. Furthermore, the world of academics should be considered in cooperation with the non-academic world, offering bridges to that realm rather than posing roadblocks.
Appearances In Health-Care Reform
Money Was Not the Cure:
Unintentional Corruption Is
Appearances Can Be Deceiving:
Money And Health Care:
Take A Deeper Look:
Additionally, we must expand our
focus to include nutrition. Furthermore, we can eliminate the cost to the
student and his family.
At what age should the
medical education start?
Without the institutions (and their inherent rigidity or expense), this education would be essentially free of cost. For a mere $29, students could begin their studies with a paperback book entitled Medical Assistant: Program Review and Exam Preparation by Patricia S. Hurlbut. This book is extremely familiarizing with the basic routine of a doctorís office. Once the student has started his apprenticeship, I would suggest that he read Current Medical Diagnosis and Treatment 2001. This book will serve as an excellent reference tool, containing information on various diseases that the student will encounter.
Although some of the information in Current Diagnosis is incorrect, most doctors still rely upon it. The student should be cautious of accepting any information at face value, and should always augment his information base by scouring the resources available on the internet, and carefully considering the information presented to him by motivated patients. It is much easier to learn about diseases and medications when dealing with a patient who is actually suffering from that particular ailment.
Once the student has completed this independent study, entirely of his own initiative, he can approach his first prospective doctor-mentor. The student's hands-on medical education would begin with the student taking patient histories. Next he would learn the fundamental elements of disease and medication.
The student will essentially offer to act as the doctor's medical assistant in exchange for the doctor's willingness to associate with him. Based on an interview to determine the applicantís maturity and other personal attributes, and a standardized test administered to measure the student's understanding of basic medical concepts, the doctor may agree to such a partnership. Both doctor and student would agree to such an arrangement. The apprenticeship would be entirely voluntary on both sides.
Although the student would not give medical advice or treatment, he would provide the valuable - and often time consuming service - of taking patient histories. This would provide the student with a wealth of knowledge.
The doctor would confirm the accuracy of the key points in the patient histories and provide reports monitoring the progress of the students. In contrast to current medical education, the student would begin in an outpatient setting, as it is less stressful. Also, the monitoring of his progress would be more easily controlled. In addition to apprenticeships with many doctors practicing in different specialties, the student's education would be augmented with conferences and discussion groups.
At the end of the second and fourth years of the student's apprenticeship, he would be required to pass written examinations, prepared by a committee of various doctors. Additionally, such doctors could, for example, create a finite set of medical multiple choice questions (between 5,000 - 10,000), from which a random sample would be drawn for the student's testing. The student could also be required to make a contribution to the medical community in the form of preparing a web site on the diagnosis and treatment of a specific disease. At the end of the four years, there would be a five-day oral exam, conducted by a committee of physicians who practice in the field of the student's specialty. Upon successful completion of this process, the student would become certified in the practice of his specialty, but may elect to test for certification in other areas if he meets the specialty-specific requirements.
At the core of our "university without walls," is the mentor/apprentice relationship. See the enlightening film, The Cider House Rules, and observe the relationship that exists between the doctor and his apprentice. They relate to each other much like a father and a son.
I would expect that after reading this particular section, a number of questions would be raised with regard to the details of executing our plan of reform. For this purpose, there is a discussion board where you can post comments and inquiries. Please do not feel as though you need any specific qualifications to post to this forum. We welcome the input of people from all walks of life.
Reform In Medical Research
Granted, there is a basic fund of knowledge that all scientists must know, but this can be learned without 'stuffing.' Even so, the essence of science remains exploration, rather than consumption of facts. An ideal situation would be the creation of community research laboratories.
The most logical place for such laboratories would be in the schools. It has been my experience that canned textbook experiments are unproductive as teaching tools. They are often both tedious and quickly forgotten. If an experience is not remembered, then real learning has not occurred. Audiovisual tools are an excellent way of teaching science fundamentals. They would make learning more enjoyable for students and less burdensome for the already overworked teachers.
Research within the schools should be facilitated by networked communication with other schools and research facilities. Many researchers would gladly donate their time to explain their research processes to students. Current research would be augmented by the combined efforts of millions of students worldwide; this could prove to be quite a powerful tool. These students would be thrilled to know that they were actively involved in contributing to both medical and scientific discoveries.
Children instinctively know what they need. As adults, our job is to listen, observe, and make ourselves available. Our job is not, however, to control. Those who are controlling are often mindless and damaging to other people.
Children do not require our control, but rather, our encouragement to explore the universe and express their uniqueness. Once we understand the needs of the individual student, we can provide the kind of environment and the amount of structure that is most appropriate. Our current system of educating young people is a dehumanizing rat-race of mindless over-activity. Furthermore, it is a waste of human potential.
One day, we will truly listen to and understand the needs of others. We will begin striving to attain mindfulness, much as we presently strive to attain athletic fitness. One day, mindfulness will be a household word.
John Martin, M.D. Ph.D. operates his own community laboratory in Rosemead, California. Volunteers are frequently invited to visit and participate in conducting research. Although his equipment is mostly a surplus collection of remnants from someone else's government grant, it is very sophisticated. Various people donate time, money, and equipment to make it a success. A great many small research companies are being created across the globe; many of which welcome volunteers, much like the aforementioned laboratory.
Communication tools have become affordable, and widely available. There is an incredible network of people who, driven either by a love of their subject or by the necessity of their illness, join together in an information exchange forum to discuss a countless array of subjects. This is real education. It is free. It is from the heart.
Learning Vs. Institutional Centered Learning
A critical problem with institutional learning is that the information taught within the institution is accepted as God-given truth. Many patients, who are concerned with their conditions, will frequently present information about their illnesses to their physicians.
If this information contradicts what the doctor has learned within the confines of the institution (i.e. medical school), the patient is considered wrong, and devalued.
A better alternative, is PATIENT- CENTERED LEARNING. By listening to the patient's stories starting very early in one's training, the patient becomes the focus. This model has powerful implications. The student would be free to do web based literature research on the patient's condition, which would take him far beyond medical school programming. Additionally he could devote much deserved time to the patients and explore non-drug, nutritional, and life-style therapies for their conditions.
Doctors are the third leading cause of death in the U.S. according to the July 26, 2000 issue of the Journal of the American Medical Association, Vol. 284. The actual statistics are probably higher, due to treatments that harm, rather than help patients. An over-reliance on prescription medication is the primary cause of such fatalities. The new model would allow the student to change that pattern of negligence.
Volume 322 of the British Medical Journal, published on February 24th 2001, presented the results of a study that attempted to ascertain what patients want from their doctors. The responses were not surprising. They were things that we - doctors included - have known for decades. Simply knowing them, however, has not been enough to effect change.
Patients want better communication. Instead of receiving a physical examination or a prescription, patients would rather spend precious time with their doctors discussing their conditions and hearing about ways to stay healthy. The researchers identified three specific areas that patients want their doctors to emphasize: communication, partnership and health promotion. More than three-quarters of respondents wanted visits with their doctor to focus on:
Doctors know what patients want, but their mindset is deeply ingrained into their character. They feel that they deserve to earn a high income after enduring a tortuous educational process. Rigid institutional requirements drastically reduce the supply of doctors, which equates to less time spent with each patient. This reduced supply of doctors also serves to increase the cost of their services. The lengthy, institutional, fact-stuffing process produces a mental rigidity that prevents these physicians from adapting to alternative styles of practice. They feel like they need to give their patients something of value in the short time that they spend interacting. This thing of value is usually a prescription.
The non-institutional, patient-centered educational plan would produce an abundant supply of compassionate, innovative, prevention-oriented doctors at an extremely low cost. Additionally, the pace of medical research would be sharply accelerated.
Q. Donít the twelve years of pre-medical
education give the student a universal education?
Q. Arenít tests
relevant in order to measure what we have learned?
Q. Arenít the internet programs going to require
the same tedious testing procedures?
Instead of utilizing internet programs why not fight to lower the cost of
Q. Doesnít the competition in medical school also test the student's ability to handle the demands of being a physician?
A. Long term stress is not healthy for anyone. It is damaging to mindfulness as well as physical health. Students shouldn't be putting in a 70 hour week and doctors shouldn't be seeing thirty patients a day. Their lifestyle should be more leisurely, and this will be better for both the doctor and the patient. The student will be able to choose his own specialty, and would not choose general surgery or emergency medicine unless that suited his temperament.
Q. If that pattern of 'pass the test and forget' exists, then why not incorporate more hands on experience in medical school?
A. We would still encounter all of the obstacles of changing an institution (mentioned above), and neither you nor I are powerful enough to do this.
Q. Will the broad-based courses provided online be sufficient enough to prepare the student to be a certified doctor?
A. The scope of medical information on the internet is far more vast than that provided by any institutional program. But we will not rely on these internet resources alone. We will also have the doctor-student-patient interaction, starting very early in the educational process, and creating a very memorable, impacting experience. Watch the film The Cider House Rules. Put your views on abortion aside, and focus on the relationship that exists between the doctor and his understudy. They related to each other like father and son. Their interactions were rich and rewarding.
Q. Instead of completely changing the medical requirements why donít we focus on strengthening what we learn in medical school?
A. The entire foundation of premedical and medical education is flawed from the ground up. This would be like trying to build a house on a foundation of sand.
Q. Are these distant online learning courses really going to fix the root-cause of the problem?
A. No, the root-cause of the problem is more complex. We need to reexamine what education is all about.
Questions Part Two
A. Because they are not following the familiar model of memorizing data, passing the test, and forgetting. They are engaged in self-motivated and self-directed medical study purely out of curiosity, or because either they, or a loved one, have an illness. They are able to focus on learning without any bureaucratic distractions. Love, rather than a desire for "success", motivates them.
Q. Don't some people say that we should not believe all of the information that can be obtained on the internet?
this is good advice. Remember, some people also say that it is wise not
to believe all of the information learned in schools.
A. We're not getting rid of medical institutions. We are giving people an alternative to the current model of education, which is damaging to creativity. Furthermore, if the typical medical practitioner sees thirty patients a day, he usually does not have time to do research.
Q. Will these internet classrooms really provide the fundamental education for a medical student?
A. Education is not something that you inject into somebody. In the end, all students teach themselves. The internet is only a resource, but virtually unlimited in it's scope, cost effective, and highly flexible. It is available 24 hours a day, and 7 days a week. There is no need to commute to get there. The internet is only one aspect of the program. There would also be the student-doctor relationships, discussion groups, and other resources of the student's choosing. The student would design a program that works best for him.
Q. Donít the existing medical schools determine whether or not the student is really ready to become a certified doctor?
A. Partially, but not adequately. In addition to the requirements of each individual medical school, each state has written examinations that must be passed. Also, each medical specialty has a board that administers it's own written and oral exams. In my opinion, the examinations conducted by the specialty boards are the most relevant to what the doctor will actually be doing. Written exams measure only a small part of whole-brain functioning, and our emphasis on them is at the very core of the dysfunction that plagues our educational system.
Q. Instead of requiring a four-year college education, why donít medical institutions let dedicated and successful high school students into their four-year program?
A. Theoretically this is possible, and has happened in a few cases. But because medical school admissions are so competitive, this is a rare occurrence. In our culture, we believe the notion that an individual's worth as a person is dependent upon his graduating from college. Many people attend college, not out of an innate desire to learn, but primarily because our culture places such a high value on formal education. Unfortunately, college is expensive, inefficient, and often irrelevant to their lives.
Q. Instead of focusing on rare conditions, why donít medical schools make the more common diseases their main focus?
A. The more common conditions are often the least understood. Traditionally, medical schools have a base in a large teaching hospital. Often this is a general hospital, which admits mostly indigent or severely ill patients, and in doing so, skews the patient population. For example, a student might see a huge number of end-stage chronic alcoholics who are dying of delirium tremens and cirrhosis of the liver. This same student may see common conditions very infrequently.
Q. Instead of requiring so much money to go to a medical school, why not lessen the cost, and make it more affordable?
A. Because institutions have a huge overhead.
Q. Instead of providing free internet classrooms for pre-medical students, why doesnít the government offer the medical institutions that exist today at a lower price?
A. The government already subsidizes medical education to a large extent. Combined, the government and private donors spend four dollars per every one dollar spent by the student.
Q. Donít a lot of students prefer the in-classroom environment in order to learn the necessary information?
A. I don't have any statistics, but my private polls tell me that the overwhelming majority of students would prefer the model that we have proposed. Keep in mind that in this model, there is nothing to prevent an individual from taking classes. The student should have freedom of choice, as long as the public is protected.
Q. Won't the test required for the student who has completed his online education be exactly the same as the memorize, pass the test, and forget type?
A. In the new system, there would be a much smaller emphasis on written exams. An exception would be the use of tests as a teaching tool. The tests would contain only relevant information with the trivial questions weeded out. Students would be motivated by love and an innate desire to learn, rather than by a fear of failure.
Q. What is the significance of the oral exam?
A. Oral exams measure judgment and other aspects of mindfulness that written tests do not. When the examiner is convinced that the student grasps a certain topic, he can change the subject and cover a lot of ground more quickly. These exams frequently have people acting as patients. The examiner can watch a student conduct an examination and evaluate his approach. Oral exams tend to be much more relevant and meaningful.
Q. What determines the length of the assistantship?
A. Generally, the assistantship would end when the student felt that his rate of learning in that particular environment had declined and it was time for him to pursue other avenues.
Q. Isnít the information in the textbooks relevant to the childís education in school?
A. Frequently it is not. Everyone learns differently. For example some people are left-brain dominant, which means that they are good with words and numbers. Others are right-brain dominant, which means that they are very creative, but often have difficulty learning from a book. When a student is allowed to be in charge of his own education, he will choose the methods most conducive to his learning.
Q. How can we be assured that the doctor will be competent and that the public will be protected?
A. Today, a future doctor receives thousands of tests along his path toward receiving his M.D. The only meaningful test, however, is the final exam, because it is the only tool that measures what he has remembered after his long educational trek. Today, there are no oral exams required in order to become a licensed physician. This is a defect in the system, because oral exams measure a much larger percentage of whole-brain function, including judgment and approach to the patient. Our approach would require extensive oral exams. Today, a license to practice medicine allows a doctor to practice in any specialty, including surgery. Common sense tells us that no doctor is competent to practice in all specialties. We would allow a doctor to practice only in those areas in which he has proven his competence. Today, there are no assessments of character required in order to practice medicine. The tedious required educational process is damaging to character. We offer proof of this! here. (link) Our proposal for medical education would offer a continuous evaluation of character in the form of close, continuous, intimate relationships with practicing physicians. We believe that our proposal would produce physicians of much greater competence, compassion, and creativity, along with a more accurate verification procedure to assure quality control and protect the public.
Questions Part Three
A. This statement is validated by the July 26, 2000 issue of the Journal of the American Medical Association, Volume 284. These deaths are due to errors made by doctors in the course of their treatment. Most often, these fatalities are the result of a doctor prescribing an inappropriate medication.
Q. Are you suggesting a college "medical major"?
A. No, I am suggesting a free, open system in
which the student
Q. You state that there are a large number of non-profit websites on medical subjects authored by non-physicians. You also state that many of these sites are extremely information rich, and usually more substantive and accurate than the information provided by most physicians. Since anyone with basic HTML skills can create a medical website, how can the layman discriminate between valuable information and nonsense?
A. We are referring to illnesses that are somewhat outside of main stream medicine, such as chronic fatigue syndrome. In these cases it is frequently difficult for both doctors and non-physicians to distinguish which treatments are effective. Furthermore, when dealing with such an illness, everyone responds to treatment differently. In these instances, it is good to be part of a support or discussion group of patients who suffer from that particular condition. Such individuals will provide a lot of valuable input pertaining to treatment options, and will do so without financial motivation, and in an unbiased fashion. Often, these groups will contain some very scholarly people who have studied these medical conditions in depth and are good critical thinkers.
Q. You state that the root-cause of our current healthcare problems resides in our system of medical education. What are the first steps that need to be taken for us to revamp this flawed system?
A. Since the general public does not understand that our system of medical education is at the core of this dysfunction, we must educate them on this matter. We must also educate the existing army of healthcare reform activists, because this concept may be new to them. We need to help such activists focus on root causes, rather than vague symptoms. We need activists to deal with concrete solutions, rather than vague notions. We must pass regulations at the state level that will allow for the creation of an alternative pathway for becoming a doctor, a pathway that we have described. Once one state does this, the rest of the country will follow. It is likely that the rest of the world will follow our example.
Q. Isn't rote memorization crucial for a medical student to learn the huge volume of knowledge necessary to practice as a physician?
A. Please refer to our page on how memory works. (link) It is difficult to memorize material from books or lecture notes, and even more difficult to retain that information for a long period of time. When the student is seeing live patients, face-to-face, he will read about illnesses and their treatments and associate this knowledge with actual patients. Not only is this a more natural and pleasant learning process, this association process is far more conducive to long term memory.
Q. I take issue with your arguing that the medical establishment should function more along the lines of the Microsoft Corporation. Although Microsoft may be successful and cost-effective, it is brutally competitive and employs deceptive marketing practices. Would you please respond to this?
A. We didn't mean that at all. We said that if Microsoft required competency plus proof of a long, formal educational process, the corporation would not be able to operate in a cost-effective way. We did not say that the medical profession should emulate Microsoft.
Q. In one section of your site you argue that most physicians impatiently prescribe a medication to their patients and bill them at a high fee. Yet in another section you cite the fact that many doctors at teaching facilities donate their time for free. What do you think?
A. Both statements are correct. All doctors are not alike.
Q. In terms of the solution you suggest for improving the medical educational system, isn't the 12 years of education crucially important for students to learn the huge database of knowledge that every doctor must draw upon in helping his patients?
A. Most of the information that the doctor learns in these twelve years is unnecessary and irrelevant to his ultimate practice. Because this knowledge is acquired in the familiar model of memorize, pass the test, and forget, the great majority of it is forgotten by the time that the student begins to practice medicine. It is true that a doctor must have a very large fund of knowledge from which to draw. This knowledge, however, must be relevant, and acquired in such a way that it is committed to long-term memory. The learning must be whole-brain, rather than left-brain learning. Simply put, there is a difference between learning by doing and 'learning' by memorizing words.
Q. Your proposals seem very
revolutionary. Won't it take a very long time to implement them?
Questions Part Four
A. Granted, there are
thousands of extremely dedicated doctors and healthcare workers. But this
doesn't change the fact that there are millions of people who do not receive
adequate healthcare, and countless diseases that cannot be diagnosed and
Q. I disagree with your suggestion that medical students would offer a valuable service to practicing physicians. Medical students (and junior-level residents) invariably slow-down experienced doctors due to their inefficiency. I am a full-time academic physician who enjoys teaching, but sees firsthand how well-meaning but inexperienced students and residents will decrease your ability to see patients efficiently.
A. Many doctors pay good money to hire medical assistants. The function of the assistant in this proposal is to take patient histories, and record them in the chart. While he is doing this, the doctor is doing other things. The student is primarily learning from the patient, not the doctor. When the doctor sees the patient, he has the advantage of a detailed history that he would never have time to take himself. Keep in mind that this is voluntary. If the doctor doesn't wish to participate, he doesn't have to.
Q. But aren't students already getting adequate patient interaction? Most medical schools begin patient/student interactions late in the first year or early in the second year. They are already spending time interacting with patients, although not several hours a day (until the third and fourth year).
A. The student has had eight years of mostly irrelevant institutional learning before he even gets to medical school. Furthermore, the patient interaction in the first two years of medical school is usually very minimal.
Q. Community physicians will need some type of compensation due to diminished ability to see patients efficiently under your model.
A. Most of
the teaching physicians in medical schools, internships, residencies and
teaching clinics are volunteering their time free of charge. Furthermore,
they are willing to commute a great distance do this. Doesn't it make
more sense to have this take place in the doctorís office, where no commuting
is necessary, and a more intimate relationship can be established?
You Can Change
The System: Just by
using your mind
Take a good look at that building
over at the right. A long hard look. Because it belongs to you.
But unfortunately, some political parties and big money have taken control of
it. Your job is to take back what rightfully belongs to you.
Learn more about mindfulness. The time will come when people will practice mindfulness like they engage in physical fitness today.
We can and will have an extremely functional healthcare system. We will be able to diagnose and treat any illness. You can be a part of the process that will bring that about.
All it takes is some attention to the things that are really important - things with lasting value. It all starts with you, and it happens one day at a time. You can help yourself while making a genuine social contribution. This will lead to more functional personal, family, and social living.