Patient-Centered Learning Vs. Institutional Centered Learning
I learned far more about the
practice of medicine AFTER I left medical school than in the classroom.
I let my patients teach me, and they loved me for it.
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.
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 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:
themselves and the doctor.
- open discussion of their feelings about treatments in
learning about ways in
which they can improve their health or prevent future illness
- Fewer wanted an examination (63%) and only a quarter
of those surveyed wanted a prescription.
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
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