Respectful Insolence

RangelMD asks: Do student doctors really need to know anatomy and that other basic science stuff? And Dr. RW chimes in sarcastically, Who needs all that basic science bunk?

Naturally, as you might expect from recent posts, I can’t resist putting my two cents in on this topic as well.

The discussion was provoked by this article:

TEACHING of basic anatomy in Australia’s medical schools is so inadequate that students are increasingly unable to locate important body parts – and in some cases even confuse one vital organ with another.

Senior doctors claim teaching hours for anatomy have been slashed by 80 per cent in some medical schools to make way for “touchy-feely” subjects such as “cultural sensitivity”, communication and ethics. The time devoted to other basic sciences – including biochemistry, physiology and pathology – has also been reduced.

Several senior consultants have told The Weekend Australian they have been “horrified” to encounter final-year medical students who do not know where the prostate gland is, or what a healthy liver feels like.

When asked by a cardiac surgeon during a live operation to identify a part of the heart that he was pointing to, one group of final-year students thought it was the patient’s liver.

A coalition of senior doctors appealed this week to the federal Government to step in, claiming public safety was at stake and that national benchmarks for teaching the basic medical sciences were urgently needed.

The Australian Doctors Fund lodged a 70-page submission with the federal Department of Education, Science and Training this week, listing arguments from more than two dozen professors, consultants and medical academics for a rethink on medical education. The document warned of a “rising chorus of concern across the medical profession” that students were not getting “exposure to the necessary amount of training in anatomy” and other key sciences.

The heads of Australia’s medical schools fiercely contest the criticisms, saying there has been an “explosion” of medical knowledge that doctors need to know, in fields such as genetics and new drugs, and that other areas have to be cut to accommodate the newer topics. They also strenuously deny that they are turning out inadequately trained doctors.

But many students are also unhappy about core science training. One group of students wrote anonymously to two noted academics last year, saying they were “sick of being asked, ‘Didn’t you study anatomy?”‘ by consultants amazed by the gaps in their knowledge.

“How can we learn if we are not taught the basics?” they wrote.


Quite.

None of this was news to me, or, I daresay, to most surgeons. When I quiz third year medical students about anatomy in the operating room, even very basic anatomy, far more frequently than I like, I’m amazed at how little some of them know or, with the exception of students going into surgical specialties, seem to care. I’ve never seen a student quite as clueless as the ones described in the Australian article, but it’s nonetheless clear to me that the deemphasis of anatomy and basic science in medical education is not a phenomenon confined to Australia. Indeed, the above article only echoes and amplifies complaints that I’ve heard for a long time right here in the good old U.S.A.

Here’s Dr. Rangel’s take on the matter:

The critics claim that too much time is being devoted to “touchy-feely” subjects such as “cultural sensitivity”. The medical schools counter that there is so much medical knowledge to learn and only a limited amount of time to do it. Who’s right? Both are.

Indeed, which is why I can’t understand why some medical schools offer electives in art appreciation. Worse, all too many schools are offering uncritical courses that feature the most dubious of alternative medicine treatments. Something has to give to make room for these new offerings, and all too frequently it’s subjects like anatomy, biochemistry, and physiology that suffer as a result. From my perspective, the purpose of medical schools is to train physicians. Period. Anything that does not contribute to the training of an excellent general physician does not belong in the medical school curriculum. Art appreciation is a lovely thing to study and makes for a well-rounded person, but it does not contribute to medical education, with the possible exception of medical illustrators. I’m less dogmatic about teaching medical students about alternative medicine is useful because so many people use it, but far too often such teaching uncritically parrots dubious claims without rigorously looking at the evidence.

Dr. Rangel continues:

But such controversy begs the question; Do most of our doctors really need a liberal medical education? Do patients really give a crap whether or not their physician knows the basic structure of every type of amino acid or where the ligament of Treitz is? I’d take a wild guess and say no. Patients want something to help them sleep at night or to find out what’s causing their stomach pain. Knowing the chemical structure of an amino acid is not going to help one bit.

Physicians traditionally get a liberal education because we have this sense that we should create a well-rounded doc as physician-scientist. In decades past it was believed that physicians should not only be practitioners but investigators on the forefront of a mysterious new field. However, these days physicians are more often seen as “providers” who toil away following practice guidelines. The attitude these days seems to be “leave the science to the scientists. Let them find new diseases and develop new treatments.”

Sadly, Dr. Rangel is accurately describing a pervasive attitude in society and even medicine that is, alas, becoming more pervasive. To no one’s surprise, I’m sure, given my previous posts about the woeful lack of knowledge about evolution among physicians and medical students, I strongly disagree with the sentiments described by Dr. Rangel. It doesn’t matter one whit whether patients care whether their physicians know where the Ligament of Treitz is or can draw the structures of amino acids. That’s not the primary question. The real question is whether being intensively exposed to such topics in medical school makes better doctors. I would argue that it does. In particular, I take issue with the attitude of “leave science to the scientists.” Less trained “providers” may seem to provide adequate or even very good care in the short run on a strictly utilitarian basis, but, I will argue, medicine as a profession loses something precious and possibly irreplaceable by devaluing the science behind medicine, something that will also, I fear, will slow the pace of future medical advances.

First off, I can’t believe that anyone would argue that thorough teaching of anatomy isn’t one of the most important components of the training of a competent doctor. It’s one of the very basic core competencies that every doctor should know. Even specialties that rely more on drug therapy and less on therapies where a solid base of anatomic knowledge is necessary (such as internal medicine, family practice, and or even dermatology) should be exposed to an in-depth study of human anatomy at least once, and the best place to do that is in medical school, where a basic knowledge set about anatomy can be taught to every medical student, regardless of future specialty. Anatomy forms the basis of so many human diseases seen by such a wide variety of specialists that it forms the basis of nearly all functional medicine. Why do people get carpal tunnel syndrome, for instance? If you don’t know the anatomy involved, you won’t understand why people get it, why the distribution of the numbness is what it is, or how to diagnose it on physical examination. If you don’t know the anatomy of the lumbar nerve roots, you’ll have a hard time determining which level that a compressing herniated lumbar disc, for instance, is at based on history and physical (you can’t order MRIs on everyone with back pain). Without an understanding of anatomy, a doctor won’t know where an infection is likely to track or to which lymph node basin a melanoma is likely to go first. Or, as a medical student put it:

“If you are assessing (a patient) who has had a stroke, if you do not have a good knowledge of the different parts of the brain, it can be difficult to assess which parts have been compromised and what treatment is warranted.”

Of course, one could argue that none of the above knowledge is strictly necessary, as long as the physician knows when to call in the specialist. However, in vast swaths of this country and others, despite the proliferation of specialists, it is still the generalist or family practice doctor who deals with most medical problems, and access to specialists can require a helicopter flight or long ambulance ride. Also, some medical conditions (such as the aforementioned stroke) are urgent matters that can’t always wait for the specialist.

But what about “memorizing the Krebs cycle” and other arcana of biochemistry? Well, many metabolic diseases manifest their effects through the downstream effects an enzyme deficiency has on different metabolic pathways. If a doctor hasn’t been exposed to these pathways at least once, in medical school, he or she will find it very hard to pick them up on the fly when issues come up. Worse, without a solid grounding in biochemistry, it’s really hard to understand pharmacology and the mechanisms of how drugs work, and I really don’t want a doctor prescribing drugs who doesn’t understand basic pharmacology.

Dr. RW responds and puts it very well:

It’s probably a waste for most of us to memorize the chemical structure of amino acids, but it may be important to know enough about their structure and properties to understand that some are hydrophobic and comprise membrane lipid bilayers while others are hydrophilic and form hydrogen bonds, the basis for the secondary structure of proteins. Memorizing all the steps in the glycolytic sequence and the Krebs cycle won’t make you a better doctor but it could be important to understand how those reactions yield energy, why a molecule of glucose yields only a couple of ATPs in the glycolytic sequence, but an additional 30 some odd in the Krebs cycle, a fact that explains the difference between aerobic and anaerobic metabolism and why folks have to breathe. It’s all about the how and why of health and disease.

But, more importantly, as I have been arguing all along (and as Dr. RW agrees), physicians need to have a firm grounding in basic science for two reasons. First, as my professors used to reiterate almost ad nauseum, a significant fraction of what we learn in medical school and residency will be obsolete in a decade, and one of the main purposes of medical school is to give us sufficient background knowledge and understanding to be able to keep up with new developments, understand them, and incorporate them into our practices. A strong basic science background makes it easier for physicians to adapt to changes in knowledge leading to changes in recommended therapy and provides the conceptual framework against which to evaluate new scientific and medical findings. As physicians we must be constantly learning, from training all the way to retirement, and that learning is much easier if we have a firm background the physiological, biochemical, and anatomical principles involved, even if we quickly forget details like the structures of various amino acids or where Rotter’s nodes are. Second, as I have argued before, a firm grounding in science helps us to recognize pseudoscience when we see it. I have been repeating again and again (likely irritating my regular readers) and providing examples showing that a poor scientific understanding of one area that leads to credulity towards a pseudoscience, is all too often a marker for or harbinger of a tendency to accept other pseudoscience uncritically. I’ve used the example of evolution, in which an acceptance of creationism leads me to worry about a tendency to accept various forms of quackery. Again, Dr. RW says it well:

Knowledge of the basics is also helpful in distinguishing between science and pseudoscience. Consider this page promoting wheatgrass from the Creighton University Alternative Medicine links. (Authorship of this page is not specified, but the main page of the alt med links suggests that the articles were written by Creighton med students and faculty. Some alt med articles are appropriately critical. Although others seem uncritical or even promotional, all contain a disclaimer that neither the university nor the med school endorses the methods). A big dose of biochemistry and physiology might help here. In “explaining” the health effects of wheatgrass the article notes that the plant contains enzymes which “aid the body in digesting foods, building protein in the bones and skin, and in detoxification processes.” Did the author not know that enzymes cannot be absorbed into the body intact? How then are they to participate in bone building or detoxification? (What is the biochemical process of detoxification, exactly?). Also among the “scientific benefits” touted for wheatgrass is its content of chlorophyll, claimed to protect against carcinogens and dissolve kidney stones. Never mind the fact that chlorophyll has no known function in human metabolism. Then there’s this page on the “mechanisms” of Reiki—speaks for itself.

[NOTE: This page is even worse.]

But perhaps the best rejoinder to those who don’t think we need basic science as physicians came from a commenter in RangelMD’s piece going by the ‘nym of Blog, MD:

Someone explain to me how making our future physicians less able and willing to formulate scientific questions based on their clinical observations will benefit us. What exactly is to be gained by making the already deep chasm between MDs and PhDs that much wider by eliminating the common vocabulary? Who do you expect to be able to translate basic research findings into valid, well-designed, well-interpreted clinical trials? NPs and PAs? Physicians with a watered-down scientific education? PhDs?

Exactly! That’s one (of many) reasons that I find the attitude of “leave science to the scientists” described by Dr. Rangel to be the most infuriating aspect of this problem! Simply by virtue of their practical experience treating disease, physicians bring a perspective to medical research that even the most brilliant basic scientists can’t.

For all the wailing and lamentation about whether the 80-hour work week for residents will detract from the training of doctors, I’m far more concerned that the lack of adequate preparation in basic science in medical school will lead to a generation of doctors lacking the background to evaluate and incorporate new findings or to recognize quackery when they see it. Worse, I fear that those wanting to enter academia will in the future have a hard time doing so without going to the additional lengths of getting a Ph.D., not because physicans haven’t been able to be successful researchers in the past and can’t be successful in the future, but rather because future generations of physicians will have even less of an understanding and appreciation for the scientific method than they already do now. As a clinician-scientist or clinical investigator myself, I strongly believe that physicians bring to the table something that a basic scientist can’t: An appreciation for the pathophysiology and clinical course of the disease being studied, a practical understanding of the most pressing problems and shortcomings of current treatments of diseases, and an understanding of the anatomy involved. Perhaps even more important than that, we see the human toll of disease, leading to an urgency to do something about it now that a Ph.D., who has never looked in the face of a patient with stage IV cancer, for example, and had to tell him that there is nothing further medicine can offer to save his life, can never share. Relegating scientific and anatomic training to a much lesser status than it has enjoyed in medical school in the past will hurt patients not just by direct effects on physician competence, but also through the long-term effect it would likely have in leading to the de facto ceding of medical research to Ph.D. basic scientists who, while often having exquisite understandings of molecular mechanisms, don’t know the human cost of the disease they are studying and don’t understand what advances that we as physicians really need to have to be able to treat disease better.

Comments

  1. #1 Bob
    May 10, 2006

    When I first heard about this I was hoping that when they’re talking about inadequate training in anatomy that they’re talking about not being able to differentiate the first part of the duodenum from the second part (thank you Wikipedia!). But confusing parts of the heart with the liver? Geez… Thanks to the wonderful Visible Man model I knew the difference in those parts when I was 8!

  2. #2 epador
    May 10, 2006

    Gotta agree with you Bob. I think the solution is to either add an additional two years to medical school or simply require applicants to have a strong science and biology background before they enter, rather than opening up to English and Arts Majors.

  3. #3 Abel Pharmboy
    May 10, 2006

    This has struck a chord with me but I will be uncharacteristically brief:

    1. “…the de facto ceding of medical research to Ph.D. basic scientists who, while often having exquisite understandings of molecular mechanisms, don’t know the human cost of the disease they are studying and don’t understand what advances that we as physicians really need to have to be able to treat disease better.:

    As a Ph.D. basic scientist, I concur wholeheartedly and would encourage my colleagues who disagree to spend just a week on rounds with a medical team most allied to your discipline. It is inspiring and eye-opening to learn what is truly required of our physician colleagues. This I learned years before I married a medical oncologist.

    2. If you are a med student or doc who wants to explore CAM research (basic or clinical), first get great, solid training in internal medicine then do a fellowship in integrative medicine. You need real medicine credentials to be taken seriously and truly advance alternative medicine research and practice. Admittedly, such training programs are difficult to find as many are led by big marquee book authors/TV personalities who rarely touch patients. Do a little digging to find an integrative medicine fellowship led by people with appropriate credentials.

  4. #4 Tim Lambert
    May 10, 2006

    I wouldn’t put too much trust in an article in The Australian — they seem to be injecting their usual culture wars stuff into the argument.

    “Touchy-feely” subjects such as “cultural sensitivity”, communication and ethics seem to be things that a doctor should know. I don’t think it does much good to know your anatomy backwards if the patient doesn’t listen to you because you don’t know how to communicate with them. I don’t know where the balance should be, but it is wrong to dismiss communication skills as “touchy-feely” stuff doctors don’t need.

  5. #5 Abel Pharmboy
    May 10, 2006

    If I may also inject a practical issue on my surprising objection to leaving “science to the scientists”: I find it very sad that academic med centers are full of outstanding MD/PhDs who have both the basic science tools and clinical prespective that could bring relevance to the didactic part of the program (the first 18-24 months), but fail to get credit toward promotion and tenure for any teaching efforts. In my own former medical school, good teaching counted as a neutral but bad teaching or lack of teaching was a mark against you. The financial pressures on teaching hospitals cause such folks to do more and more clinic and surgery…and that’s without getting into the strain of supporting a NIH-funded research program. Even translationally based Ph.D. (mostly in anatomy, pathology, and surgery) are not given adequate credit for their contributions to the medical curriculum.

    As long as the almighty dollar governs academic med centers, the medical curriculum will continue to be taken over by those with extra time on their hands and, sadly, those least qualified to shepherd through our next generation of docs, leaving you attendings to deal with the mess. As an educated semi-outsider, what is needed in medical education is another effort comparable what led to the Flexner Report in 1910 or so.

  6. #6 Orac
    May 10, 2006

    “Touchy-feely” subjects such as “cultural sensitivity”, communication and ethics seem to be things that a doctor should know. I don’t think it does much good to know your anatomy backwards if the patient doesn’t listen to you because you don’t know how to communicate with them. I don’t know where the balance should be, but it is wrong to dismiss communication skills as “touchy-feely” stuff doctors don’t need.

    I’m not doing that at all; perhaps I should slightly modify what I wrote if it gave that impression. Communication skills are an important skill necessary to being a good doctor.

    However, let me tweak your example a bit: I don’t think it does much good to be the most brilliant communicator with your patients if you don’t know your anatomy and the science behind what you recommend to your patients. Without knowledge of anatomy and the basis of recommended treatments, it doesn’t really matter how good a communicator a doctor is; that doctor will likely have problems practicing medicine, except in a minority of specialties. A doctor who does not know that the heart is in the chest and the liver is in the abdomen is a crappy doctor, regardless of his or her communications skills.

    As we used to say: Which would you prefer, a doctor who is a cold fish but knows your disease inside and out and treats it so that you get better, or a doctor who holds your hand and tells you it’s going to be alright while screwing up your treatment? (I know which one I’d pick.) Yes, to some extent this is a false dichotomy, but not entirely. I realize that a balance must be struck, but a physician must above all know what he or she is doing.

  7. #7 Mark Paris
    May 10, 2006

    I cannot believe that anyone remotely involved with medical practice could argue that basic anatomy is not an absolute requirement, the foundation upon which everything else is built. I certainly wouldn’t let a car mechanic work on my car if he couldn’t tell the difference between a fuel pump and a fuel filter.

  8. #8 MarkCC
    May 10, 2006

    The argument that people don’t need a doctor who knows all that biochemistry gunk, and just want someone who can give them a pill to help them sleep to to stop their heartburn… Well, I’m a pretty solid living example of why, even just to stop heartburn, knowing the detailed anatomy is very important.

    I was born with a seriously defective lower esophageal sphincter – the “valve” at the top of the stomach that stops acid from coming out of the stomach. It was bad enough that by the time I was 30, I had pre-cancerous lesions in my esophagus, and seemed to have horrible chronic asthma, caused by acid getting into my lungs. Now – so far, this is not all that unusual. Many people have reflex disorders; mine was very much towards the worse side; but still within a normal range.

    After trying treatment with various drugs that inhibit acid production (all of which I developed resistance to over time), I finally had surgery to correct the problem. The surgery is taking some tissue from around the fundus of the stomach, and essentially tieing it in a knot around the sphincter, and then putting that knot against the opening in the diaphram that the esophagus passes through. The result of this is that when the stomach starts to fill with gas, which would cause it to spasm in ways that would push acid into the esophagus, the wrapped tissues in the knot are “inflated”, and because of the way they’re pressed against the diaphram, they’re forced to squeeze the sphincter, which makes it close.

    So – a year after surgery, I started having chest pains and stomach spasms.

    First, they sent me for a stress test using a passive imagine system. After the results came in, I got a hysterical call from my doctor to get to the hospital immediately, because I was in danger of having a heart attack. It turned out that the passive imaging system uses such low levels of radiation that the extra tissue mass of the fundoplication knot blocked part of the image, so that it appeared that my heart wasn’t getting enough blood. The radiologist and the cardiologist doing the test had both been informed that I had a fundoplication; but they didn’t know what it meant, and so misread the results.

    Then they sent me for an upper GI. Fine, fundoplication intact, no reflux.

    So they sent me for a cat-scan. Cat scan report comes back with “an anamalous mass on the under the diaphram”. The radiologist had been informed that I had a fundoplication, but again, didn’t understand what it meant.

    I ended up spending a whole year in pain, getting every test in the known universe, with no one able to tell me what the hell was going on.

    Finally, I gave up on the bozo suburban doctors I’d been using, and went to a doc at Mt. Sinai in Manhattan. She looked over the test results I’d brought with me; said “They didn’t know what was wrong? It’s obvious”, and immediately made me an appointment with a gastroenterologist who specialized in the problem. Three days later, I was on medication that cured the problem.

    What was the problem? Muscle spasm. My stomach is highly prone to spasm (which is extremely common among reflux sufferers). When it spasms, because of the fundoplication “knot”, it presses in the diaphram in a way that causes the diaphram and the smooth muscles in the lower esophagus to spasm as well. The spasming of the esophageal muscles is what caused the pain I was suffering from. It’s actually remarkably straightforward anatomy, according to my internist. She’s teaching faculty at Mt. Sinai, and said that their residents are always quizzed about those symptoms, which is why she was so amazed that none of the dozen or so doctors that saw me before her were able to recognize it.

  9. #9 Julie Stahlhut
    May 10, 2006

    A related perspective from an insect ecologist:

    As far as “memorizing the Krebs cycle” goes: I’d doubt that too many people need to do so unless they’re biochemists whose research is specific to this area. However, a thorough understanding of the concept of biochemical pathways is, IMO, crucial to understanding biological phenomena. If you don’t often need to remember how many molecules of NADH are produced through the Krebs cycle, you can always look it up. But, it should be second nature, to anyone in either medicine or other life sciences, to know that enzymes and other biological molecules interact in regulated pathways that can (a.) be manipulated therapeutically by drugs, (b.) be disrupted by poisons or extreme environmental conditions, and (c.) differ in function or efficiency among individuals due to underlying genetic variation.

    So, no, I don’t worry about whether my physician has ever memorized the Krebs cycle, but I’d be very, very distressed if my physician didn’t understand the importance of metabolic pathways and wasn’t able to think clearly in terms of pathways when diagnosing illness or prescribing drugs. Of course, when one thinks about pathways, one thinks about gene products, which one hopes would lead to an understanding of the relationship of phenotype to genotype. And, that’s why I’d also be distressed if my physician dismissed the idea of biological evolution.

  10. #10 CCP
    May 10, 2006

    I totally agree with the gist of the post–ALL physicians must have a solid grounding in physiology (and therefore anatomy and biochemistry) to function competently.
    As I always say, I had a lot more respect for physicians before I started teaching physiology to pre-meds.
    My wife had some minor surgery…I asked the anaesthesiologist what drug he was using…he asked why, did I know anything about it? Well, I answered, I teach physiology for a living. “Ooooh,” he sez, “the hard stuff!” I wanted to ask for a different anaesthesiologist.
    Pedantically, however, this:
    “some [amino acids] are hydrophobic and comprise membrane lipid bilayers”
    is wrong. Lipid bilayer membranes comprise phospholipids. Hydrophobic amino acid sidechains are exposed in integral membrane proteins, allowing the protein to embed within the phospholipid bilayer.

  11. #11 Orac
    May 10, 2006

    Yikes. You’re right. I suspect it was a matter of reading too fast and seeing what I wanted to see, namely that Dr. RW was referring to hydrophobic amino acids making up hydrophobic portions of membrane proteins that rest in lipid bilayers. At least, that’s what I must have assumed that he was referring to.

  12. #12 Tara Mobley
    May 10, 2006

    I can personally say that I would never want to think I might know more about anatomy or biology than my physician.

  13. #13 Deacon Barry
    May 10, 2006

    Knowledge builds on knowledge. The basic science you learn at school is the foundation for the advanced stuff you learn during medical training. If you don’t have that secure foundation, then the edifice of knowledge that you build on it will be flawed. Then a misguided allegiance to pseudoscience or superstition will act like expanding ice to crack your edifice to its rotten foundation.
    Basic anatomy should be learned by heart (On Old Olympus’ Topmost top…)

  14. #14 Roman Werpachowski
    May 10, 2006

    But what about “memorizing the Krebs cycle” and other arcana of biochemistry?

    Believe it or not, but I had the Krebs cycle in high school, on biology lessons ;-)

  15. #15 Blader
    May 10, 2006

    The med students are demanding the dumbed down education, on the basis that basic science offers far more detail than they think they need, and on the basis that they want ‘real’ medicine earlier in their studentships.

    Basically, the hens are running the chicken coop. But they are partially right. Basic scientists could have done a better job of teaching the salient information for years, and now find their services unnecessary.

  16. #16 Kitty
    May 10, 2006

    When I took gross anatomy (here in the US), the course was open to anthropology and anatomy grad students as well as medical and dental students. We grad students had to score 80% or above to receive credit for the course, while med students only had to score 60% or above. There was nothing dumbed-down about this – the course was structured so that 60% of the information presented was more than adequate – but the fact
    that I walked away knowing more about anatomy than my physician *is* sort of unsettling

    And now I teach physiology to pre-meds. Oh, pre-meds.

  17. #17 erabt
    May 10, 2006

    I recently had to explain to a doctor of mine what the concept of ‘half life’ means.

    The subject came up when she mentioned that the drug Lamictal that I take will soon be available as a controlled release tablet. “Why would Glaxo do that? The drug has a half life of 24 hours,” I remarked. “What would be the benefit? A person only has to take the drug once a day right now.” The doctor looked puzzled.

    I continued. “Half life means the time it takes for the concentration of a drug in your bloodstream to reach one half of its maximum concentration. This is why it’s called ‘half life’. It’s not the time it takes for the concentration to reach zero. With Lamictal, half of it is still available 24 hours after the previous dose.”

    She looked at me like this is the first time she’d ever heard of the concept. I assume that sometime in medical school this was mentioned. Though one can’t blame this incident on the current way that medical schools are run. The doctor in question is in her mid-40′s, has been practicing for ~15 years, and is board-certified.

    I suppose the question I have is should a doctor know enough science that they can understand the information in the PDR? This is where I found the information about Lamictal’s half life.

  18. #18 impatientpatient
    May 10, 2006

    Hmm…the student thought he was looking at a liver when he was looking at a heart. And some have no idea where the PROSTATE GLAND is???? Would these be men or women?? AARRGGHH.

    My one note band is becoming a little unhinged reading this. I am having fits and chickens in fact. The explosion of knowledge in genetics does not seem to me to encompass a lot of cultural sensitivity- except in some instance when genes passed down in one particular race “race” – think sickle cell, I guess, where it is more probable that you will have it than a Norwegian. But if you don’t know what a blood cell is, what it does and what a normal one looks like because you are too busy being touchy feely—————-@#$% you and the horse you rode in on.

    I had this argument a few months back on another blog- should doctors be highly trained in science. I, the non scientist, non medical person was adamant that this was a good idea. The smart people- well- not so much………..Why should we know chemistry? Why should we know (insert science here)?

    Umm- because most laypeople don’t have a hope in hell of knowing what to do with an illness. And we are hoping your background will be of benefit to us. We don’t necessarily want House for a doctor- but if the alternative is Mr. Magoo???? Well, I think we will settle for someone much smarter, though not necessarily kind and whoo hoo saccharine sweetness and light who is obviously a bumbling idiot.

    Looking things up is always a good idea- but if you don’t know what you are looking up, or why, as a doctor that could be a bit of a problem.

    Stupid, stupid, stupid, stupid—–(muttering to self and clutching a security blanket for its placebo effect.)

  19. #19 Maggie
    May 10, 2006

    As a junior biology major who has hopes of becoming a MD or PA, I truly believe that an understanding of the basic science is essential for doctors or physician assistants. How else will they be able to read and understand the literature on new drugs or research? I am sometimes amazed at how my understanding of scientific literature and health articles in the newspapers has increased since I have started my undergraduate education. It has also caused me to analyze and be skeptical while reading instead of just digesting the information mindlessly.

  20. #20 Xerxes1729
    May 10, 2006

    How could you *not* want to know this stuff? This makes me nervous, as a basic science-lover heading for a medical career. Hopefully I’ll be able to find a few other geeks to study with…

    I find memorization as frustrating as the next person, but it really pays off later on when you can start connecting all the disjointed facts together to actually do something with it. This applies to music and languages just as much as the sciences. You’ve got to learn lots of Russian vocabulary and conjugation schemes before you can read Tolstoy, but it’s worth it in the end.

  21. #21 NA
    May 10, 2006

    Maggie,

    It’s good that your knowledge of the sciences has increased over time as an undergraduate student. I’m also an undergraduate student who reads genetic literature papers everyday. I caution about reading newspaper articles for science knowledge though. Most often the newspapers have the findings way wrong or make the findings sound like its a day away from curing a disease. The best way to increase ones knowledge is not by newspapers or textbooks, its reading the scientific literature that is published in science journals.

  22. #22 Maggie
    May 11, 2006

    NA,

    Oops, I don’t think I made myself clear. As far as the newspapers go I meant that it has helped me to be more skeptical of things I read and without my science background I don’t think I would be as good at picking out the facts from the crap in the media. :)

  23. #23 William the Coroner
    May 11, 2006

    Don’t blame the medical students. There’s a curriculum review and change in my institution right now, with a push to go to prosections and virtual microscopy instead of dissections and microscopes. The new technology is sexy. There is a lot of information to impart. There is now a research component for medical students.

    It’s turning out, though, that anyone who is interested in a surgicial subspecialty, radiology, or pathology will be getting a MS in anatomy to be competitive for a residency.

  24. #24 Jurjen
    May 13, 2006

    Regarding the matter of not whether or not patients care about what their physicians know about “piffling” details, I would hazard a guess that they don’t pay it much thought, but if and when that previously trivial piece of knowledge becomes a major issue, yes, they’re going to care a great deal.

    And I’m sorry for trotting out my pet peeve, but it’s “ad nauseam.” People suffer nausea, not “nauseus.”

  25. #25 Paul A. Hoadley
    May 15, 2006

    I read the original article in The Weekend Australian, and while I’ve thought for some time that medical school curricula in this country have been changing for the worse (and my alma mater, the University of Adelaide, seems to be a favourite target of The Australian), there’s no way I’m buying this:

    When asked by a cardiac surgeon during a live operation to identify a part of the heart that he was pointing to, one group of final-year students thought it was the patient’s liver.

    There is no way that ever happened. A group of final-year students collectively made this mistake? Final year medical students are a pretty competitive bunch–if a single one of them made such an obvious mistake, the others would have been correcting her faster than the surgeon could raise his eyebrow.

  26. #26 A. Nonymous
    June 19, 2006

    What surprises me about this article is that what the medical students were lacking comprised much of my daughter’s high school biology and chemistry courses (except actually feeling around inside the human body for hearts, livers, and such – my daughter’s class did it on a fetal pig).

    Isn’t high school science a pre-req for studying it at the post-secondary level, let alone in med school?

  27. #27 George Smiley
    August 4, 2007

    As we used to say: Which would you prefer, a doctor who is a cold fish but knows your disease inside and out and treats it so that you get better, or a doctor who holds your hand and tells you it’s going to be alright while screwing up your treatment? (I know which one I’d pick.) Yes, to some extent this is a false dichotomy, but not entirely.

    I suspect that the two are totally uncorrelated, and that the dichotomy is a false one. Indeed, we all know (or know of) doctors (and other technical professionals) who cover up a lack of technical skill with a cold, arrogant affect, and others who are technically superb and warm, generous, empathetic spirits. If you really think otherwise, I’d suggest the hypothesis that you are substituting observer bias for (quantitative) evidence.

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