Graham has an excellent post on changes to be made in medical school curricula:
But one area where I think we’re lacking—because medicine has changed so much—is the treatment of the chronic disease. We focus so much on the acute still in medicine, when our patients have primarily shifted to the chronic. Sure, as residents we have clinic time where we see patients as outpatients in a chronic disease setting—but most of our residency (and much of our medical school) training is still focused on the acutely ill patient. While this definitely hammers home important concepts in many diseases, which can then be translated to the outpatient basis, I wonder if there’s more we should be learning. If you look at physicians as a whole, they’re not working in hospitals, taking care of acute patients. They’re working in private practices, seeing outpatients.
In terms of care, the U.S. is great at acute treatment and really lousy at preventative care. Perhaps the focus of medical school is reinforcing this problem?
I have to think, however, that this is a difficult balance to strike, there only being so many years we can keep people in medical school. But our system produces much less general practitioners and primary care physicians than other nations, another undesirable result of the medical school curriculum (and also of market distribution, of course -- specialists get paid a lot more). Both of these facts are costly in our health system -- specialists are more expensive than generalists, and poor management of chronic illness can result in hefty costs over time.
I think Graham's onto something...