Med school teachings

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...

Comments

[marcus newberry]

Yes, Graham is on to something but he is hardly the first. As you stated, medicine does a good job with acute care and there are ways to organize for more effective and efficient chronic care. But, what is missing is health promotion, healthy lifestyle and disease prevention. Primary prevention should not be treated as a medical problem. It is a cultural problem with large portions of individual responsibility and community commitment. There are communities working on this. Check out CardioVision 2020 in Olmsted County, MN and Healthy Greenville in Greenville County, SC. The two have an informal health challenge match.

Governor Huckabee of Arkansas is chairman of the National Governors Association. The topic for the NGA Forum in Washington DC later in February is Healthy America. Both Arkansas and SC have statewide initiatives. We will accomplish something much faster this way than changing medical curriculum. I know because I administered a medical school for 11 years.

With all that being said, I am extremely pleased to see you on this topic.