Psyched Out

As a person who occasionally depends on doctors to save my life, I would prefer that they were required to demonstrate prior to med school admission:

1. An aptitude for UNDERSTANDING medical and scientific research. I really couldn't care less if they are brilliant scientists themselves. I sure as shit don't care if they're good at physics. I want them to know that epidemiology can never establish causation. Correlation does not establish causation. Period. Ever.

I want them to know they need to read their journals weekly, and that they can't rely on the authors' conclusions but need to read the WHOLE paper and draw their own conclusions. The ability to understand basic genetics and MZ vs. DZ twin vs. parental concordance is needed. Knowledge of the relative scientific strengths and weaknesses of quantitative and qualitative research should be firmly in place as well. With rare or currently untreatable illnesses, and even healthy conditions like pregnancy where you can't just randomly assign treatment and no-treatment groups, following a population clinically is both ethical and informative.

2. An ability to LISTEN to what patients say and what they don't say, and draw correct conclusions then check with the patient (and witnesses) to clarify. This can be done in seconds in an emergency. A couple of social work courses in assessment would instill this critical ability.

3. A basic understanding of human psychology, including but not limited to: human developmental stages; motivated behaviors (thirst, sleep, hunger, breathing, pain, pleasure) that are not under a person's control; a class on the biological basis of addiction (neurologically similar to epilepsy) as opposed to psychological dependence (which happens equally with marijuana, hugs, and asthma inhalers), and last but not least the common mental illnesses.

4. Female anatomy, physiology and health (including pregnancy) as a medical norm equivalent to male anatomy, physiology and health.

5. While we're at it, how about a grounding in health (including pregnancy) on which to build a separate and parallel knowledge of pathology. I want doctors to recognize the natural variation in human phenotypes, and the effects that harsh or oppressive environments have on individuals and groups over time.

6. Economics, including a thorough review of the cost of treatment and medication compared to the typical income levels of different populations, so that they will not label poor people "non-compliant".

7. Ethics - so that when they see other doctors abusing or butchering patients, they REPORT them to the police. And so when they are having trouble themselves, they seek help instead of harming patients and relying on other doctors to cover for them.

8. A medical history class detailing health and science fads that are still with us today. Positive fads are important, but aversion fads are critical to understanding that one's own biases can cloud clinical and scientific reasoning.

I'd rather be treated by an English Literature BA or Auto Mechanics AD with those skills than a double major Biochem/Physics undergrad without them. It amounts to ten undergraduate classes at the most, only two semesters even for relative slackers.

And while we're at it, I want working interns, residents and attendings to get at least 8 hours of sleep in 24. I've nearly been killed by doctors who were so sleepy they couldn't have counted to ten if asked. Fortunately, either nurses took over and TOLD the comatose docs what to do, or I was an asshole and demanded a doctor who was competent to make legal decisions, let alone diagnoses and treatment decisions. How can people emerge from even a basic biology class without understanding that humans need sleep?

I guess I needed a rant. Hopefully you did too. :)