Do you know a good doctor when you see one?Most Americans are convinced that it is very important to be able to choose their own doctor. But what criteria do they use to make that choice? Do patients want to know their doctor’s college GPA, their MCAT scores or their board scores? Are doctors trained at Harvard really better than those coming out of Iowa, or St. George's, or Maulana Azad? Does every doctor need to have dissected a cadaver, memorized the urea cycle, or know how to start an IV? What makes one doctor better than another?
John Berger wrote about the difficulty of assessing the value of the work of an ordinary doctor. "What is the social value of a pain eased?" he asks. "What is the value of a life saved? How does the cure of a serious illness compare in value with one of the better poems of a minor poet? How does making a correct but extremely difficult diagnosis compare with painting a great canvas? In our society we do not know how to acknowledge, to measure the contribution of an ordinary working doctor." i
This year marks the centennial of Abraham Flexner’s famous report that transformed medical education in the United States and medical education is in turmoil. Zeke Emanuel wants to redesign the pre-med curriculum - to replace required calculus, organic chemistry and physics with statistics, ethics, psychology, genetics and molecular biology. A number of lofty commissions have recommended that the medical school curriculum include more attention to health care financing, leadership, and social accountability. Donald Barr has pointed out that there is absolutely no evidence that “one's knowledge of science represents a continuous metric of the quality of one's preparation for the study of medicine”. Residency training has already changed dramatically, with the imposition of work hour restrictions by the Accreditation Council of Graduate Medical Education. These restrictions are supported by the public but opposed by many medical educators. Further restrictions on resident work hours are coming soon.
Pediatrics has some unique problems all its own. Leaders in pediatric residency education have called for more emphasis on the management of chronic illness, on cultural diversity, and on changes in information technology. The pediatrician of the future may need to decide, early in her career, whether she wants to be a generalist or a specialist, a primary care physician or a hospital-based physician, an acute care doctor or one with expertise in the management of chronic conditions.
All of these shifts beg the question of what it means to be a “good doctor.” We talk about ethics and professionalism, technical skill and a broad range of knowledge, facility with information technology and superb interpersonal skills. Students learn in simulation laboratories. They are videotaped and critiqued. Residents get more sleep than ever before. But are we producing better doctors?
What were the most important lessons you learned during your medical education? Which courses helped? Which were useless? Send your thoughts.
i Berger J. A Fortunate Man. Vantage. New York. 1978. p124.