How did the med school evaluate one’s chances of going into primary care in rural or minority underserved communities? Was it mostly through statements made in interviews or personal statements (e.g. “I want to go to med school because I want to cure cancer in remote fishing villages of far northern Alaska, yeah, that’s right, totally.”), or were there quantitative metrics involved that could e.g. estimate that a person whose background check showed more frequent than average travel to rural or minority underserved communities probably has some interest in those communities and thus might be more likely to want to practice there? Were there aptitude tests that could gauge a candidate’s likelihood of not becoming discouraged in such a community and deciding to catch the next train for the coast?
My medical school of the same era pretty much actively discouraged primary care. OTOH they were very good at choosing a diverse group of pre-medical experience … we had an accountant, a computer science major, a poetry major, so on … but those of us interested in primary care were a distinct minority and the one most interested in serving the underserved indeed had much experience to back it up … mostly mission work (he was quite religious in a not in your face way).
I’d love to see a list of highly successful doctors and what their undergraduate majors were. Harold Varmus, for example, a Nobel Prize winner, majored in English. Last year’s Nobel Prize in Medicine and Physiology went to three psychology PhDs. Previous years have been to those who majored in physics, biology, chemistry … pretty much all over the board. Paul Farmer, founder of the international health organization Partners in Health, was an undergrad sociology major.
Then again we have the counterfactual - Ben Carson was a psychology major. 
In general I think the humanities majors who apply to medical school are going to be subject to a positive selection bias as much as anything else. It is a challenge to take and succeed at the requisite hard science classes while also completing the degree requirements for, say, the History or English departments. Those who accept that challenge and succeed with good enough grades in all to reasonably apply to med school have minimally not taken the easy route. The same applies to Physics and Math majors.
In what way have I rejected the idea of a team approach to treating patients? It’s been an essential part of pathology practice for a long time*.
Your contributions to this thread (including the conviction that any resistance to the direction the MCAT is evidently taking must mean that critics only want candidates who know their way around obscure chemical equations) have convinced me that a set of questions on the new MCAT dealing with the strawman fallacy** are greatly needed.
*even when certain primary care and other referring docs are too lazy to provide relevant clinical information to us, requiring that we form Therapeutic Alliances with them (i.e. nag them for the information necessary to do our jobs properly).
**which also includes the idea that I’m worried about traditional science-based applicants not scoring well on the new MCAT. I’m sure they’ll be able to memorize and regurgitate enough sociology glurge to bull their way through, “boot camp” or not.
You seem to have a lot of worries based upon nothing substantial; I posted a link to data that shows how well various majors did on the old MCAT, why do not not address that or say where it is wrong or even read it?
You clearly have a disdain for people who major in liberal arts, especially sociology, yet will not do anything other than repeat the same tired old meme about how such people can’t handle hard science. If you are worried about that sort of thing, you should have been complaining about the old MCAT because it certainly did not weed out liberal arts majors.
I think the disconnect is that as a pathologist you are pretty much removed from the changes that have occurred and are accelerating, not just in denial about them as many other docs are.
I am not talking about consulting specialists. That’s still looking at a single tree.* What I am referencing is at a much larger structural level and impacts internists and FPs much more than it does me in pediatrics and you in pathology. It’s about population health management (PHM) and the larger team approach needed to do that effectively.
The insurance industry has been implementing these carrots and sticks for years now and changes to Medicare are accelerating them.
Doctors in small groups are going to have a hard time surviving. Many are, as a result getting bought up by hospital dominated systems and becoming employees: skilled workers, but not leaders. Leadership there are the MBAs looking at short term bottom lines.
I believe patient care will suffer if physicians are relinquish all leadership responsibilities to the MBAs (even when a few of those MBAs also have MDs but do not actually practice). Of course an intro soc class does not give all the tools needed to do that and does not build us physician directed health care systems, but it recognizes that understanding populations, how they form systems, and how the systems impact the populations and population-wide outcomes, are important concepts, and gives a taste of taking that broader perspective.
*Even your example of having to nag referring physicians for clinical information reveals the myopia. Pull back the view and look at the system rather than blame individual “lazy” docs and the job becomes to develop the structure that makes your getting that information near automatic. Eh, what do I expect … pathologists and their microscopes …
The point of the changes, I believe, is to account for the fact that just being an uber-biochem nerd isn’t enough to be a doctor. You need a little of that sociology stuff. For example, maybe your patient Bill is not getting better because you prescribed him a medication that needs to be kept refrigerated and he doesn’t have a refrigerator, so he just leaves it on the back porch and the pills spoil. Or maybe he’s a recent immigrant from Belarus and can speak, but can’t read, English and thus can’t read the directions that come with the medication, leading him to take the pills on an empty stomach when the directions clearly say take with food. Or maybe he lives in a high-crime area and his pills keep getting stolen. Perhaps he’s a woo-woo homeopathy devotee and is just paying lip service to you and is really throwing away his treatment. Maybe he’s poor and is selling them on the street. Wouldn’t you want to be able to recognize these conditions so you can at least try to alleviate them?
robert, Jackamnnii does not need it so much … he’s a pathologist, not a clinician. His contact with patients is with bits taken out of them, cells and tissues and fluids and such stuff.
Moving past the MCAT changes Jackmannii, are you an employed physician or part of a partner group? Hospital-based?
Now there’s a classic example of the myopic, stuck-in-the-mud view that our academic medical leaders are successfully overcoming.
Instead of huffily dismissing integrative medicine as “woo”, DSeid needs to accept that it’s the wave of the future. University medical centers and cancer clinics increasingly promote alternative methods because they are holistic and patient-centered. Instead of the old-fashioned model followed by practices like those of DSeid and other allopathic physicians, who run patients through en masse without listening to them and throwing drugs at every problem, the new paradigm promotes a gentle system of cleansing and toxin removal, following techniques in use for thousands of years.
For instance, the University of Arizona Cancer Center uses reiki, cranial massage and reflexology.
"Reflexology is a holistic healing technique that moves energy to release tension and
improve health. It is based on the principle that the organs of the entire body are
mirrored in the feet. By working the feet with stretch, pressure, and specific thumb
techniques, healing and relaxation can occur throughout the body. "
And George Washington University’s integrative medicine center knows that essential oils are vital components of health care:
“Essential oils are more than nice smells. They also have anti-viral, anti-fungal and anti-bacterial properties. Essential oils are 50 – 70 times more potent than their herbal counterparts making them a perfect choice for many of your health care needs.”
Indeed, the physicians of tomorrow (exemplified by the pro-integrative and holistic American Medical Student Association) are encouraged more and more to abandon the sterile double-blind controlled study and accept a model that is…holistic.
Now, cynics and skeptics (the same thing, really) like Orac sneer at “quackademic medicine” and suggest that these patient-centered and holistic initiatives are driven by misguided ideology, misleading buzzwords and desire to cash in on popular fads (much as the same cynics and skeptics would argue about integrating “institutionalized racism” and anti-power structure rants into medical education). They would dismiss the new emphasis on holistic and patient-centered care, claiming that good physicians have been following such principles for a very long time. But we know this is not so, because Dr. Weil, Dr. Oz, Dr. Mercola and truth-telling websites like NaturalNews have revealed otherwise.
I am disappointed in DSeid’s dismissive attitude towards "“woo”. But what else can we expect from an allopathic practitioner who remains mired in the old ways, dispensing drugs to all comers and refusing to get in step with and help lead medicine towards its bright and holistic future?*
*thankfully, not all private sector physicians are ostriches who become incontinent at the very thought of abandoning their precious “evidence-based” philosophy. A hospital system at which I practice recently advertised the hiring of an acupuncturist, who not only relieves pain but accomplishes numerous other healing tasks, including boosting the immune system. One hopes that our oncologists will eschew bone marrow-stimulating drugs for patients who are neutropenic following chemotherapy, and will send them to the acupuncturist instead.
At the risk of being inappropriate for the forum, what the … fudge … are you going on about?!?*
No, Jackmannii, being able to critically evaluate ideas about how minds work and how cultures and societies function and able to apply those concepts to novel sorts of problems not only does not equal acceptance of woo, it helps give us the tools to fight it more effectively. (Amazingly merely “huffily dismissing” it has not been the most effective approach.)
To return to the concepts that I brought up that you ignored, that do have to do with the MCAT changes, I do want to make something clear: yes, the ability to accomplish “population health management” as part of cohesive systems is now requisite to being able to make a decent living in medicine (and will be more so over the next decade) and yes I believe that the next generation of practicing doctors should have the education, skills, and perspectives, to be the leaders and active participants of those systems (rather than resentful, or worse complacent shift working, skilled drones taking orders from suits), but not only because of the financial carrots and sticks. If we are in leadership roles we can make sure that when the payors (private or public) have us jump so high, we can make sure we take off and land on the foot that makes an actual difference in real quality and not just the metric chosen by the payor.
*Really it sounds like you are doing the “they have been wrong before” that is … what number in the Pillars of Woo? Yes, it is very disappointing to read this sort of argument being posted under your name.
So why do you summarily reject holistic, patient-centered medicine? Does this threaten your economic model of shuffling patients through your office and pressing drugs on them, instead of spending time with them and listening to their concerns?
Respected academic centers like George Washington University and Cleveland Clinic recognize the need to integrate what you contemptuously refer to as “woo” into their practices. Apparently you and some of your backward-thinking allopathic compadres have arbitrarily decided that academia has not critically evaluated these elements of a holistic and personalized medical practice.
You seem to be cherry-picking concepts (“buzzwords”) you like and rejecting others, even when they are requisite to producing cohesive, integrated, responsive practices of the future. Some would deem that hypocritical.
*I just heard an ad for a website promoting its efforts on behalf of type II diabetes patients. “At last, there is someone who listens to me and what I want” said the patient/model featured in the ad.
So why, DSeid, aren’t you and your fellow allopathic practitioners listening to diabetes patients?
Actually I do NOT summarily reject “holistic” medicine and I don’t reject patient-centered medicine at all (although I do not accept is as meaning “the patient is always right”).
“Holistic” is not a buzzword automatically triggering off a fixed action pattern* to me. I instead evaluate the evidence for the claims and reject claims that the evidence does not support. You know, by the process of critical data analysis that the new MCAT has added more to evaluate skill in. When something that is called “holistic” meets the evidentiary burden of benefits versus potential harms, then I accept it. Noted that they rarely do.
“Patient-centered” is, well, what clinical medicine always has been about in private practice, at least successful ones in competitive markets, especially in pediatrics. Giving orders to families has never worked as well as a process of listening to and addressing concerns with some education thrown in. The fact that much of my competition does not bother to do that is why our practice has done so well, quite frankly.
To continue with the hijack, the fact is that many many “allopathic practitioners” do a lousy job listening to all patients, inclusive of those with diabetes. Doctors interrupt patients on average after only 18 seconds and are often perceived as rushing out of the room. It is shocking to me that most docs don’t know that it ends up taking longer to get the good history when you cut someone off that quickly and that finishing a visit with a relaxed “Any other issues while you are here?” will almost always be answered with a 3 second pause and then a “No. Thanks.” and have patient feel like they had all the time in the world instead of feeling rushed. (And the items rarely brought up are usually able to handled in very little extra time.) Consistency of treatment approaches between partners is also patient centered as it avoids confusion. Also amazingly, practices that are in that sense, “patient centered”, get sued much less often.
“Buzzword” seems to be your buzzword, Jack. Is “evolution” a buzzword too? “Antibiotic resistance”?
You seem to think that you huffily dismissing a concept as a buzzword means that you do not need to engage in any critical thinking about the concept’s value. That is not the mark of a critical thinker; it is the mark of willful ignorance. And again, such surprises me from you.
*Yes, a term from intro psych class.
I don’t think you appreciate the trap you’ve fallen into.
You’ve suggested repeatedly that without labeling present-day health care as “institutionalized racism” and getting prospective med students to regurgitate the line that undesirable outcomes are due to “power, privilege and prestige”, we can’t possibly provide decent health care to minorities or address related problems in health care delivery. Med school deans (according to the linked story) are gung-ho for this change, because they believe in the ideology, or even more likely because there’s money in doing so (government and foundation grants, donations etc.).
Meantime, some of the same academic medical leaders have pushed to incorporate reiki, reflexology and other modalities you dismiss as “woo” into offerings by medical centers and even med school curricula. These modalities are heavily identified as “holistic” and crucial elements of “patient-centered care”. And they’ve gained traction at these medical centers for the same reasons - their leaders’ belief in “woo”, or even more likely offering it because there’s money in it (i.e. increased business from the gullible, donations etc.).
But now you’re rejecting the implications of this jargon, saying that you’ve always offered patient-centered care (sans woo), and holistic means…well, what you want it to mean. This sounds uncannily like what I was saying earlier about a long-standing practice in medicine of addressing ethnic differences in disease incidence and treatment without the necessity of cramming idiotic Sociology 101 buzzwords down students’ throats.
Whatever happened to the need for physicians to get in on the ground floor and lead the way to the New Health Paradigm, as you were telling us earlier? Shouldn’t you accept what these academic medical leaders are telling us, and incorporate “woo” into your practice, so that it can truly be holistic and patient-centered? Without reflexology, acupuncture and cranial massage therapists in your practice, isn’t it just Neanderthal medicine that fails to meet societal needs?
It seems like you are hearing and reacting to things that you are imagining. Persistently. Both within the MCAT and of what I have argued.
-
No I have made no such suggestion. I do believe that a critical understanding of the concepts and perspectives contained within the fields of sociology and psychology are of great utility to the current, and more so to the upcoming, generations of physicians if they want to have a major voice in how health care is delivered in the future and can benefit clinicians in the trenches as well.
-
Your tendency to relegate words and concepts that you do not understand or do not like as “buzzwords” does your argument no service. Either address the concept or do not. If you do not understand what the concepts actually mean then admit it: there is no shame in being ignorant of concepts you have not had the chance to learn about; there is however shame in being afraid of something just because you are ignorant of it.
-
Addressing the concept contained as one small part of an intro sociology class that you somehow find offensive and scary … Is it your belief that there are no impacts of the structure of society, culture, and in particular of the structure of health care delivery systems, on racial and ethnic disparities in healthcare outcomes? Without reference to “buzzwords”, yes or no? Really the fact that such seems to be even a controversial concept to you makes me think that maybe a separate GD thread would be useful.
-
Indeed I reject the notion that “patient-centered” care means channelling Dr. Oz regardless of what a few academic centers do. More to the point it is completely immaterial to the MCAT changes other than that they are both Jeopardy! responses to “Things in healthcare Jackmannii doesn’t like.”
-
The fact that marketing people are leading the way with a few employed academic physicians aiding and abetting selling whatever there momentarily seems to be a market for, rather than physicians as leaders, is exactly what I do not want to continue to happen. But it is where the path leads without involved physician leadership that is adequately prepared to lead … Being prepared to lead does not mean uncritically accepting whatever academics say any more than it means uncritically accepting what the marketing suits say. I think you understand that leading the way does not mean blindly following academics … who are not prepared to be leaders in these systems. It means having the tools to critically evaluate what they say though, neither rejecting it knee-jerk because it is new and different or contains a phrase that you do not understand, nor accepting it blindly and uncritically either. Critical thinking, about concepts expressed as data and about concepts expressed as words, about both how intracellular machinery works and how society functions and all points in between, are all needed skills, and is what the changes in the MCAT are aimed at.
-
“Holistic” as used by most who use the word don’t mean shit and you know it. Call it “holistic” call it “alternative” call it “traditional” call it “allopathic” call it “standard of care” call it “late for dinner” … what matters is still the same: what is the evidence for benefits and risks of harms? If an herbal medicine has been studied and works with little risk of harm I will accept it as an effective approach even it has previously been labelled as “holistic” or “alternative” … you wouldn’t?
Great Debate thread to discuss the value vs buzzwordiness of “institutional racism” vis a vis health care now extant.
I regret that you reject holistic and patient-centered care. Fortunately, there are increasing numbers of pediatricians who recognize the need to relinquish the doctor-centered, patriarchal model you cling to, and give patients what they want (indeed, this is critical to the Patient-Centered Medical Home concept, considered a model for maximizing [del]reimbursement[/del] patient satisfaction).
For a model pediatrician of the future, look to this practice. The holistic pediatrician explains the disillusionment he experienced before finding the correct path:
“At that time, Dr. Dane’s own children were experiencing chronic health conditions of their own which, despite seeing many specialists, were not getting answers using the conventional medical model. Out of frustration and desperation, his kids saw an alternative healthcare practitioner, who effectively diagnosed and healed them after one visit, when they had seen numerous specialists and general pediatricians over the years and essentially got nowhere!” (italics and bolding not added)
Dr. Dane also practices Functional Medicine (which people like you sneer at as “woo”), and has a Vaccine-Friendly practice, featuring an “alternative” schedule, because he recognizes there “are many fears regarding vaccinations and their link to several chronic conditions, especially autism.”
(Dr. Dane’s practice is in Newport Beach, California, a part of the country where vaccine-preventable infectious disease outbreaks are unheard of, as we know)
Can you boast of having a 500-hour yoga certification, DSeid? I didn’t think so!
I can understand that you find change painful. But it’s all beneficial.
Academic exams are necessary as a screening tool to ferret out brains able to amass and process the data required to become a competent physician.
Though necessary, this ability is not sufficient for clinical competence, and I am not aware of a single med school that thinks it is.
Med schools have always tried to have the admissions process embrace efforts to evaluate the many other skillsets required and get matriculants from a broad spectrum. Approaches include looking at breadth of volunteer/life experience; recommendations; lowered MCAT standards for blacks and hispanics to make sure they are given access; and so on.
I doubt changing the MCAT itself will make a toot of difference one way or the other. Having sat on a med school admissions committee for many years, it’s not my impression that a typical admissions committee is blind to the notion that physicians need to be more than regurgitators of facts.