Why your doctor’s education is unique

What makes your doctor’s education unique from that of other health care providers?

Recently, I was sitting in on a lecture by one of my favorite physician-teachers (certainly my favorite neurologist).  I’ll call him Dr. Deeds (for his resemblance to a character from the movie, Mr. Deeds).  He was giving a sort of broad, generalized lecture to prepare us for a series of lectures on neurodegenerative diseases (Parkinson’s, Alzheimers, and the like).

Medical students are busy, and under constant pressure to memorize and apply knowledge in short periods of time, while maintaining busy schedules filled with research activities and a blend of simulated and actual patient encounters.  Appreciate the picture I’m trying to paint for you – by all means, this should have been one of those lectures that made us wish we stayed home or went to the library to catch up on work.  Instead, it wound up being a potent reminder of why I decided I wanted to spend my life learning and practicing medicine.

Dr. Deeds went off on a tangent about apoptosis and caspases, which seemed better suited for a lecture to first year medical students (who learn largely about processes at the cellular and biochemical level), but pulled it together with one of the best quotes I’ve ever witnessed in the field of medicine:

“… Now, the reason for understanding [these] pathways is that, if you just know medicine and you say ‘Okay, I’m gonna take this drug and give it to so-and-so who has [a] headache, and the headache is gonna improve,’ you’re no better than my grandmother, who was a ‘certified healer.’  She had only a third grade education, and she knew all about herbals and [pharmacopoeia] and all that.  People would come [to her] and she would perform a ritual and give them [some] Willow bark to boil and then drink the water.  Willow bark, as you know, has a lot of [aspirin] in it, and if someone had a terrible headache or pain and they drank that, they got better.

And the reason for that, it was sort of an empirical medicine – she knew that this thing [was] gonna work for this, and she was very good at it, in fact.  But the difference between you, who pay $250,000 for your education, and you [go through] residency, and torture yourself through this, and her who had only a third grade education, is that you know these sequences of pathophysiology.  Okay?  And [in] these sequences of pathophysiology … at each point of understanding, you have an opportunity for intervention.  Right?  And you say, ‘I’m gonna choose this drug that’s gonna block this pathway, or activate this pathway, and as a consequence I can fix this disease … ”

I’ve been meaning to write an article on the complexity of disease and why we can sometimes only hope to slow the progression of certain processes with our current understanding and treatment options.  The idea came to me while reading some critical reader comments on a medical news article – it’s disheartening to see such a large number of people be so skeptical of doctors (whether they think they’re liars or in bed with the pharmaceutical companies, it doesn’t matter).

The problem is multifaceted – science and health literacy in America are dismal, and with credulity abound (credulity toward anything but “Western medicine,” that is), there is far too much room for people to be swayed by misinformation.  We in the health care system are also to blame – seldom do we have the time (or patience!) to explain the disease process to our patients (who deserve nothing less).  We also have a difficult time admitting when we don’t know the answer to something (whether that’s a common personality fault, a product of the system we work in, or a result of our training, I can’t say).  The role of the media is also important, as are many other factors, but I’ll spare you and return to my point: 

I oftentimes feel that if we helped people to just grasp how modern medicine works – what doctors do, and how they make decisions based on evidence – that there might be some hope in salvaging the cherished doctor-patient relationship that is threatened by the growing anti-medical rhetoric, opportunistic “alternative medicine” practitioners, and fallacious and misinformative resources, both in print and on the web.

“Be careful about reading health books. You may die of a misprint.”
–Mark Twain

James Haddad is a medical student who blogs at Abnormal Facies.

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  • http://secondbasedispatch.com Jackie Fox

    Good, articulate explanation of why doctors still matter, and always will. It’s too bad so many of us need to be reminded.

  • Kristy

    Excellent reminder. I am very thankful to all the doctors out there for their hard work in trying to help the patients with their ongoing medical problems. I speak to this effect not only from the patient perspective but as a Medical Assisting student (with the next step being to go on to Nursing School). Please keep up the good work.

  • http://abnormalfacies.wordpress.com/ Jim

    Thank you both for the feedback, I’m glad it struck a chord with someone.

    Unfortunately, as I neglected to mention, I think this same philosophy (i.e. target a pathway) may be partially to blame for our reliance on pharmacotherapy vs. lifestyle changes. Perhaps a topic for a future post.

  • Heart Patient

    This certainly struck a chord with me. I have what seems to be a growing number of “specialists” that I see routinely, and I love my doctors, particularly those that take the time to explain things to me. I also try to schedule my appointments when the fellows are with the doctors, because I always learn more at those appts. I had to comment since last week was the first time I learned about caspases, even though I’ve been treated a few years, every 3 months, by my neurologist. This because he was explaining what he was doing to the medical students in his office. It would have been bettter had he explained this when I first started these treatments with him. Not to say I’ve not had many conversations with him…just not about this disease process.

    So, from a patient perspective, please explain our disease processes. I’m sure doctors can tell if we ‘get it’ or not, and whether or not they are wasting their time. Some of us are compliant/cooperative patients!

    • http://abnormalfacies.wordpress.com/ Jim

      Patients should definitely be educated on their specific disease process(es), but doctors can’t explain apoptotic pathways to everyone who just needs to hear “cells die” – it’s not only a waste of time, it’s information overload for the vast majority of patients. In my opinion, information overload is just as bad as not providing any information. It can be crippling to someone who lacks health literacy and needs a “big picture” idea of what’s going on.

      The patient population I’m immersed in is that of North Philadelphia. If I chose 10 patients to explain the above example to, 5 of them would glaze over, 2 of them would be on their cell phone before I reached my first “caspase” and 1 would tell me to shut up. And I think that’s being generous.

      Certainly, though, when patients have the health literacy and interest to go above and beyond a basic understanding, doctors should help them in their quest to learn more.

      That’s why medicine is so personal – it all comes down to who’s on the table and who’s on the stool, as it were.

  • Molly Ciliberti, RN

    Thank you for an excellent post. It is precisely the knowledge of pathophysiology on top of normal anatomy/physiology that makes the difference between medicine and alternative snake oil homeopathic voodoo. You don’t have to believe in science, but it is real and true whether or not you believe it or not. Education helps our patients to understand the why and how and helps to obtain better compliance from them.

  • gzuckier

    Amen to all.
    Of course, alternative medical practitioners will explain to you how their treatment regulates energy flows in the body, and voodoo practitioners will explain to you specifically what needs to be done to motivate the evil spirits to leave the afflicted patient.
    In fact, there are probably more treatments in “Western” medicine for which the mechanism of action is unclear than there are in alternative medical practices. Which is probably an indication in favor of Western medicine.

    • http://Abnormalfacies.wordpress.com Jim

      What’s interesting is that more than a few people who are close to me believe in and utilize alternative medicine.

      I believe it can be beneficial to explore other modalities of care, but it’s very important for patients to realize that if a treatment isn’t a result of evidence-based medicine, it likely hasn’t undergone rigorous testing. I don’t immediately vilify alternative medicine, but I certainly notice that many sources purporting alternative medicine do vilify Western medicine, and that should always make a rational person suspicious.

      Funny that I didn’t read your post until today – I just published a post this morning about how we sometimes don’t even understand how drugs work, but use them anyway.