Recently, I attended a conference on integrative medicine. It was a lovely conference and I learned a lot: about Chinese therapies used for cancer, about osteopathic manipulation, and about the growing community of doctors that respect the value of complimentary medicine practices and are working to integrate them into their general practice.
I also left with a sense of dissatisfaction with what I know of the allopathic medical education experience and a series of questions about how it is taught.
1. Why isn’t the musculoskeletal system covered more in allopathic medical school? As highlighted by a recent article featured on Kevin MD.com, allopathic medical students graduate with very little confidence in their abilities to help with musculoskeletal issues. This is alarming given that back pain is one of the top complaints that bring people to their doctors (and that I’m learning the musculoskeletal exam right now and am kind of terrified if that is the only exposure I am going to get to those issues).
The article rightly points out that DO students graduate with greater confidence in their ability to deal with musculoskeletal issues, but offers few solutions. Should we all have gone to DO school? Why aren’t allopathic schools or residency/fellowship programs offering more chances to learn osteopathic manipulation? A Google search revealed one abstract about an osteopathic elective for allopathic family medicine residents but no signs of whether this program has continued or whether any other programs like this exist.
2. Why isn’t nutrition a bigger part of conventional medical school education? I realize that time is limited in the world of medical education. However, nutrition plays a huge rule not only in obesity, the biggest public health epidemic of our time, but also, according to Dr. Dean Ornish, nutrition could also be huge in preventing heart disease and prostate cancer. Yet as of 2004, medical students across the US only averaged about 24 contact-hours of nutrition education during medical schools
On average, that may not sound so bad, but it does mean that over half of the schools that responded to the 2004 survey required 20 contact-hours or less of nutrition education. Considering at least two of those hours will just be a list of the biochemical properties of the major vitamins (because I know my “nutrition education” at medical school certainly included that), it is a bit inexcusable why we don’t learn more about nutrition. For one thing, our future patients will already know that being fat is bad for you and that you should take your vitamins. If anything, that should be where our nutrition education starts, and not where it ends!
3. Why is alternative medicine still considered a therapy for the rich? This is partly a rhetorical question because obviously, a great deal of insurance-related policy is behind the reason that most alternative medicine practices are paid for out-of-pocket. Even if Medicaid currently pays for chiropractice or acupuncture treatments in some states, that does not mean that they pay as much as people are willing to pay out-of-pocket or that they would pay for the lengthy personal follow-up visit that is required for the personal, holistic approach intrinsic to basically all therapies that fall under the umbrella of complementary and alternative medicine.
The doctors that presented at the conference seemed to accept this approach to offering complementary therapies. One even mentioned that not accepting insurance was the compromise that she had to make with her institution to allow her to continue to take as much time with her patients as she felt was needed. I felt that this acceptance was easy in the hospital where the conference takes place, surrounded as it is by downtown Chicago and its office buildings and condos made of glass and stone. Yet I wonder how such a comment would sit if we held the conference at my home institution next year, surrounded as it is by the Chicago Southside community and its very different set of demographic considerations.
In the end, I was left wondering about alternative medicine’s reticence regarding policy concerns. I recognize that this could be a skewed view presented by this particular conference (whose emphasis was on building awareness and warm feelings towards medical students towards alternative medicine), but I could not help wondering, are we really doing everything we can to better protect the time that a doctor spends with a patient? What would happen if doctors advocated for greater access to processed foods? Aren’t these areas where alternative medicine practitioners could lead in policy changes that all physicians should be hoping for?
Given how difficult it (apparently) was for doctors to even present a united front on health care reform last year, I recognize that it would also be difficult for doctors to rally around these seemingly simple policy issues. But I wonder – has it ever been tried? And if not, why not?
Emily Lu is a medical student who blogs at Medicine for Change.
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