Let’s talk for a moment about medical education. I went to a work-related party recently and rode in the elevator with a dear friend who is my contemporary, and a more senior and highly regarded faculty member known for her work in medical education. Both were afraid for the future of medical education in different ways.
My contemporary was concerned that the emphasis on the use of advanced technologies like ultrasound will make residents dependent on these devices and unable to function without them. The more senior doctor was actually concerned that residents weren’t learning technologies adequately, a seemingly opposite opinion.
Then I read a nice post by a medicine intern: Is deep learning in medical education possible? In it, Dr. Peteet expresses his concern that superficial and strategic learning outweigh deep learning in medicine, and that the residency process emphasizes individual learning of acute illness in a large hospital setting and that the skills of collaboration and teamwork needed in the current medical climate are ignored.
Then I read posts touting the advantages of technology in the areas of both education and clinical practice, with both authors managing to emphasize the removal of the doctor from the hands-on care of the patient. One was a wide-ranging and extremely optimistic evaluation of emerging diagnostic tools in the form of computer algorithms. The other talked about simulators and simulated patients and how awesome and helpful they are.
Look. You want to learn to be a doctor? So go doctor. On people. That’s what doctors used to do. Now you’ve got an office where the patient logs in in the waiting room to their personal data page, prints out an algorithm-generated list of medical priorities. The patient then sticks their hand in another computer and gets their vitals taken. Then they sit in another office and a nurse comes in and repeats all the information the computer has and asks you what your symptoms are. She enters it in her computer, which generates a list of what is wrong with you based on your symptoms from most likely to least likely. Then the medical student comes in and repeats it all and enters it in his computer, which he is adept at because he majored in molecular biology and biochemistry. The resident then comes in and tries to do the same again but his beeper keeps going off. Another technician comes in and does an EKG with his little machine.
The medical student takes his computer (given to him by the medical school) to his simulated patient in his artificial classroom and plays out scenarios involving how to break bad news to this patient or how to do a rectal examination. The student then simulates doing a venipuncture on the simulated patient. The resident sits in the back room updating the computer program that tracks his team’s inpatients and calling radiology because he can’t find the ultrasound machine he must have to do an arterial line on 98-year-old Mrs. Jones.
Meanwhile back at the office the actual real patient has not been seen or touched by an actual doctor since his arrival.
We have arrived at this utopia in a variety of ways, starting with the way we pick our medical students and going all the way through how we organize our private practices. Medical students come fully equipped with a knowledge of how to get ahead in an academic situation and are adept at superficial and strategic learning.
Those who have a deep and abiding care for real people either don’t get in or don’t get far before that care is beaten out of them by the constant demands of technologies that remove the real people from their care. Residents are used as grunt labor and to fill seats and write orders and chase down x-rays. The intern sits in the lounge entering data in a computer while the attending deals with the gunshot wound.
We doctor real people. Forget the radiology images. Throw out the simulator. Send the practice patient home. Sabotage the robot. Teach caring people how to be caring doctors.
Of the patient sitting right in front of us.
Shirie Leng, a former nurse, is an anesthesiologist who blogs at medicine for real.