What can we do to educate our doctors?

Question

Dictionaries define the word ’doctor’ as ‘learned’, ‘teacher’, ‘most highly qualified’ etc. However, at least in our country, doctors are among the most ignorant. It may be natural for a doctor not to know much about hydro-geology. It may be possible for him not to be aware of the latest breakthroughs in astro-physics. But for a doctor not know much about Medicine, or not to be aware of the developments in his specialty is not only untenable, but also dangerous and criminal. Yet, there are thousands of doctors in our country who do not know much about Medicine, as it is practised today. Most of these doctors, it will be surprising to know, are very busy practitioners. I personally know of professors of Medicine who advise patients of Rheumatoid Arthritis to get Ayurvedic help since there is no drug in Modern Medicine (still erroneously and unfortunately called Allopathy, meaning “approximate”) for this disease. This is when even the most basic of textbooks of Medicine has a few pages discussing the drugs available for the treatment of this disease. Of course, the treatment of Rheumatoid Arthritis, like that of most other medical illnesses, is developing and improving continually.

“Harrison’s Principles of Internal Medicine”, the most trusted and respected resource on General Medicine all over the world, says, “Medicine is an ever-changing science.” It is estimated that about 50% of the medical knowledge is replaced by new, scientifically researched, proven and more robust information every ten years. This would mean that a person who qualified ten years ago and since has not tried to update his knowledge is 50% outdated. He may be more dangerous than the diseases that he treats!

One important contribution for ignorant doctors come from private medical colleges. People purchase their degrees from these business institutions. Not much is taught or learned in most of these places.

Paradoxically, it is frequently a blessing for a doctor not to know much. If one knows enough and well, relevant differential diagnoses (the other likely possibilities that must be excluded) will come to the mind when seeing a patient. It may make investigating and treating rather difficult, given the peculiar milieu of our country.

It is important to introduce new legislation that makes it compulsory for doctors to renew their license every year after passing an examination designed to prove that their medical knowledge is up-to-date. It is unclear why the Government are reluctant to make any move in this direction, though one can make a few guesses.

Please note that this querry relates specifically to the situation in India. I know that most of what is discussed here do not apply to many other countries, especially the U.S and the U.K.

Well, I am post-graduate physician, presently working as a registrar in Cardiology.

Medicine is not a failure! We have eliminated a few dreadful diseases, small pox being a notable example. We strive to eradicate more diseases, but then to this end, we need a fuller participation of the wider society, internationally. Today, people live longer, and the quality of life has significantly increased. Today, diseases get diagnosed and treated whereas in the past, people used to die from poorly understood and mostly untreated conditions loosely termed “consumption”. Health is the state of complete physical, mental, social and spiritual well being, and not just the lack of bodily sickness or infirmity. The physician mostly takes care of the physical derangement. Of course, a fully evolved system of Medicine should address the other aspects of ailments. We already have Community Medicine that takes care of preventive aspects of Medicine. Escalating health care costs, obesity, diabetes, the HIV pandemic etc. are symptoms of a much more devastating and emergent social disease.

Answer 1

Medicine has been an enormous failure in so many ways. What else can you think of that has hyper-inflation year after year and produces very little for the increase in cost.
People are obese, unhealthy, and sick. Medical care costs ten times more now than it did only 15 years ago, but our life expetancy hasn't changed by any measurable amount, and in fact may be declining. Many think that today's children my be the first generation to die at a younger age than their parents.
Medicine hasn't cured anything in 50 years. We still have cancer, diabetes, aids, herpes, influenza, autism, pneumonia, and many other horrible diseases and at HIGHER rates than they were a generation ago. Our treatments for many of these diseases cost tens of thousands of dollars a year (if not a month) and have not increased our life in terms of years or quality. There is no prevention, only bandaids and pills. There is no cure, only tests and more tests.
Healthcare is indeed a failure, unless you are one of those getting rich from it.

Answer 2

You raise some VERY good points doctor.
[And answerer "PS" raised my eyebrows]
1st - there is repeat testing for medical boards in the US though not every year - that would be a bit much to expect.
2nd - medicine has cured some diseases over the past fifty years - most notably SOME forms of cancer (ask Lance Armstrong). Unfortunately the kinds of cancer and leukemia that can be cured are relatively infrequent compared to incurable cancers such as advanced lung cancers which are predominately due to smoking. Doctors don't cause smoking.
3rd - Obesity in America and elsewhere cannot be blamed on uneducated doctors. People need to help us help them.
4th - You are correct that knowledge of differential diagnoses can lead to more testing. More testing costs more. We have many new tests and treatments which are very expensive. The successful cure of Lance Armstrong's widely metastatic malignancy would have been very expensive, but without it he would be dead today. How much is a human life worth?
5th - You know the answer to the question about legislation. The doctor lobby is a strong one, but I'd venture to say that the insurance company and pharmaceutical lobbies are even stronger. The "people lobby" diminishes in comparison.
Lastly - When I was a practicing cancer and leukemia specialist working very long hours, I still made sure to spend an hour a day with journals to keep up with the latest. I always did my paperwork immediately which takes more time actually than the patient care does. The result is that I burned out after 13 years of practice (after 13 years to get board certified in my specialties in the first place). There are only so many hours in the day. It is very difficult to be all knowing and always available. It can mean you have no life. Heck, I didn't even make a lot of money since many of the people I saw could not pay. You can decide not to put braces on a patient's teeth when they have no money to pay, but you cannot refuse to treat a life threatening leukemia or cancer for that reason - at least I could or would not turn any patient away for poor finances. There are doctors who try. I have known others like me who have burned out trying too hard.

Answer 3

WOW! I am inclined to think either you are not satisfied with the course you've taken or you got disappointed with the medical field .must have been a serious reason for you to deduce such. Although, I agree with you that "doctoring' doesn't end really upon obtaining one's license.Not everyone who passes the medical licensure exams goes into residency.Some just become General Practitioners.Whether one does either, a doctor should be updated at all times. Medicine is really a dynamic science. What may be true now might be false tomorrow. Many things have already changed;be it for the best or worst , such that if a doctor is really not updated,surely, it's the patient that suffers as you've pointed out.Here in the Philippines,for instance, we can still see General Practitioners giving IM injections in the clinic when in fact, it was long ago discouraged.Giving IM injections in the "hip area" to children are also still being done by some .A continuing medical education is what is really needed whether one is a general practitioner or a specialist.The Philippine Regulation Commission which regulates all profession except for lawyers requires a certain number of CME units before renewal of license i.e. every 3 years. Each subspecialty society also requires their members certain number of units also before being considered a member in good standing. A certificate on this is required by some agencies before becoming an accredited physician. I think these activities allows one to become in touch with what is going on around and update or review ones knowledge.A good doctor also needs to attend more scientific meetings, convention to enhance personal professional growth.
To my fellow colleagues in the medical field,i guess it's time to grow professionally. Patient's look up at us and give all their trust to us in case of illness. Let's go back to the old practice of "patient's first before anything else".Money will follow..

Answer 4

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Answer 5

Been to med school, have you? (ETA: apparently he has.)

Thought not.

I am willing to be as noisy as you like regarding doctors who espouse such nonsense as aruveydic practice. Or homeopathy, or acupuncture, or ay other pseudoscientific mumbo-jumbo you like. It's bunkum. Horsefeathers. Bull puckey. Does that help?

I happen not to go to a private medical school, but I am not aware that the curriculum varies significantly from the public university I do attend. The idea that students at *any* medical school "purchase" their diplomas does not bear scrutiny. There are standardized exams every year or so that every medical student must take and pass to remain in medical school. Are you aware that these exist?

I am all too aware that there is much that I do not know, and even more aware that there is more being discovered every day. Sorting through new discoveries in any one given field is a career in itself.

Renewing one's license every year is probably impractical. The examining boards alone would preclude it. However, your dialectic would seem to indicate that you believe that doctors never requalify. This is simply not true. They must, if they wish to remain certified, and regularly.

I own a copy of Harrison's. I consult it frequently. Have you read any of it beyond your quote? (ETA: Probably he has.)

I understand that your mind is unlikely to be changed by what you will undoubtedly see as the defensive rantings of an oversensitive medical student. However, any others who may be unfortunate enough to happen by should know this. Nothing that anyone like this can say can make me any less proud of the profession I have chosen to pursue. No such lies or disrespect can make me any less determined to do the best I can by my future patients. And no self-satisfied, priggish diatribe by someone who has clearly been educated beyond his ability to comprehend can possibly make the practice of medicine any less important to those who are ill.

If you think so much is wrong with the current system--and I am far from defending the peculiar mix of insurance and misinformation that does seem to permeate this country--then I suggest you get off your *** and help change it. (ETA: Wrong country, apparently.)

You know--like my classmates and me. The ones actually doing the work.

Answer 6

In the USA, education requirements vary from state to state but most require relicensure on a two to four year basis. With the application for renewal the physician must certify that he or she has completed continuing medical education courses (CME), roughly 50 hours (or credits) per year. Most specialty boards require a re-certification exam every 7 to ten years. In addition to being challenging, it is also expensive to take, both in exam fees and time lost to prepare. Many hospitals require board certification for staff membership and many HMO's and PPO's require it also. And for the cynics out there, many of us want the public to be aware of our qualifications.

As to the increasing costs of health care, look first at managed care where 20% of health care dollars go to administrative costs and top executives earn salaries above $30 million per year. Additionally, the ever increasing standard of care drives up the cost. Finally, you require seven to ten years (including residency and fellowship) of intensive post college education, so you must expect that a person who has accomplished this ordeal will expect compensation.

Answer 7

can't. Medical doctors follow a protocol and are based on patients having same symptoms being treated repeatelly most of the cases. each pt is treated differently but with same protocol.