I Propose a Toast

I propose a toast to all of those healthcare educators who find time some how, to incorporate some elements of life beyond medicine, into their curricula / courses

I recently experienced a first in my 50+ years of teaching. I received some negative student evaluations because at sometime in my teaching I talked about such topics as the conditions surrounding the influenza epidemic of the early twentieth century; the genome project of the later 20th century; the political conditions historically, that helped mold ethical thinking of today; the historic relationships between religious thinking and the world of science and medicine; the famine conditions that existed during the great depression of the mid-twentieth century. Their comments echoed similar comments regarding their application process. They saw no reason why during their application process interview they were asked what they liked to read, if anything, other than their school related texts.

They did not see the need to talk about anything that would most probably not be represented on their PANCE exam (the national certification exam for Physician Assistants). They came to school to learn: how to diagnose a pheochromocytoma; how to evaluate an Achilles tendon tear; when to prescribe a decongestant and or antibiotic; how to help in the removal of a tumor; how to sew up the laceration from the fishing hook; or does Prozac have greater efficacy than Paxil. This is all they wanted to know.

We know that medicine is in constant flux. We are constantly encountering new technology, more and newer medicines, more and newer instrumentation, and more information in general. It seems as if the curriculum is swelling. We have expanded nutrition and behavior in medical education. We have added genetics in medical education. We have, in many cases, introduced Complimentary/Alternative Medicine, so as to give students some insight into healing practices that are quite ancient and "foreign” to many of us.

The question would be then "how could we be adding material not directly related to the practice of patient care?” Perhaps one answer is that many of the newer, changing elements of medical education are not those of adding but more involved in replacing. Medical applicants seem to be getting younger, with less worldly exposure. They appear to be less aware of history and the events that have helped shape our present and future times. In addition we see more people moving from culture to culture and doing it more frequently. It seems as if it would be to the advantage of the practitioner to have a more global perspective and understanding of ”peoples” and events effecting "peoples.”

It is quite possible today, to see a patient who perhaps up to the first time he entered our office, was used to being treated by homemade, herbal medicines only; or the sole application of acupuncture, no matter what the original complaint or subsequent diagnosis was. Or a patient whose life revolves around reading; or is quite focused on a religious existence; or perhaps void of any education as we know it; or is struggling to make a transition from one culture to another or from one political system to another.

There was a time when you practiced medicine in a particular community, be it private office practice or a professional center such as a clinic or hospital, the chances were that the bulk of the patient load was quite homogeneous culturally, ethnically, racially, and/or economically

The point being that our patient spectrum is getting broader and much more representative of an extremely varied background and set of life experiences. Wouldn’t it enhance the relationship of the practitioner with the patient if the practitioner had a broader perspective on life?

All too often we hear the student who is studying medicine (be it physician, nurse, or physician assistant, etc.) saying, "I don’t have the time to listen to the news,” or "I can’t watch a newscast because I have to study.” Too frequently we hear a student saying, "if I have the time to be reading that book, I should be spending it with Harrison’s Principles of Internal Medicine or Gray’s Anatomy or Guyton’s Physiology.” Are we doing a student a service when we create an atmosphere that could prohibit the mind from opening up further? Is this analogous to the coach who wants his player to participate in one sport only, all year around, thus creating the potential for overuse injury? Is it possible that there can be excessive conditioning to just one set of neurons in the brain?

Many years ago it was almost unheard of to be a pre-medical undergraduate student and not majoring in one natural science and most probably minoring in another, e.g. a major in Biology with a minor in Chemistry. Then a wave swept across medical schools’ admissions people and they started accepting non-science majors such as history or literature. Yes, they still had to have specific undergraduate science courses, but the recognition of wanting a more "well rounded” candidate started to take hold. As educators, even in such a highly sophisticated set of courses such as medicine, shouldn’t we want to foster and nourish a well rounded practitioner?

More and more we see practitioners getting involved in government and politics. More and more we see practitioners, by necessity, getting involved in the business end of medical practice, in addition to their personal business needs. More and more practitioners get involved in legal issues. The point being that in today’s world, clinicians should be more exposed to some degree of relevant historic background and some degree of cultural and ethnic differences, for more effective practitioner-patient relationships and better medicine. In addition, isn’t it possible that there are aspects of broader exposures that can enhance the practitioner’s personal and practical elements in practicing medicine?

I firmly believe the more eclectic the practitioner can become, the greater appeal he/she would have towards the patient. I applaud those educators who are willing to take a step beyond their "assigned data” and syllabus objectives. I propose a toast!


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