Fix medical education…but don’t mess with specialty choice

Fix medical education

I could not agree more with Dr. Susman’s commentary regarding the current state of medical education (“Where medical education goes wrong” (Editorial, J Fam Pract. 2012;61:382-383). What we really need today is a physician who can actually communicate with patients instead of worrying about a lab result or an obscure diagnosis.

I have been a primary care physician for 20+ years. I also have a master’s in public health (epidemiology), and this has served me more than my actual medical degree in regard to patient communication.

Competencies are great for those who plan our education. But they are useless, in my opinion, in measuring our ability to function efficiently in everyday clinical practice.

I agree with Dr. Susman’s assertion that we need to emphasize the social sciences, communication skills, and basic statistical concepts (the why and not the how). As many wise physicians have observed, most astute clinicians can come up with the correct diagnosis the majority of the time by listening to patients and asking the right questions—usually within the first 5 minutes of the clinical encounter.

If we’re unable to communicate effectively with patients, all the training in the world won’t help. Let’s start focusing our limited resources on the basics of medical education, which will serve us (and our patients) better in years to come.

Marcelo Perez-Montes, MD, MPH
Wilmington, NC

… but don’t mess with specialty choice

While I respect Dr. Susman’s motivation for writing “Where medical education goes wrong,” a heavy-handed interference with a student’s career path is anathema to a free society. I am surprised that he would suggest such a thing.

Physicians are not society’s chattel.

I realize Dr. Susman was trying to “stir the pot,” but words are dangerous. Health and Human Services Secretary Kathleen Sebelius may take you seriously and, once again, initiate a program that is unproven (think Accountable Care Organizations), adds little to quality (EHRs), worsens efficiency while providing no savings (prior authorization), interferes with the patient-physician relationship (patient-centered medical homes, adversarial chart review, etc.), and further restricts the noble profession we have been so lucky to join.

Would you like an academician or editor directing—and restricting—your career? God knows where physicians in training will end up. I sure don’t, and neither do you, or some well-intentioned medical board. Ultimately, we need to discern only one thing in applicants to medical school: Do they care deeply?

Keeping altruism alive in medical students is the essential first step in improving medicine. It always has been and always will be our greatest professional asset.

Kevin Kelleher, MD
Roanoke, Va