Thursday, February 28, 2013

Medicine is a biologic AND social science

 I'm embarrassed to admit but I had cliched notions of why I wanted to be a doctor in my formative teenage years. Get ready to cringe folks.

" I want to help people! "
" I love science! " 

I decided to major in Biology as an undergraduate because I believed medicine was primarily about biology.
I did the bare minimum liberal arts courses as an 18 and 19 year old. A little bit of economics, a little bit of European history, a little bit of English and a little bit of philosophy. I didn't take any courses in law, ethics, psychology and anthropology. I didn't appreciate its value and moved on to medical school with the goal of helping people, utilizing my expertise in this biologic science.

Despite medical school and residency programs' feeble attempts at educating trainees on taking care of the "whole" patient,  most young doctors today cling to the notion that medicine is primarily a biologic science.This is despite the fact that we have young doctors with many different degrees and backgrounds. I've seen this manifest in many ways.

I've spoken to many medical students to ascertain some of the motivations behind their impending career choices. Many choose careers in surgical specialties because of their love of the surgery itself and its hands on approach to managing disease. I've had students tell me they've pursued certain career paths because they are more comfortable in fields that put less emphasis on patient contact. Even in my own field of Internal Medicine, students seem to love the academic discussion on disease diagnosis and management. No matter what field they choose, there seems to always be an underlying appreciation for the life science aspect of disease.

With post-graduate trainees (residents) the story is similar. Many are choosing sub specialty fields because of their appreciation for the specific subset of diseases they get to manage. Even those staying in internal medicine, are largely choosing hospitalist careers for many reasons including an interest in managing the acutely ill. I've come to the conclusion, a common fundamental thread in career decision making is that same trite statement and assumption I started my own career with; " I love science. "

But medicine is not just a biologic science. The concept of treating the "whole patient" simply means medicine  is both a biologic and social science. But our training and attitudes don't reflect that. I often hear students and residents mention an aversion to the "social " issues of a patient. It has become largely acceptable for specialists to let hospitalists and primary care physicians handle the "social" issues. Even hospitalists will sometimes defer social issues to their outpatient counterparts.

This cynic will look at this and call it "dumping." No matter the perspective, neglecting the social sciences aspect of patient care is simply incomplete bad medicine.

How do we change this?
For starters, we need to change the image of medicine as a field for life science lovers. We need people that also love the human aspect of disease.

 Secondly, we need to value social sciences education when we assess potential for medical school.  I think we are already trying to do this. But despite our subjective efforts to  identify well rounded students, the objective admission criteria is weighted heavily towards basic sciences grades and MCATS.

Thirdly, medical schools need to incorporate the social sciences in their curriculum to further augment skills to be a complete physician. I would even advocate for more flexible curriculums that allow medical students to get dual degrees such as an MD + (JD or MBA or MPH).   This would also be the pipeline where all our physician leaders would eventually come from.

 Finally, education in post graduate training  needs to emphasize the importance of a patient's social situation and how it relates to clinical outcomes. Concept's like the " Patient Centered Medical Home" and "Team Based Care" utilize concepts from the social sciences to improve the way healthcare is delivered. Residencies need to teach this, and accreditation bodies should look for expertise in such things before giving the green light to practice medicine independently.

I realize I'm advocating for something I didn't have. It just means instead of doing the usual Internal Medicine CME stuff, I'll be getting in touch with my liberal arts side to continue to become a better physician.

New York Med, Non traditional path to medicine


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