Medical education has changed drastically over the years. As theories and practices continue to change, what was once standard 10 or 20 years ago has been replaced with newer ideologies, processes, or technology. It seems likely, then, that you may disagree with some of the things that you learned as medical school has evolved.
Medscape Medical News asked physicians what they learned in med school that they now contest. Many of their answers include newer philosophies and practice methods.
Treat Appropriately for Pain
Jacqui O'Kane, DO, a 2013 med school graduate, was taught to avoid prescribing controlled medications whenever possible.
"Initially this attitude made sense to me," says O'Kane, "but as I became an experienced physician — and patient — I saw the harm that such an attitude could cause. Patients on controlled medication long-term were often viewed as drug-seekers and treated as such, even if their regimen was largely regarded as appropriate. Likewise, those who could benefit from short-term controlled prescriptions were sometimes denied them because of their clinician's fear."
Today, O'Kane believes controlled medications should seldom be the first option for patients suffering pain, anxiety, or insomnia. But, she says, "they should remain on the table and without judgment for those who fail first-line treatment or for whom alternatives are contraindicated."
Amy Baxter, MD, believes that the amount of time spent on pain education in school needs to change.
"Doctors in the US get only 12 hours of pain education, and most of it is on pharmacology," says Baxter, who graduated from med school in 1995. "In addition to incorrect information on home opioids and addiction, I was left with the impression that medication could treat chronic pain. I now have a completely different understanding of pain as a whole-brain warning system. The goal shouldn't be pain-free, just more comfortable."
Practice Lifestyle and Preventive Medicine
Dolapo Babalola, MD, went to medical school eager to learn how to care for the human body and her family members' illnesses, such as the debilitating effects of arthritic pain and other chronic diseases.
"I was taught the pathology behind arthritic pain, symptoms, signs, and treatment — that it has a genetic component and is inevitable to avoid — but nothing about how to prevent it," says Babalola, a 2000 graduate.
Twenty years later, she discovered lifestyle medicine when she began to experience knee pain.
"I was introduced to the power of health restoration by discovering the root cause of diseases such as inflammation, hormonal imbalance, and insulin resistance due to poor lifestyle choices such as diet, inactivity, stress, inadequate sleep, and substance abuse," she says.
Adebisi Alli, DO, who graduated in 2011, remembers being taught to treat type 2 diabetes by delaying progression rather than aiming for remission. But today, "lifestyle-led, team-based approaches are steadily becoming a first prescription across medical training with the goal to put diabetes in remission," she says.
Patient Care Is at the Core of Medicine
Tracey O'Connell, MD, recalls her radiology residency in the early to mid-90s, when radiologists were integral to the healthcare team.
"We interacted with referrers and followed the course of patients' diseases," says O'Connell. "We knew patient histories, their stories. We were connected to other humans, doctors, nurses, teams, and the patients themselves."
But with the advent of picture archiving and communication systems, high-speed CT and MRI, digital radiography, and voice recognition, the practice of radiology has changed dramatically.
"There's no time to review or discuss cases anymore," she says. "Reports went from eloquent and articulate documents with lists of differential diagnoses to short checklists and templates. The whole field of patient care has become dehumanizing, exactly the opposite of what humans need."
Mache Seibel, MD, who graduated almost 50 years ago, agrees that patient care has lost its focus, to the detriment of patients.
"What I learned in medical school that is forgotten today is how to listen to patients, take a history, and do an examination using my hands and a stethoscope," says Seibel. "Today with technology and time constraints, the focus is too much on the symptom without context, ordering a test, and getting the EMR boxes filled out."
Physician, Heal Thyself
Priya Radhakrishnan, MD, remembers learning that a physician's well-being was their responsibility. "We now know that well-being is the health system's responsibility and that we need to diagnose ourselves and support each other, especially our trainees," says Radhakrishna. She graduated in 1992. "Destigmatizing mental health is essential to well-being."
Rachel Miller, MD, a 2009 med school graduate was taught that learning about healthcare systems and policy wasn't necessary. Miller says they learned that policy knowledge would come in time. "I currently disagree. It is vital to understand aspects of healthcare systems and policy. Not knowing these things has partly contributed to the pervasiveness of burnout among physicians and other healthcare providers."
Practice With Gender at the Forefront
Janice L. Werbinski, MD, an ob/gyn, and Elizabeth Anne Comen, MD, a breast cancer oncologist, remember when nearly all medical research was performed on the 140-lb White man. Doctors learned to treat patients through that male lens.
"The majority of the anatomy we saw in medical school was on a male figure," says Comen, author of All in Her Head,a HarperCollins book slated to release in February 2024. She graduated from med school in 2004. "The only time we saw anatomy for females was in the female reproductive system. That's changing for the better."
Werbinski chose a residency in obstetrics and gynecology in 1975 because she thought it was the only way she could serve female patients.
"I really thought that was the place for women's health," says Werbinski, co-chair of the American Medical Women's Association (AMWA) Sex & Gender Health Coalition.
"I am happy to say that significant awareness has grown since I graduated from medical school. I hope that when this question is asked of current medical students, they will be able to say that they know to practice with a sex- and gender-focused lens."
Talk About Racial Disparities
John McHugh, MD, an ob/gyn, recalls learning little about the social determinants of health when he attended med school over 30 years ago.
"We saw disparities in outcomes based on race and class but assumed that we would overcome them when we were in practice," says McHugh, an AMWA Action Coalition for Equity member. "We didn't understand the root causes of disparities and had never heard of concepts like epigenetics or weathering. I'm hopeful current research will help our understanding and today's medical students will serve a safer, healthier, and more equitable world."
Curtiland Deville, MD, an associate professor of radiation oncology, recalls having few conversations around race; racial disparities; and diversity, equity, and inclusion.
"When I went to medical school, it often felt like you weren't supposed to talk about the differences in race," says Deville, who graduated in 2005. But today, in the post-2020 era between COVID, in which health disparities got highlighted, and calls for racial justice took center stage, Deville says many of the things they didn't talk about have come to the forefront in our medical institutions.
Information at Your Fingertips
For Paru David, MD, a 1996 graduate, the most significant change is the amount of health and medical information available today. "Before, the information that was taught in medical school was obtained through textbooks or within journal articles," says David.
"Now, we have databases of information. The key to success is being able to navigate the information available to us, digest it with a keen eye, and then apply it to patient care in a timely manner."
Ana Gascon Ivey is a health and medical writer based in Savannah. She also teaches creative writing at a men's correctional facility.
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