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« The Spirit Is Willing | Main | Get That Man A Blog »

Lousy Bedside Manner?

I've never been as impressed by doctors as I'm supposed to be. It's a lot of work to get through medical school, but I've never seen much evidence that it requires a lot of intelligence, at least not as much as some would have you believe, and certainly not enough to justify the arrogance of many of the practitioners of the medical profession. I've seen too many medical screwups, and known too many (successful) pre-med students who didn't seem all that brilliant to me. I'll confess that I probably couldn't either get into med school, or through it, but not because I lack intelligence--it's because I lack the more important qualities--persistence (not to mention desire) and a good memory.

Anyway, this is preamble to linking to a column by Marjorie Williams, in which she puts her finger on something that's been bothering me about Howard Dean as well. He's an MD, with a manner to match. I agree with her that her thesis has great explanatory power.

Of course, I don't know if we can generalize this to all physicians. After all, Bill Frist has been a fairly successful politician, and as far as I can tell, his medical training doesn't seem to have harmed his career--he's one of the people to watch to replace Dubya in 2008.

[Update on Tuesday]

Galen, who runs a doctorblog, says that one reason that doctors won't admit error is fear of losing lawpractice suits. And congratulations to the new addition to the family and the planet (go to the main page and scroll down).

Posted by Rand Simberg at January 05, 2004 12:01 PM
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My wife is an RN and the amount of memorization it takes to work in the medical field is unbelievable. I'm with you Rand, I don't have the drive to take care of people or the memory to remember all the drugs, drug interactions, dieses, anatomy, etc. required to be a doctor. But having a good memory does not make you intelligent.

However almost all the Doctors I have ever met sure think they are more intelligent than the rest of us. One of them was so bad I had to tell him ?You may think you're smarter than I am, but you aren?t. You?re just more arrogant.?

Posted by Rocket Man Blog at January 5, 2004 12:14 PM

With today's computer technology, an expert system could largely handle the diagnostic process. Recently I had a serious ear infection -- using my symptoms as a starting point for some brief web research I was easily able to diagnose the problem and come up with a treatment plan. The only thing I was unable to do was to look into my own ear to see if I had a perforated eardrum, which was possible, although unlikely. And, needless to say, googling around for medical sites is hardly an expert system.

Of course, to actually GET treatment, I ended up in a local clinic, where after a three hour wait, the doctor spent all of 5 seconds looking into my ear and prescribed the exact medication that I had read about on the web, right down to the specific type, dosage, and duration of antibiotic.

Processes that are largely iterative and memory-oriented, such as medical diagnoses, are perfect for expert systems -- and at some point in the (far far distant) future when the AMA has a bit less clout, perhaps they'll actually be used to simplify getting treatment for a common condition.

Posted by Hermit Dave at January 5, 2004 01:02 PM

By some strange coincidence, my father and I were having a conversation on this very topic this afternoon. He was of the opinion that the aura of godlike infallibility and elitism that many doctors used to project is becoming increasingly transparent to the layman, precisely (as noted above) because of the Internet. Not so much because anyone with a browser can self-diagnose, as because people are becoming better informed on medical conditions, and can thus spot when doctors are overlooking or ignoring symptoms or making just plain stupid mistakes.

Then there is the constant flip-floppery on diet and the effects of common foods. When doctors swear up and down that you need to eat this and not eat that, and then next week exhort the public to do the opposite, or exhort people for decades to eat a carb-rich diet and then bemoan the "epidemic of obesity" that results, it's easy to conclude (rightly or wrongly) that they don't really know any more about what they're doing -- or possibly even less, given the complexity of the subject -- than professionals in other disciplines.

Posted by T.L. James at January 5, 2004 04:16 PM

I find that MD really stands for Master's Degree. I remember the Pre-med guys at Duke puting on airs about the requirements for entering medical school. I remember being stunned that the medical degree was only a masters adn not a PHD or even the equivalent) as these guys would like you to believe. I have a 5 year BSME from Dook, a 3 years M.Eng. from OSU, P.E. licences in 5 states and am a CEM and department head for a small engineering group (I am also working on my M. Div.) I, like many others in engineering, don't have but about half of the income these arrogant clowns bring in. Remember, if you've got it, it's because an engineer made it possible.

Posted by markbert at January 5, 2004 06:26 PM

Actually, M.D. stands for Doctor of Medicine, and in terms of the amount of work the student has to complete before being considered ready to practice medicine it is equivalent to a doctorate. The degree itself takes four years to earn, but an M.D. by itself doesn't qualify you to practice anywhere in the U.S- that takes another three to seven years of residency, depending on specialty.

I'm not arguing that doctors are more intelligent than other people, or that they're not arrogant- because many of them are. But I would argue that comparing a medical degree to a master's is not accurate, and that the amount of work required to achieve it is certainly comparable to what's required to earn a doctorate in other scientific fields. (IIRC, the average now is 5-7 years for a hard science Ph.D, depending on how well your thesis work goes)

Posted by Jeff Dougherty at January 5, 2004 08:35 PM

Her article hits the target. Dean is making these incredible statements and apparently no one is telling him to keep his mouth shut. This more than anything else will cause Dubya to win the election. It is the same old Liberal conceit that pervades New England that will cause this guy to lose. He thinks that because he comes from a "progressive" new england state, that is enough to win the election. Just look back at the 1988 campaign, M. Stanley Dukakis though that he could win the election based on his "Massachusetts Miracle". Boy was he wrong.

Posted by Pierce Barnard at January 5, 2004 09:09 PM

Not quite equivalent Jeff, Some of that time is spent in residency which is a time of gaining practical experience under the wing of an MD or in a hospital situation, but then so was the 4 years that I had to spend under the wing of a PE after graduating with my BSME so I could take the practical part of the P.E. test. The same si true with the CEM. During my career, I have known three gentlemen who bore both ME's and MD's. One was the PE under whose wing I served the other two worked for U.S. Surgical and Barden Instruments. All three claimed that the MD was the easier program.

I'm not knocking the medico's for having a bigger income than I or most other engineers, for that matter (sorry if it sounds like it). I do not have unique memnomic capabilities that an MD must have, but the superior creativity and problem solving ability that an engineer has is what has mad this world a better place. Those operating procedures would not be possible if not for engineers like the two I have mentioned.

Posted by markbert at January 6, 2004 11:14 AM

The hardest part of medicine in getting in. There is significant competition for the 15,000+ spots, but once you're in, it is difficult not to finish. There is still a tremendous amount of work, but it wasn't much more difficult than working plus undergraduate coursework. Those students persistent enough to make the cut don't have much problems finishing

Memorization skills are important, but there is a much greater emphasis on critical thinking skills than there used to be. With the increased use of things like PDA's, medical information is much more accessible, making memorization less important.

Most physicians are of above average intelligence, but aren't all at the far end of the bell curve, and are comprable to other graduate academic disciplines. While there are many arrogant physicians, I don't think this comprises the majority, and for God's sakes don't extrapolate Dean's persona to the rest of us. I don't think being a physician has any special bearing (plus or minus)on a political career, otherwise we would see a lot more of them.

Those who can do do. Those who can't do teach. Those who can't teach administrate. And I guess those who can't administrate go into politics...

Posted by Ben England at January 6, 2004 02:19 PM

Sherwin Nuland - a surgeon - wrote a tremendous book for the general public several years ago called "How We Die", and it describes just that.

In it, he says, and I paraphrase: surgeons are often wrong, but they're never uncertain.

Posted by John J. Coupal at January 7, 2004 07:33 AM

Q: What do you the call the man who graduates at the bottom of his medical school class?

A: Doctor.

Posted by Mike Earl at January 8, 2004 07:53 AM

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