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When I hear medical school deans rushing to reform
curriculum in order to adapt to the changes in medical practice they see
coming, I fear for the unintended consequences. We don’t have a very good track
record in health care reform. Nearly everything government has done to improve health
care and reduce cost has had the opposite effect.
Yes, the insured fee for service system needs to
change, but preparing our young doctors to work for a salary under
institutional guidelines opens the flood gates for a limitless influx of
unscrupulous health care entrepreneurs. The physician of tomorrow might better
look to organized medicine, group practice and a leadership role healthcare design.
Instead of preparing medical students for electronic
health records and best evidence algorithms, we should focus on genomics,
proteomics, artificial intelligence and the humanities. (public-health poverty
and nutrition)
Should we want to educate our young doctors as a feldsher[1] or
as a scientist trained to lead us into the era of the genome?
I would hope that an evolution of the curriculum could focus
on genomics, humanity and the underlying science of statistics and the computer.
One might also consider extending medical school a year or two longer in order to
explore the clinical applications of genomics and the related science, awarding
a PhD for credible contributions in these applications. Doing so would give the
young physician the credentials to lead the profession as well as patient care and community health.
The Civitas
Hippocratica in Salerno, Italy 900 AD required 5 years of medical school.
The graduate was awarded a ring, a laurel wreath, a book and a kiss. By 1158 UNIBO in Bologna, Italy required 6 years
and until recent times awarded the PhD. Students were protected by law from all
political and religious interference.[2] We
should do so well.
Free enterprise has no place in medical practice; it
has replaced compassion with greed. We sense this intuitively but the
reasons are elusive. Politicians impose a lassie-fare
philosophy with a religious fervor. Health care is not a free market, and with
insurance there is no competition and no restraint; Insured fee for service
effectively creates a monopoly subject only to a token proof of necessity. Our
medical graduates need to stand tall and lead with overwhelming competence.
[1] Feldscher (Gr.) a health care professional who provides
various medical services in the Russian Federation and other countries of the
former Soviet Union, mainly in rural areas.
[2] 1158 Frederick I Barbarossa promulgated a
Constitutio Habita, establishing that every school be established as a
"societas di socii" (group of students) overseen by a master
(dominus) remunerated by the sums paid to him by the students. The Empire
undertook to protect scholars travelling for the purpose of study from the
intrusion of all political authorities
