Our Diminishing Resources

In the closing statement of his last lecture to my graduating class, the late Ludwig Eichna, M.D., then chair of the Department of Medicine at Downstate Medical School, told us  that 50% of what we had learned in the preceding 4 years would be proved wrong in 10 years.  He was too conservative:  more than 50% proved to be wrong and the timeframe was half of what he predicted.

Medical school graduates move through their internships, residencies and fellowships and,  like fish wrenched from the ocean,  lose their freshness and even begin to smell. They practice with the skills they acquired in their training. They apply the principles they learned early in their careers. They receive their continuing medical education ("CME") from programs sponsored by hospitals (often directly or indirectly funded by pharmaceutical companies), not-for-profit or for-profit educational companies (which may be funded directly or indirectly by pharmaceutical companies or similar vendors), and become focused on common medical problems which present no great intellectual challenge. Like those ocean fish, their eyes glaze over and they lose their enthusiasm and skills for anything other than simple non-taxing straightforward cases for which they have had hours of lectures telling them which pharmaceutical product to prescribe that day (without recognizing that the courses they have had were really intended to push a commercial "cure" or "maintenance medication" for the problem they were dealing with in their 10 minute patient visits). I should be clear: there are legitimate continuing medical education courses, but they are often not as convenient in terms of location, access and time requirements, as the commercially-sponsored programs, though some publications (i.e., the New England Journal of Medicine and The Medical Letter) do provide CME through internet or other available access.

Enthusiasm from investors and IT personnel aside, computer diagnosis programs are not much help to physicians who never had or have lost,  or don't have the time,  to exercise the skills in history-taking they may have once learned.  Computer diagnosis programs don't provide help to physicians who have lost, or never had, adequate skills in physical diagnosis.  Lab tests may mislead physicians through false positives and false negatives, causing unnecessary additional testing and procedures which add not only cost to our system, but expose patients to inappropriate and unnecessary risks. X-rays and CT scans expose patients to potentially high doses of ionizing radiation

Many states have mandatory continuing medical education requirements, meaning that some physicians get at least 25 hours of dozing a year as the lights in auditoriums are turned-down for PowerPoint programs of the day, provided to the speaker by a pharmaceutical company or device manufacturer with the expectation that their investments will generate increased sales of their products.

Health Care Reform will require an up-to-date, well-trained, physician force whose competency is continuously upgraded.  Is there anything that you have heard from the President or Congress which will deal with these issues? Is there a line-item in the health care reform budget for updating and upgrading physicians' knowledge bases? Is anyone thinking about training 20th century doctors to take care of 21st century patients?