Agag and the Amelekites are not common household subjects of discussion, but there is a lesson to be learned from their biblical history. Agag was the title of Amalek king(s) and his people, the Amelekites picked off, robbed and murdered the elderly, infirm, and weak stragglers among the Israelites. For their ruthlessness, cruelty and haughtiness, the Amelekites - in turn - were later slaughtered.by the Israelites.
The lesson taught with respect to the Amelekites has application to our health system. As insurers, health systems and providers abandon their responsibility to care for the elderly, infirm, weak and those who cannot defend themselves, they may provoke society to punish them (and those who accept their support in order to fund their election campaigns) for their ruthlessness, greed, cynicism, arrogance and cruelty.
Have we created our medical schools, licensed our practitioners, created non-profit health systems, provided franchises for insurance companies, and subsidized all of these institutions so that an injured person who is brought to a hospital emergency department writhing in pain may be told by the physician consultant called by the ER that he will not render care to this unfortunate person because he doesn't accept that person's insurance? Is Agag still walking among us and setting the standards for our health system?
Showing posts with label Medical School. Show all posts
Showing posts with label Medical School. Show all posts
Sunday, March 27, 2011
Monday, September 21, 2009
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?
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?
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