Wait a minute... Im a doctor and I disagree with this.
> They put the students through hell because that's what they had to go through...
True. But the reason is that it toughens you up and winnows the wheat from the proverbial chaff. The forced marches through the wards at 2am in the morning prepare the budding doctor for the real world where he can be called upon as say, the sole doctor for miles in a rural area to attend to a mass casualty event.
>In most other countries, doctors don't have an accreditation board. ...
I do not know of any country that does not have an accreditation board. The difference between countries is the process of accreditation. Sometimes it is direct: the student takes centralized a board exam; sometimes indirect: the student takes a uni exam approved/supervised by the board.
> it doesn't require years of school to set a bone or put in some stitches
Maybe. But it requires erudition and experience to anticipate that a poorly set bone can heal with complications(malunion, non-union,infection etc.)
Fun fact: when Admiral Nelson was wounded in the battle of Santa Cruz de Tenerife in 1797 field surgeons had his arm amputated but mistakenly trapped his nerve in a ligature that caused him great pain until the mistake was corrected )
> it doesn't require years of school ...(to) diagnose the flu or pneumonia
That pov is exactly how people get misdiagnosed and killed (by quacks).
There are many different diseases that present alike and even subgroups of the same diseases that have different management regimes.
While it may seem obvious for instance, that a patient has pneumonia, one would also do well to ask what kind of pneumonia he has, why he has it (immunocompromise?, zoonosis?) and what the alternatives could be( the differential diagnosis). More than once has "ordinary pneumonia" been found to be lung cancer.
It takes years of post graduate training and practice to become proficient enough to identify different disease conditions and manage them with confidence.
Medical school hazing is not done because the seniors are sadists. Some aspects of the process could be improved but the rigor works and makes for good doctors.
> The forced marches through the wards at 2am in the morning prepare the budding doctor for the real world where he can be called upon as say, the sole doctor for miles in a rural area to attend to a mass casualty event.
When has that happened to you, or anybody you've known?
> There are many different diseases that present alike and even subgroups of the same diseases that have different management regimes.
Sure, how frequent is that?
My point is that we're training doctors like they have to be Navy Seals, equipped and prepared for every situation, whereas in real life, a grunt with 3 months paramedic training would be up for the task.
> When has that happened to you, or anybody you've known?
Are you kidding me?
I practiced medicine until 8 months ago when I burned out and had to take a break. One of the cases I recall having on an offshore medical center, involved 4 victims who had suffered burns(in one case over 80% of his body surface area), on a night when I had 2 other patients on admission. It easily took my team of four 5 hours to stabilize the patients and have them evacuated by helicopter.
In 2014, the oil company we subcontracted for had an incident where over 90 people suffered acute food poisoning from eating dinner at the staff canteen. This was a bacillus cereus infection with vomitting and stooling. Dont attempt to imagine that number of sick patients. There were only 2 doctors and five nurses initially to manage the incident. I could tell you war stories all day so could many other doctors.
In these incidents, how many times did you have to reach on your advanced medical training instead of the basic ones to treat burn wounds and fix food poisoning?
How was any aspect of your job improved by your years of medical school, your years of residency?
Would you rather have more less trained doctors, or fewer elite doctors in those circumstances?
Its difficult to explain to lay people (and I in all honesty do not mean to be condescending) but even in the "simplest" of cases a doctor is called upon to draw on advanced skills and concepts he may not even remember he has.
People fail out of the profession at various levels. A classmate of mine fled in the second year during her first dissection of a cadavar, never to return, some make it to residncy then quit. Certainly we should be vigilant and catch students before they become suicidal. But really, the practice of medicine requires a certain temperament. Some people are built for it and others are not.
> Would you rather have more less trained doctors, or fewer elite doctors in those circumstances?*
Unfortunately there is no middle ground. A doctor is either capable or he/she is not. We simply cant train them halfway. There are countries that have carried out the experiment you propose and attempt to train doctors to 'adequate' levels. The results are not good.
> but even in the "simplest" of cases a doctor is called upon to draw on advanced skills and concepts he may not even remember he has.
But how often does that occur? And is it worth the economic cost of not having doctors available, or doctors overworked? Individual human life is cheap.
>A doctor is either capable or he/she is not. We simply cant train them halfway. There are countries that have carried out the experiment you propose and attempt to train doctors to 'adequate' levels.
Do you have a source? I'd be quite interested in reading it. And the phrase "either <x> is capable or either he/she is not" can be applied to any other profession.
> But how often does that occur? And is it worth the economic cost of not having doctors available, or doctors overworked? Individual human life is cheap.
As someone currently in medical school, I'm going to have to agree w/ the previous comment that often "simple" cases are not so simple. For dealing with something as simple as diarrhea, you have to understand the anatomy of the GI tract, the physiology of nutrient absorption, pathophysiology of different diseases, important details about infectious causes (i.e. toxins, mech of transmission, etc.), labs, clinical presentation, associated phys/pathophys like neurological, immunological, and hematological features, associated symptoms, common patient histories, drugs and their mechanisms of actions, etc. etc. etc. The sheer volume of knowledge that you need to know and how everything fits together is something I hadn't realized before coming to med school. Plus, you have to learn clinical skills like how to take a patient history, do a physical exam, etc. all of which is only for treatment of diarrhea. Now imagine learning all of this for topics as wide ranging as all the different cancers, heart failure, emphysema, diabetes, all the different congenital defects, etc. You also have to know how to read radiology, how to intubate, draw blood, perform disease-specific tests, maybe learn how to do surgery, etc. Anyway, the point is it takes a lot of skills and concepts for a fully trained doctor to work up simple things.
> For dealing with something as simple as diarrhea, you have to understand the anatomy of the GI tract...
You don't have to understand it. You can say "Hey, usually when you take this pill things get better" or "Just keep him hydrated with a water/salt/sugar mixture, and these things generally take care of themselves."
Human life is cheap. There are 7 billion of us. Why are we optimizing for the very few to reduce medical care for the masses?
I think this is the main point I and the other commenters are trying to explain. You do have to understand it. Imagine someone coming and telling you your software job is better done by overseas contractors - they're less efficient and cheaper so you naturally must be overpaid.
Except that ignores the many ways in which your training might make your higher cost worthwhile.
> Why are we optimizing for the very few to reduce medical care for the masses?
Are you implying there's a concerted effort to deny care? With the proliferation of nurse practitioners and physicians assistants, we're broadening the range of people who can take care of our population. Overseas, groups like Partners in Health are training community members to offer care in order to fill in gaps in health care availability.
Sorry to take this to its extreme, but I think you're proposing the idea of the marketplace finding the optimum amount of training for caregivers. As a point of opinion, this kind of system would be far more disadvantageous for society's less powerful than what we have now.
Would you prefer to go to a medical office with your kid presenting a serious condition and get a paramedic who doesn't know what to do outside of his protocols?
I'd prefer to go to a medical office without taking out a loan. If the choice is mortaging my house to get an elite doctor to check something out or paying a reasonable fee for somebody who would probably do just as good a job, or escalate it if he was over his head, I'm going for the second every time.
I'm not sure how you can prove what you're saying. It sounds a lot like someone seeing an app/website and thinking, "I could do that in no time."
The scope of what a paramedic does and what a doctor does are totally different. The way medical care is organized capitalizes on each person's training: paramedics stabilize and transport patients; nurses carry out treatment plans; and doctors create treatment plans.
It sounds like you're saying, just because we don't always need to use an efficient algorithm all the time, we should never be trained to use efficient algorithms. This could make sense in the context of the next Rails app, but, when your life is at stake, the extra training matters.
> When has that happened to you, or anybody you've known?
In the state I grew up in, there were only three pediatric psychiatrists for multiple millions of citizens. If a doctor's training confers the ability to affect hundreds of children's lives, I definitely want them to be as knowledgeable of their area of practice as possible.
> the sole doctor for miles in a rural area to attend to a mass casualty event.
Seems like the issue is not a lot of doctors in the area. While we can't test this easily, wouldn't reducing the forced marches give more people incentive to join the profession? Then you have more doctors, better coverage and people scheduled to be on call for this.
Essentially, where's the balance between few superheroes who survived and a large number of doctors who are just pretty good.
> but the rigor works and makes for good doctors.
You're commenting on an article which talks about medical students being suicidal. And I know of 2 local doctors actually going through with that. That's not my definition of "good".
> They put the students through hell because that's what they had to go through...
True. But the reason is that it toughens you up and winnows the wheat from the proverbial chaff. The forced marches through the wards at 2am in the morning prepare the budding doctor for the real world where he can be called upon as say, the sole doctor for miles in a rural area to attend to a mass casualty event.
>In most other countries, doctors don't have an accreditation board. ...
I do not know of any country that does not have an accreditation board. The difference between countries is the process of accreditation. Sometimes it is direct: the student takes centralized a board exam; sometimes indirect: the student takes a uni exam approved/supervised by the board.
> it doesn't require years of school to set a bone or put in some stitches
Maybe. But it requires erudition and experience to anticipate that a poorly set bone can heal with complications(malunion, non-union,infection etc.) Fun fact: when Admiral Nelson was wounded in the battle of Santa Cruz de Tenerife in 1797 field surgeons had his arm amputated but mistakenly trapped his nerve in a ligature that caused him great pain until the mistake was corrected )
> it doesn't require years of school ...(to) diagnose the flu or pneumonia
That pov is exactly how people get misdiagnosed and killed (by quacks).
There are many different diseases that present alike and even subgroups of the same diseases that have different management regimes. While it may seem obvious for instance, that a patient has pneumonia, one would also do well to ask what kind of pneumonia he has, why he has it (immunocompromise?, zoonosis?) and what the alternatives could be( the differential diagnosis). More than once has "ordinary pneumonia" been found to be lung cancer. It takes years of post graduate training and practice to become proficient enough to identify different disease conditions and manage them with confidence.
Medical school hazing is not done because the seniors are sadists. Some aspects of the process could be improved but the rigor works and makes for good doctors.