by Several years ago, I had the pleasure and the honor to teach the humanitarian side of Public Health policy at a major, East Coast, medical school. My students were talented, trained, gifted, and unbelievably strong and well-educated.
The School of Public Health wanted their students to have a more rounded world view. The head of the program was concerned his students were too centered on logic and statistics and book learning and that they weren’t focusing enough on the human side of medicine.
I was delighted to help. The sole instruction from my department Chair was to “take off the sharp edges” from my hardened and inflexible — “The World Is Black and White” students — and help make them find a way to sense a little more grey in the universe and to facilitate their hidden wants to add a little more flexibility and free-thinking to their view of serving the public.
My classes were a tremendous success. The students excelled beyond my brightest expectations. The department head and Chair were thrilled.
Unfortunately, my classes were small. To really make a “humanities effort in Public Health” you need to make the course a mandatory part of the training.
As it stood, my course was merely an “encouraged elective” and the hardest and most inflexible students in the program refused to take my class precisely because they were afraid their “de-edging” would sand a few points off their GPA and ruin their scholarship and financial aid.
I tried to soothe all fears and frustrations, but one student said the reason he dropped the class after the first day was because he “didn’t understand what I wanted.” He said he had no idea how to get an “A.” My syllabus was clear and and pre-approved by the department.
When the Chair questioned me about that student, I said, “I sensed he was afraid of failure. He wanted to know the one answer to getting an ‘A’ grade and I told him there wasn’t just one path: You could earn an ‘A’ in many different ways.”
Well, that variety of success — to a hardened and edgy medical student — is too risky to bear because more than one right answer means their work might just be open to interpretation, evaluation, value judgments, and even extrapolation, and that is deadly dangerous to a kid raised on getting a perfect 4.0 all his life instead of being congratulated for “Outstanding Work.”
My Public Health classes were filled with students who were already keen, sharp and delightfully well-rounded. We had a great time in class, but I couldn’t shake the notion that the students who most needed to take my class were purposefully skipping it because they were fearful of not doing well.
Without any way to reward or require those timid students into taking my class, the course began to lose interest for me as a teacher: I was rounding off edges that were already pretty smooth and shiny.
Last week, I read this great article in the New York Times, “Getting Into Med School Without Hard Sciences” —
For generations of pre-med students, three things have been as certain as death and taxes: organic chemistry, physics and the Medical College Admission Test, known by its dread-inducing acronym, the MCAT.
So it came as a total shock to Elizabeth Adler when she discovered, through a singer in her favorite a cappella group at Brown University, that one of the nation’s top medical schools admits a small number of students every year who have skipped all three requirements.
Until then, despite being the daughter of a physician, she said, “I was kind of thinking medical school was not the right track for me.”
Ms. Adler became one of the lucky few in one of the best kept secrets in the cutthroat world of medical school admissions, the Humanities and Medicine Program at the Mount Sinai medical school on the Upper East Side of Manhattan.
I had a spine chill as I realized the Mount Sinai medical school program was precisely what the world needed — and what my School of Public Health was trying to do, except backward.
Instead of accepting students who are already sharpened and hardened — and then vainly trying to round them off with an elective course that they wouldn’t take after admission — Mount Sinai eschews the traditionally prepared medical student and looks for a more rounded global learner with the intention of giving them a slightly sharper sciences edge in their program, and that is absolutely the way to get real people, with true feelings, and honest human experiences, embedded in the medical profession:
The Humanities and Medicine Program provides a path to medical school that offers maximum flexibility in the undergraduate years for students to explore their interests in humanities and social sciences at top liberal arts colleges and research universities. The program assures highly motivated undergraduates admission to Mount Sinai upon successful completion of program requirements and graduation from their undergraduate program. MCAT’s are neither required nor permitted to be taken.
More chills! I love the Mount Sinai brilliance and vested insight and inherent trust in their future students.
I can tell you from direct experience that it is always easier to teach a know-nothing chemistry tables than it is to get a traditionally trained chemist to revel in the beautiful frailty of the universal human condition.
That is brilliant, David. It’s good to get a variety of learners in school.
I agree, Gordon. Most patients would choose a warm and friendly doctor over a cold and calculating one — as long as their training and expertise were the same.
Came across this article via browsing philosophy tagged posts.
I could not agree more. As a doctor myself, one of the most depressing things one encounters are colleagues trapped in an excessively narrow scientific worldview and so incapable of engaging meaningfully with their patients. Medical schools are gradually trying to reverse this side-effect of the professionalisation process, by actively encouraging development of communication skills. But even there, there’s often more focus on techniques than understanding.
It’s worth noting that this syndrome is most common (at least in the UK) in doctors about 3-10 years after qualifying. By this stage, they’ve been immersed in clinical practice for a while, studied for and passed speciality exams and embarking on independent practice. They’ve focused on their career so much, they’ve forgotten there’s a much wider world out there. In the later parts of their career, they realise that actually the science side of the job is pretty easy and fairly circumscribed. It’s the human side of the job – the art of medicine – that really makes a difference to people.
Thanks for the exquisite insight in your your profession and the training regimen in the UK.
We have lived in and around NYC for over 20 years and we change MDs regularly — not by choice, but because of insurance roulette — doctors get fed up with a certain insurance company and they refuse to take on new patients, or they just drop the insurer entirely, stranding hundreds of needy people who now have to search for a new “in-network provider.”
My wife and I have probably seen a over 20 MDs, dentists, surgeons and other specialists over the years and there are, perhaps, 3 who we felt saw us as people and not a payday.
There is an incredible growing lack of compassion and sympathy among those doctors — and even the nurses and assistants are getting colder and more disconnected from the human realm.
The medical industry blames that mode of operation and punishment mentality on the cattle-like phenomenon of the desperate need to “process” as many patients in a day as possible to meet their payroll needs — but the patient is always the first and the last to suffer most.
The doctors (and other staff) suffer also though, as their jobs become drier/more distant and less enjoyable. Once it gets to that stage, it stops being medicine and becomes administration/filing and so is much less interesting.
That’s exactly right. It all quickly devolves into a toxic circle that becomes more about money and less about service.
Even the “good, human, doctors” we know are often stuck in a medical system that doesn’t allow them the freedom to be real and caring and compassionate because those fine qualities take too much time and none of those traits voluptuously add to the bottom line.
Support this all the way. Kindness goes a long way in any profession. In medicine, compassion need to be part, too.
Well said, Anne. Medicine is a people business of original sort!
Where was this kind of Medical school about 20yrs ago? I might have actually been interested in getting into that one!
But I have my doubts as to whether forced classes would ever work. Empathy seems to come more from life experience. Perhaps that is what the Mt. Sinai program realized.
Because I grew up with a disabled aunt, there is never a time that I don’t think about the grade of ramps, the size of bathroom stalls with bars and height of the toilet, the way that grocery store shelves are stocked.
Because my grandmother was schizophrenic and I watched the side effects of her medication and the mental torture she endured, I do not treat others with mental challenges as less of a person.
When I was in a non-weight bearing cast, I was enlightened in how difficult and time consuming the most mundane tasks can be. Was getting up and struggling on crutches really going to be worth that drink of water on the other end of the house? And when I got there, I could not carry it back with me. Maybe I’d rather skip the water and the med’s–they aren’t really worth the effort…
When I had my first child, my mother watched me look at him and said, “Now you understand love.” I thought I had understood before, but now I know that nothing I had ever experienced before came close to it.
Treating physical symptoms with med’s is easier than understanding why they don’t follow their treatment program, take their med’s, care about their health, disclose all their symptoms, etc. It’s good to see that some are now understanding that there are more symptoms of illness than just the physical.
Well argued, Linda!
We must be more than machines and pills in the healing process. We need to consider the human aspect of it all. The body is strong and can usually heal itself when helped by the mind. Unfortunately, “whole body” medicine today really means treating the core and not the existential ends.