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Kathy Merrell

iwellville.com

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What if medical schools cultivated the art of healing along with knowledge acquisition.

By the time a person actually becomes a doctor they've been stunted by spending years on the backbreaking labor of knowledge acquisition. Not only does this activity break the connection to one's "small little voice in the head" that might save the patients life, but it makes a person a slave to knowledge that is quickly outdated. Doctors can be myopic and closed to new information precisely because medical education is overwhelming biased toward studying; it leaves new doctors wildly unprepared to listen and heal.

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    Jan 31 2012: I think we focus too much on treatment of symptoms and not enough on prevention of disease. Eating healthy isn't emphasized enough and people are relying on medicine too much. Doctors could do a better job if they treated patients as people rather than subjects/experiments.
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      Jan 31 2012: I don't think it is a realistic expectation. Doctors are trained to treat diseases many thorough a process called problem based learning. That means, that as a patient, you are a problem to be solved.

      http://www.pbli.org/pbl/medical_pbl.htm
      • Feb 2 2012: Not all doctors are trained like that. Neither patients nor doctors are widgets to be fit into the corporate machine. People are messy. We don't fit molds.

        And any doctors who don't realize this should stop inflicting their dysfunction on humanity.

        on edit: Not all doctors stay stuck in that kind of training. They outgrown and out evolve it. It is a starting point, not an end point.
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          Feb 2 2012: Um. In the United States they are. Check any medical school you like.

          I had the chance to tour Mayo's simulation lab. They have entire rooms set up and dedicated to this type of learning. Most medical schools even advertise this method of instruction.
      • Feb 10 2012: linda - whoops. Mea Culpa.

        I didn't check the link and transposed in my grey cells with another concept. Sorry about that. Age can be a mofo.

        Having said that I would say that yes, PBL is taught in all medical schools, but an alarming number of doctors don't seem to be using it much post graduation. We see WAY too many patients who come to us after seeing another doc who is practicing recipe card medicine: they take the symptoms, mix them together and follow the recipe to find an answer and if it doesn't work, well, it must be because the patients wasn't compliant (or some other excuse).

        I don't blame docs however. It is difficult, if one is mired in insurance based practices to move beyond the box the insurance company is willing to pay for without causing the doc to spend hours arguing with an uneducated no-think-em about necessary. After a while it just becomes easier to do what you know will be reimbursed, cash the check and walk away. Anything else is punished.
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          Feb 10 2012: I completely agree. That is why I am saying why do we think that the docs should do everything? They have a job to do. They are trained and do it well. They got 10 minutes to see you and your issue. Be respectful. I would rather have the science of medicine that the art of healing anyday.

          Besides, the only person I have ever seen heal anything was the patient.
      • Feb 10 2012: Linda,

        The problem as I see it in focusing that diagnostic process to disease management rather than patient management, that you tend to get systems analysis.

        Pt:"Gee doc, I have symptom X, Y, and Z. What should I do?"

        Doc: "I don't deal with X and Z, but here is a prescription for Y and a referral to Dr. A for symptom X and Dr. D for symptom Z.

        The problem here is that too many physicians are not given the time nor tools to make those connections, and if we aren't going to have the doctors do that work, who do you suggest when you say that we shouldn't have the docs doing everything.

        BTW - at our clinic our docs spend an average of 20 to 30 minutes with every pt follow-up appt. and sometimes over an hour with each new pt. intake. They get a thorough history and work up of subjective and objective data. By giving that time to the pt, they are able to miss fewer things and work up a functional understanding of that pts. case. There is a reason that we are where pts come when no one else is helping.

        Again, I don't blame the docs who are mired in the insurance paradigm. FYI - we do not bill insurance (national average of insurance billing specialists to doctors, 3:1 - in Canada that ratio is 1:7 - yikes!!!) and as a result of lowering that significant amount of overhead and wasted medical specialist time, we are able to lower our costs to pts while still maintain a healthy profit margin to attract good docs.

        The insurance (broken) system time is done. Let's stick a fork in it.

        Could you explain your second last sentence more? I'm not sure what you are talking about.
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          Feb 11 2012: Actually I think the docs should do the work you describe. What I don't think is that they should do everything. They don't have the time or the tools so what next? Insurance companies over the years have increasing dictated how health care is delivered and many docs have to refer to doc A and doc D exactly for the reasons you list. (I predate HMOs and remember major medical. I also would like to go to your clinic. 30 min for F/U is a real treat).

          I agree 100% the insurance system is broken. It is troublesome that third party payors are more interested in stockholders than healthcare. I really think Obamacare is gonna tank the entire system. I have been posting against that for a long time. It is not about healthcare, its about insurance.

          That said, many people are going around saying they are healers. Spiritual healers, alternative healers. The art of healing. The word is over used and over applied. The only person I have ever seen heal anything is the patient themselves. Wounds, illness, infection. I think we need to work with patients to help them heal with medicine, treatments, and surgery. But the person that heals is the patient.
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      Jan 31 2012: Yes I totally agree! Doctors are human too, we shouldn't expect miracles...or at least meet them halfway with self-care!
      • Feb 11 2012: I agree with you in most ways in your OP. I do think that too many docs run the recipe card for a particular set of symptoms, matching them to the prescription they know. They do this because of the seriously flawed time constraints forced upon them by the insurance reimbursement system. Many doctors who have never practiced outside the USA don't even realize that there is another way.

        A friend of mine is a doc in Canada and he spends about 20 to 30 minutes with each patient. His nurse handles his entire days insurance billing in less than a half hour at the end of each day online. He works 35 hours per week and never deals with insurance dorks overriding him or not paying him. He knows a year ahead of time what his reimbursement rate is, and if that isn't good he and his professional organization is able to negotiate changes. Best of all he has plenty of time for CE and keeping up with journals.

        Compare that to the USA where docs also see pts for about 35 hours per week and spend the rest of the time in paperwork, plus the also support some of the 3 insurance billing specialists employed for every doctor in the USA.

        I do agree with Linda that the only people who heal are patients. At best docs help them on that journey.

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