Berks County Medical Society Medical Record Winter 2021 - 18

M e d i c a l R ec o r d F e a t u r e

MORE HUMANITIES
IN MEDICAL EDUCATION
by Peter A. Schwartz M.D.

" Nothing will sustain you more potently than the
power to recognize in your humdrum routine, the
true poetry of life - the poetry of the commonplace, of
the ordinary person, of the plain, toilworn, with their
loves and their joys, their sorrows and griefs. "

Sir William Osler

Patients are suffering. And doctors are suffering.
A week ago a high school classmate of my wife's wrote in
Facebook, " It finally happened, the doctor came in, barely said hello,
sat down at his computer, asked a few questions without ever looking
at me, said something to the assistant and got up and left. I am not
sure he even knew I was there and couldn't have been in the room
more than 5 minutes. I will never go back. "
This open letter suggests there is a problem, offers a pathway to
improvement and begs for your opinions and involvement.
What has happened to medicine?
A simplistic view: industry harnessed and marketed computerdriven, lightning fast advances in science and technology to promote
cure of disease. " Old fashioned care " was preempted by big pharma's,
instrument manufacturers', hospital systems' and insurers' demands
for physician efficiency in an attempt to balance the enormous
economic impact of the scientific and technological development and
legal and administrative burdens.
We do not have a Health Care System. We have a Health Cure
System. Rather than focusing on optimizing health, preventing
illness and caring, we focus on curing disease. Our health economics
thrives on illness rather than on well-being.
And we, patients and physicians alike, have paid the price of less
nurturing care and more " burnout " .
More simplicity: 90% of what we learn applies to 10% of our
patients. Much of what I learned and needed to re-learn several times
over in preparation for exams, I never utilized in my 45 years of
patient care. 10% of what we learn applies to 90% of our patients.

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We must not only learn this information well, but also learn how
to apply it and to whom it should be applied. This 10% is our
fundamental knowledge. Probably at least 50% of what we learn is
useless 10 years from when it was learned, and this includes not only
therapeutics and surgical care but disease processes as well. Medicine
has been changing rapidly and will likely change with logarithmically
increasing swiftness as Augmented Intelligence continues its
development and application. I learned by reading textbooks from
cover to cover, yet textbooks may be 5 years' old information by the
time they are printed, well along the continuum to obsolescence. I
learned by reading journals from cover to cover, oblivious to how
inefficient it was to attempt to learn without reference to a patient
and by skipping from entity to entity without any continuity. Rote
memorization should be mitigated by the more valuable bedside
learning or proximate-to-patient-care modalities such as the fingertip
presence of " Up to Date " and " Pub-Med. " The need to memorize
information for future use will have less relevance with the advent of
AI.
However, there is one thing that we learn in both Medical School
and Residency that will resist change over the course of our careers:
how we relate to patients and the teams in which we work.
How we relate to our patients and the people within our teams is a
function of " our humanity. "
Premise: Instruction in the Medical Humanities, while gaining
traction in medical school education, needs to also be an integral
part of both our Graduate Medical Education and our Continuing
Medical Education and be prominent in our care of patients.
Do you think we need or could benefit greatly from more
Medical Humanities in both our GME and CME?
What should be included in the curriculum and how should it be
delivered?
Here are some thoughts, not decisions:
1. Medical Ethics: guidelines for ethical behavior, discussion of
the grey areas, and hints as to how to navigate ethical dilemmas are


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Berks County Medical Society Medical Record Winter 2021

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