San Francisco Medicine, September 2010. Beyond Medical School: Learning to Be a Great Physician and Citizen.
Beyond Medical School It’s Not Too Late One Dozen Important Topics You Might Not Have Learned Enough about in Medical School Philip R. Lee, MD, and Steve Heilig, MPH Note: A previous version of this article appeared in this journal in 2004 (with additional coauthor Pradeep Natarajan, then a UCSF medical student). It stimulated a fair bit of discussion. Some professors have used it as a class handout. Revisiting it now, we note that unfortunately most of the problems discussed are still with us and have even worsened—but with encouraging improvement in some cases. We thus offer this updated version. M edical training is intense by design. Starting with medical school, most of the formal curriculum is filled with numerous essential topics, and as scientific and medical knowledge increases, it is further difficult to “triage” what must be learned. Efforts to insert new topics are often fraught with obstacles and resistance. Thus it may seem ridiculous to suggest that even more be taught in those finite years of formal medical education. It is not ridiculous to suggest that practicing physicians put these topics on your to-learn list now. The following is a somewhat subjective list, but it is based on research, reports, and experience. The discussion of each area is short, with resources listed for those who want to learn more. Again, improvement in these (and other) topics is taking place across the nation. Consider this is an “alert” list conveyed with the hope that future physicians will be aware of these issues on their way to becoming good physicians. 1. Addiction The American Medical Association has recognized that drug abuse is one of our nation’s prime public health www.sfms.org www.sfms.org problems. It’s a clinical problem too, and the biggest culprits are not stereotypical street junkies; they are often everyday patients using legal drugs. For example, despite much progress in reducing smoking, more than 20 percent of adults still use tobacco. Alcohol overuse is rampant at almost all ages. Abuse of prescription drugs is also rising. As for illegal drugs, the epidemic of methamphetamine addiction has spread everywhere. Yet many MDs are not aware of addiction issues; alcoholism and other problems often go undiagnosed and, even if recognized, untreated. It is known that having MD counsel about smoking, for example, is an important step toward quitting, yet many MDs are uncomfortable even talking about these problems. More doctors need to know more about and apply addiction medicine principles. Resources American Society of Addiction Medicine. www.asam-csam.org “Addiction and Recovery: From Neurons to National Policy.” www. sfms.org/source/members/magazine_archive_list.cfm?theme=June%20 2 0 1 0 % 2 0 Ad d i c t i o n % 2 0 a n d % 2 0 Recovery§ion=Article_Archives 2. Nutrition and complementary therapies The dean of the UCLA School of Public Health has stated that, due to obesity, “For the first time in two centuries, the current generation of children in the United States could have shorter life expectancies than their parents.” In a society obsessed with weight but also increasingly obese (or shockingly bulimic), nutrition becomes a critical matter for patient guidance. Information about extreme nutritional deficiencies like scurvy or pellagra may be interesting but is usually irrelevant. More common problems related to physiological development; drug interactions; and use of supplements, herbs, and other “alternative” or “complementary” approaches are far more important. Unfortunately, patients often do not look for nutritional counseling from their MDs. Physicians should inquire about and become better able to counsel their patients regarding diet and nutrition. Resources Nutrition in Medicine. CD-ROM series. Chapel Hill: University of North Carolina. www.med.unc.edu/nutr/nim/ Nutrition Guide for Physicians. Wilson, Bray, Temple, Struble (eds.), www. springer.com/new+%26+forthcoming+ti tles+(default)/book/978-1-60327-430-2 3. Sexuality Human sexuality has long been taught in a biomedical fashion that often does not reflect real lives. How comfortable is the average MD in talking about sexual practices and health? Homosexuality? Sexual dysfunction? Sexually-transmitted infections? Cultural issues? Teen sexuality? With epidemics of sexually related disease a part of modern life, and unwanted pregnancy a perennial problem, education and training to elicit such key aspects of patients’ daily lives are vital. This includes contraception. Taking the time to delve into the “unContinued on page 21 . . . September2010 San Francisco Medicine 19 2010 San Francisco Medicine 19 September