Medical Care

Medical Education

Some Topics

  • Resources for Medical Students

    Medical schools provide a hectic tour through a variety of disciplines that contribute to the medical view of the word. Medical students are challenged to learn too much too quickly and have little time to reflect. Medical education has a friendly surface, that invites you to study anatomy, biochemistry, physiology, pharmacology and pathology, all noble disciplines that reveal life processes in health and disease. There is also a somewhat hidden curriculum that transforms smart and free individuals into obedient servants of the medical system. Medical Student suffer from overwork, increasing debt, poor living conditions, bad food and little time to relax and enjoy their young lives. The adversities they face create increasing problems with drug and alcohol abuse, poor health, burnout, sometimes with suicidal thoughts. Their plight is increasingly acknowledged in academic circles but the challenge of reforming medical education often exceeds the resources of medical schools. As soon as a student graduates with an MD, they enter a demanding, less forgiving residency in a teaching hospital. In the popular imagination, medical residency is less a training program than a rite of passage. Those who successfully navigate this process are crowned physicians, with the ability to make life-and-death decisions. Those who don't succumb to the necessary culling process that ensures optimal patient care.

    System in Trouble

    The medical system includes many wealthy and powerful players who have little or no tolerance for smart and idealist students who want to innovate and change the way the system works. Conformity is the highest value in medicine and some beginning students have trouble adjusting. Wealth means vested interest which translates into a desire to control medical school curricula, post-grad medical education and government policies. The system is in trouble; so much so that commentators such as Glickman-Simon offered a gloomy prognosis. At the American College of Physicians 2006 Annual Session, he stated: "According to the American College of Physicians, the healthcare system in this country is threatened with an ominous future. Without prompt and significant changes in the way that healthcare is organized, financed, and taught in this country, the "collapse" of primary care is imminent. What will remain in its place is an increasingly fragmented jumble of poorly coordinated subspecialized services, even higher costs for even lower quality of care, reduced access, rising inefficiency, and more patient dissatisfaction."

    Dr. Pamela L. Wible wrote about physicians' bullying medical students and each other. Increasing concerns about physician burnout and suicide have surfaced in the US. Medical students suffer bullying and some end their lives. Wiebe stated: "The truth is, doctors are suffering. Surrounded by sickness and death, we watch families wail, shriek, cry while we stand silently—sacred witness to their sorrow—until we're called to the next room for a heart attack, a gunshot wound, a stillborn. Week by week. Year by year. Doctors are not allowed to grieve. Today a physician tells me she's been cited for unprofessional conduct. Why? She was seen crying. Her boss told her, "Unless you are dying, crying is unprofessional behavior and not to be tolerated." Medicine is an apprenticeship profession. Trained by wounded doctors, they're now wounding you. Your bright eyes, your enthusiasm, your idealism remind them of their loss. Rather than feel their own grief, they lash out at you." Pamela L. Wible. Physician Bullying: 'Not Allowed to Cry'. Medscape. Feb 20, 2015.)

    One wealthy, powerful player in the system is the drug industry. Every year they sell more drugs, become more wealthy and increase their influence on every aspect of medicine. Drug companies control all the free publications that medical students and practicing MDs read. Drug companies own post graduate education. I was encouraged by the American Medical Student Association's stance on drug companies gifts to students and physicians. They argued that to accept gifts is to feel indebted, and doctors indebted to drug firms may not be prescribing medicines based solely on what's best for their patients. In the US, $22 billion was spent on physician public relations (2003 data); $16 billion was spent on free samples given to MDs. Students who oppose drug company influence do not conform to the status quo and will often pay a personal price; they may find that they are excluded from preferred hospital positions. As residents, they will work with staff and peers who enjoy drug-industry gifts, academic appointments and research contracts. Indeed, without drug company support, physicians' career choices are limited.

    Medical Student Psychopathology

    In the USA, a national survey sent to 12,500 medical students in 2012 one third of medical school students met criteria for alcohol abuse or dependence ― double the rate of their age-matched non–med student peers ― with burnout and high educational debt primarily to blame. The rate of suicidal ideation (9.4%) was similar to that reported in previous research among medical students. It was higher than the rate reported in the general US population Approximately 35% of medical students who reported having suicidal ideation in the survey had coexistent alcohol abuse/dependence. Dyrbye, professor of medicine and medical education at the Mayo Clinic College of Medicine said: "No previous study has explored the relationship between medical student alcohol abuse/dependence and educational debt. Financial debt, however, has been previously associated with alcohol abuse/dependence in the general population. So although the finding was not totally unexpected, it is very important, as the cost of attending medical school has risen by over 200% in the past decade.” ( Med Students: Exceptionally High Rates of Alcohol Abuse. Medscape. Mar 24, 2016 and Accessed online March 2016 Academic Medicine.)

    Rates of depression are high among medical students in the United States and around the world, according to a systematic review and meta-analysis of nearly 200 studies involving 129,000 medical students in 47 countries. More than a quarter of medical students suffer from depression or depressive symptoms, and 7.2 to 24.2% report suicidal ideation during medical school. Only 15% of students seek help for depression.

    Douglas A. Mata of Brigham and Women's Hospital and Harvard Medical School stated: ”I think there needs to be more proactive wellness interventions promoted among students, where we try to prevent people from becoming depressed in the first place. The training of medical students needs to change and that might involve decreasing work hours and pressure on the students, which would actually allow them to perform better. People have focused on teaching wellness and self-care, but that ignores the environmental issues that are in the medical school and hospital that cause these issues in the first place, like chronic sleep deprivation."

    (Lisa S. Rotenstein et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students. A Systematic Review and Meta-Analysis . JAMA. 2016;316(21):2214-2236. doi:10.1001/jama.2016.17324)

    Biological Method of Medicine

    A proper biological method of medicine begins by recognizing and solving problems in food, air, and water supplies. Medical students seldom develop insights into the extreme complexity of modern ecosystems. They learn that diseases are problems of individuals and are discrete entities with names and biographies. Medical students may not realize that a steady flow of molecules from the environment enters the body of each individual through the air breathed and the food and liquids ingested. This body-input determines health and disease in whole populations over the long-term and the moment to moment functional capacity of the individual. A person's performance can change dramatically with changes in this molecular stream.

    A biologist sees living creatures connected to and interacting with their environment. It is normal for a biologist to think in terms of populations, food supply, seasons, weather, and social-behaviors, and to do field studies that reveal patterns of adaptation to specific environments. Anyone who has worked with animals or fish in closed environments knows how critical environmental conditions and diet are in determining both the behavior and the physical status of the residents. When a fish in an aquarium displays disturbed behavior, you do not call a fish psychiatrist; you check the oxygen concentration, temperature, and pH of the water. You have to clean the tank and change the fish diet.

    Modern ideas in science describe the complexity of the natural world in terms of networks, systems, information and control, turbulence, chaos, fractals, strange attractors, and self-organizing systems. The first insight is that the human body is not a simple, linear machine. We a re unstable, rhythmic, pulsing creatures with many different body-mind states, strongly influenced by our sense organs and exquisitely touch sensitive. We seldom respond the same way to any repeated stimulus. As the astronomer, John Barrow in his Theories of Everything describes the difference between linear and nonlinear:

    "...If a situation is linear or dominated by influences that are linear, it will be possible to piece together a picture of its whole behavior by examining it in small pieces. The whole will be composed of the sum of its parts...the output of a linear operation varies steadily and smoothly with any change in its input...Non-linear problems are none of those things. They amplify errors so rapidly that an infinitesimal uncertainty in the present state of the system can render any future prediction of the state worthless after a short period. Their outputs respond in discontinuous and unpredictable ways to very small changes in their inputs."

    Nutrition: We recognize three basic truths

    Medical Students seldom appreciate that food is the basis of biology. The study of biochemistry is abstract. You may learn about the Kreb's Citric Acid Cycle but fail to understand where the molecules are coming from an how their appearance is regulated, starting with food entering the digestive tract. The study of nutritional biochemistry is assigned to other disciplines and not given the priority it deserves in medical schools. I suggest starting with some basic insights:

    First: Most of the diseases that lead to premature disability and death are caused by eating too much of the wrong food and exercising too little.

    The second truth is that normal is not normal: The foods implicated in causing illnesses are common foods that almost everyone eats. To become a healthy person you have to redefine normal food.

    The third truth is that each person is responsible for their own health. Rather than waiting for the next “miracle cure” for high blood pressure or diabetes 2, for example, responsible people get busy and fix the problem for themselves.

    Medical Students must learn to apply these ideas to themselves and then translate their findings to patients.

    This website attempts to provide a perspective and an overview, with an emphasis on removing the causes of disease rather than treating the effects. We emphasize basic biology and recognize that human health depends on the proper supply of food, air and water. The improvement in the diversity and availability of foods has been a mixed blessing with major problems emerging to negate the potential benefits. Food is the most intimate part of the environment because we ingest it. We look not only at the composition of the food but also, and more importantly, at the interaction of the ingested molecules with body. Adverse reactions to food are common and produce many disturbances by a variety of mechanisms.

    Air is the second most intimate part of the environment, because we inhale it. When something goes wrong, it makes good sense to look at the flow of substances through the nose and mouth for the source of the problem.

    Learn more about self-regulation

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