erraticwisdom

There’s a lot of really great doctors out there, but unfortunately, there’s also some bad ones. That’s a problem we don’t need to have, and I think it’s caused by some problems with the rules about becoming a doctor.

1. The money

Becoming a doctor is expensive. I’m about halfway through and I’m nearly $100,000 in debt. Many “problem” doctors have improper expectations about their value and compensation. Part of this is due to the high cost of medical education, but another cause is this sense that they’re owed more because of the relative difficulty and sacrificed profitability during the long training period.

However, the real value of being a doctor is in the profession itself. Simply put, those who don’t find that sufficient shouldn’t be doctors. It’s not about discouraging people, but if the primary focus is financial, there are probably easier ways of making money.

How do you select for this? Make medical education free and then fix doctors’ pay at a more reasonable rate. People don’t become soldiers for the money, they do it because they believe in their mission. If you take the money out of the equation for becoming a doctor (both the mountain of debt and the tantalizing prospect of success), you get a volunteer army.

2. The education

Another problem, both contributing and a result of #1 is the focus of medical education on intelligence, and specifically the measurement and valuation of that quality through standardized tests. Too many potentially great doctors are excluded based on test scores, and just as many potentially bad doctors are funneled in for the same reasons. This pattern continues once in medical school, where a test (unceremoniously called “Step 1”) now helps determine your range of specialties.

Is dermatology really that much more demanding than being a psychiatrist?

Being smart isn’t the most important part of being a good physician, being empathetic, genuinely caring about and able to connect to people is. What’s the point of knowing the molecular underpinnings of a condition if a patient’s never going to trust you enough to tell you what’s really going on?

VisualDx is a tool to help diagnose skin conditions. Punch in some information about what you see and you’ll get a list of possible diagnoses. Tools like these will become much more common and accurate with time.

My experience at UCLA has convinced me that there’s been alot of improvement in this area. We take a course called “Doctoring” that exposes us to different people and situations (through standardized patients) in an environment where we can get guidance from our peers and teachers as we learn our patient’s history, deliver (sometimes bad) news, and provide counseling. It’s an incredible learning experience and I’m sure it’s made me a more caring and compassionate person.

It upsets me when I hear a story about an asshole doctor because they clearly should’ve done something else, and there’s probably someone out there who would’ve made a much better doctor but was turned down because they couldn’t afford it or forgot some utterly useless fact that they could Google on their phone in 10 seconds.

On a side note, have you ever had any bad experiences with a physician? Let me know and I’ll try not to do that.