What Part of Idiopathic Epistaxis Don’t You Understand?

If we want doctors who can communicate, maybe we need med students who weren't pre-med

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About a year ago, I accompanied my 80-year-old mother on a visit to the cardiologist’s office. She had been having unexplained dizzy spells and a rapid, irregular heart beat and was in for tests to see what the problem was. After the first test, we sat with the electrophysiologist, who explained Mom’s results.

Actually, the electrophysiologist did not make anything plain at all. Instead, she went on about P waves and the sinoatrial node and what my mom’s EKG looked like, all at lightning speed. I know a lot about medicine, and even I had a hard time following the doctor’s rapid-fire diagnosis.

As for my mother, she sat there nodding numbly the whole time. After the doctor left the room, I turned to Mom and asked, “Did you understand any of that?”

“Not a single word.”

I don’t blame the doctor for being a poor communicator. Numerous studies have found it’s a common enough symptom among physicians (although the speed at which she delivered her diagnosis didn’t help). Other studies have shown that poor communication between doctor and patient is bad for patients. To take just one example of this, when patients don’t understand what their doctors are telling them, they are more likely to stop taking a drug they need or take the wrong dose.

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Recognizing the importance of communication, the Council for Graduate Medical Education, an organization that oversees the training of young doctors during their residency, began requiring residency programs in 1999 to implement programs to improve communication skills. The success of this program has been mixed. (Exhibit A: the doctor who rattled on unintelligibly at my mother was young enough to have gone through her residency after that requirement was put in place.)

As pre-med college grads await their letters of acceptance about now, it’s worth asking if the lack of communication skills among doctors might have something to do with the hyper-competitive brainiac science majors who tend to get into med school. Anybody who has gone through the full pre-med package of hard sciences in college (a year each of biology, chemistry, organic chemistry and physics) knows there isn’t a lot of time left for history or philosophy, courses that involve a lot less memorization and a lot more writing and speaking — in other words, communicating.

If we want to have a medical profession made up of people who can relate to patients as well as to petri dishes, maybe what’s needed is a different kind of med student. Two years ago, the Mount Sinai School of Medicine launched a Humanities and Medicine Program (HuMed) which recruits students during their sophomore year of college and offers early admission into one of the most prestigious medical schools in the country, on the condition that they major in something other than the traditional pre-med hard sciences. The theory is that humanities students will be better able to interact with patients, and that they may be more able to deal with the stresses of medical school and residency. Other medical schools have launched similar efforts. At Columbia, there’s a program in Narrative Medicine, which uses readings from fiction, medical anthropology and philosophy to help medical trainees connect with their patients.

Of course, humanities majors will have to handle the heavy science load in med school. At Mount Sinai, non-pre-med majors were perfectly capable of doing the science that’s needed to become a doctor. They scored slightly lower than their science-major peers on one science-heavy qualification exam but were no less likely to be in the top quartile of their med-school class or to earn honors-level grades. An added benefit: they also showed a tendency toward primary care specialties in their residencies.

Of course, some medical students will still choose to major in the hard sciences, regardless of what med school admissions are looking for, out of passion for the subject. That’s fine, but there should also be room for students with other skills. A doctor with an undergraduate degree in math or social science may be better able to interpret medical evidence for patients than one with less familiarity with statistics. A doctor with a philosophy or theology background may be better-equipped than a bio major to talk to patients and families about the care they want at the end of life.

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The pressure to invest all of our medical workforce’s effort in pure science is emblematic of the central problem in our medical care delivery system — too much focus on fixing the technical problems with people’s bodies, and not enough work on caring for patients as individuals. We don’t have to abandon science to agree that those people skills are valuable. It would have been nice if the electrophysiologist who ran tests on my mother had been able to tell her in plain English that there was nothing wrong with her heart.