Patient Involvement in Medical Education Research: Results From an International Survey of Medical Education Researchers, Moreau et al, 2021

Open access, https://journals.sagepub.com/doi/full/10.1177/2374373520981484

 

I have a couple of comments on this...

1) I would love to know how much input pharmaceutical companies have into MER.

2) I don't know exactly when it started, but medicine seems to have given up on curing a vast number of diseases and illnesses. Instead doctors only try to mitigate symptoms rather than actually cure people - but even that only happens if they believe in the symptoms in the first place. This is not to anyone's advantage other than the pharma companies. Why have doctors allowed this to happen? I thought doctors were supposed to have a "calling" but it seems they are just doing the minimum they can get away with in many cases of chronic disease.

 

Everything I see suggests to me that leaving health care entirely to medicine has been a mistake. Health care is about far more than just medical practice and I think this is where the flaws mostly lie, that leaving people trained with one skillset to do many things unrelated to their skillset is a recipe for failure. You definitely want nuclear engineers building a nuclear reactor, you very much don't want only nuclear engineerings running the entire electrical infrastructure in an area, including policy and regulation, deciding for themselves based only on their own technical needs.

Instead of using people trained in the logistics of health care, you have people trained to be doctors doing health-care logistics. Same for administration, including basic business administration, information technology, quality assurance (which is entirely missing from the discipline) and more. There are many roles in health care but ultimately it is medically-trained people who have the first and last word, and nearly every word in-between. The attitude of "not an MD, your input is worthless" frankly ranks higher than the so-called first principle of medicine.

Skillsets are not necessarily transferable and being smart, especially here being book smart and able to memorize a lot of stuff, doesn't change that. Medical training doesn't even guarantee basic competence in medicine, it surely can't guarantee all those other skills that health care involves.

The world has changed but medicine itself barely has in the last half-century. Still paternalistic to the point of hubris. Still completely unresponsive to world outside the echo chamber. Still unable to shed old myths and beliefs because this pressure can only come from the outside and no external input is accepted.

A massive paradigm shift is needed. Medicine has basically hit a wall, having solved all the "easy" stuff, what remains is too far outside of the old ways of doing things. That wall is not technical, it's largely political and self-inflicted. Medicine has fallen to the iron law of institutions, where with time people involved in an institution spend most of their efforts on their own status in the institution, to the point of neglecting its fundamental aims and principles.