MEDICAL NOTES.

Auckland Star, Volume LXII, Issue 50, 28 February 1931, Page 7 (Supplement)

MEDICAL NOTES.

training of doctors.

PHYSICIAN'S SUGGESTED

REFORMS.

experience and learning,

(By PERITUS.)

An address given to a London branch of the B.M.A. by an East London physician is of so much practical value in relation to medical education, and of such high literary quality that one would like to distribute a copy to each of the medical practitioners of the Empire. It is evident that the accumulation of medical knowledge is such that even in seven or eight years no student can do anything like justice to the whole of it. There was never a more suitable time than now for restoring (under new conditions) the old apprenticeship system, for by working, after graduation, with an experienced practitioner, the young, incompletely trained man can put his knowledge to practical use without carrying for so long:the "hospital manner" and impersonal way of regarding diseased persons which so frequently obstruct him in private practice. Not Specialists. The doctor referred to said that the chief business of the training centres is to turn, out good doctors and not specialists or consultants. Much of what the student learns to-day applies immediately to the smaller quadrupeds, and he hears much less about the workings of intact human beings, "but perhaps they are only large-scale guinea-pigs." Medicine, to the student, is obscured by its subsidiary services and the patient concealed behind the supposed reality of his disease. At examinations ho turns stuff out of his mental saddle-bags "as readily as he once lightened them of Latin o-enuers, and travels on with hardly more of permanent luggage than at the outset of the course." "The time spent in loading up and the labour spent in carrying this unnecessary burden of nnsorted facts no one can give him again." Training of Doctors. Should the student seek to increase practical knowledge by a year or two of residence at hospital he finds himself as house physician or house surgeon soon forced to regard himself as a specialist. "If self-critical and observant, he ■will keep on finding that he knows lamentably little of normal men and women and children and their bodily functions, in spite of years spent in the study of anatomy and physiology intended, presumably, to teach him this very thing." The trouble is that it is laboratory anatomy and physiology lie has* memorised, and this leaves him unfamiliar with the clinical aspect of normal patients. There is no fact, says the doctor, more, obstinately forced upon us than that our patients have minds, and yet for some time past the profession has not been on speaking terms with "mens." Nevertheless, if we disregard our patients' minds, we do so at our own peril and theirs. Small Troubles. In the course of hia. training, general systematic diseases" and abdominal catastrophes are quite usual, but in private practice it is the small troubles of eye, ear, throat, and skin which come to him, to say nothing of diseases of women and children; in short, is the common run of daily life which brings him his daily task, and his training has left him hut poorly prepared. The doctor quoted Napoleon's physician, who said that "medicine is not the art of curing diseases, it is treating them in the hope of cure and soothing a'nd satisfying sick people." Doctors are of value to their patients for what they are (and here no curriculum' can help them), "next for what we can do, less for "what we know, least for what we can, or think we ca'n, explain.

Teaching oft the Future. Of the teaching of the future, the doctor said: , "The curriculum of my hopes, the gooa practitioner's curriculum, will lay moie stress on experience and less on learning; it will impute far more value than at present to technique and skill ot hand; it will be far more discriminating in its choice of facts to be learnt, and will be chary of teaching any theories at all. "The young man in this golden age to be will attend few lectures, for they will be strictly confined to _ matter not to be found in books; he will learn an anatomy imbued with a sense of proportion, paying regard to what is clinically important and is not; an anatomy, too, constantly mindful of the relation of structure to function. will be made quite clear that certain anatomical facts which experience has shown to have little or no clinical va ue are not to be memorised and will not o asked in examinations, and the list o these facts Avill be long. _ Thereby so ™° justly famous mnemonics will pcrisn from the earth, but we cannot lave everything. Lest this lead to slo\ en liness stress will be laid on good and careful dissection and far _more_ ma: v will be given for the practical than the written examination." < "In his clinical years our student will spend more time with patients, less in the museum, the library, and laboratories, and very little time m • o operating theatre. He will be taught that while he cannot 4ie expected know all about his patients disease, must know all about his patient. every stage of his career lie wiu p® hibited from specialising; in vain wi he disclaim all knowledge of heart or lung in a surgical, of ears and nose in a medical ward; he may not know voa,, is wrong with them, but he must examine them and report what lie sees and

hears. , "At his final examination our stuilent will not be dumbfounded if he is asked to describe the common types of dyspepsia and treatment; a question on tonsilitis, on influenza, or inflamed ear in a child will not surprise him, nor will ho think it unfair to meet as a 'short case' a patient suffering from sciatica whose, dental radiograms he will be expected to demand. "In a still more golden age the student will be marked like a schoolboy on his term's work and examinations will become relatively unimportant; heir written parts, I think, will largely disappear, and the practical and viva voce examinations will be planned to test thoroughness in examination, clinical experience, and acumen, manual dexterity and perhaps even skill in handling garrulous, reticent, or otherwise difficult patients."

Such a doctor would he fairly self sufficient and not go crying out for laboratory help, blood tests, blood counts, and X-ray examinations so often abortive and so exceedingly expensive.