|
MEDICAL SCHOOLS
With such an explosion of information, unstandardized, small medical schools in this country had major problems keeping up-to-date. Instruction was so patchy that in 1910, the Carnegie Foundation for Advancement of Teaching initiated a review of the situation. Abraham
Flexnor, an experienced educator, produced a report which hastened much needed reforms in standards, organization and curriculum of American medical schools. A national organization was created to examine and license the schools and many, that did not meet the criteria, were closed down. The great institutes, like Harvard and Johns Hopkins flourished, producing great teachers like William Osler and the Mayo brothers, but the university centers of England and Europe still attracted those who wished to hone their clinical skills.
After World War II, however, medical technology opened tremendous new avenues of treatment. In cardiology, for example, catheterization became a diagnostic rather than a research tool and open heart surgery, with its advances in
anaesthesiology, heart muscle preservation during chemical arrest and electronic monitoring of circulatory function, propelled American medicine to the forefront and established this country as the mecca of medical progress and learning.
My own experience was typical of the time. Up to and during the 1950s, British Commonwealth physicians spent a couple of years in England learning the finer points of clinical consulting, returning home to Canada, Australia, South Africa and India as specialists. But when my turn came in the 1960s, it was to the U.S. that I was directed, as were the specialists-to-be from all over the world. Later, resident training in hospitals, like the medical schools before them, became regulated. National organizations set standards, defined curricula and assumed the power to approve or close training programs. Ongoing inspections occur every four years and examinations of physician's competency must be passed to assume "specialist" designation.
GOOD CHANGES?
But in my mind, the very technology that propelled American medicine to the forefront is changing the methods of teaching and the expectations of both patient and doctor, no all to the good.
The cost of the CAT scans, MRIs, internal pacemakers, kidney dialysis, coronary artery angioplasty and surgery -- and the list goes on and on -- is becoming prohibitive in this constricting economy and defacto rationing of medical services, so obvious in Canada, is heading south. Physicians are losing their confidence in their physical examination capabilities and are more inclined to send patients for expensive and time consuming tests, performed by machines and reported by doctors who never see the patients, than by undertaking meaningful histories and hands-on examinations.
The practice of medicine is losing that magical and therapeutic special human relationship between doctor and patient and there is no time in medical school, with so much to learn, to imbue that relationship with any sort of value. It is forecast that, in just a few years, surgeons will have lost the skill to examine patients to make diagnosies and will feel and be taught that laboratory tests are not only good enough but that hands-on examination is not worthwhile.
In the distant past, medical diagnosis and treatment was mired in religious incantations and mythical practices. In the near future, it might well be just as much in trouble in the hands of fantastic but inhuman, cold machines. As in just about every aspect of life, the good old days seem always to be in the past.
Dr. Dennis Bloomfield is a cardiologist affiliated with St. Vincent's Medical Center and is president of the Staten Island Heart Society. His column, Heart on your block, appears Mondays in the Health & Fitness section. Questions and comments can be addressed to him in care of the Advance.
(Ref :
http://www.silive.com) |
|
