Human Exceptionalism

“Hypsokilia:” Are Our New Doctors Poorly Trained?

A very interesting and disturbing article, written by medical school professor Dr. Herbert L. Fred, has been published in the Texas Heart Institute Journal. Dr. Fred warns warns that our medical students have a “laboratory oriented” rather than a “patient oriented” mindset due to poor training. From his article:

I call this malady hyposkillia–deficiency of clinical skills. By definition, those afflicted are ill-equipped to render good patient care. Yet, residency training programs across the country are graduating a growing number of these “hyposkilliacs”–physicians who cannot take an adequate medical history, cannot perform a reliable physical examination, cannot critically assess the information they gather, cannot create a sound management plan, have little reasoning power, and communicate poorly. Moreover, they rarely spend enough time to know their patients “through and through.” And because they are quick to treat everybody, they learn nothing about the natural history of disease.
These individuals, however, do become proficient at a number of things. They learn to order all kinds of tests and procedures–but don’t always know when to order or how to interpret them. They also learn to play the numbers game–treating a number or some other type of test result rather than the patient to whom the number or test result pertains. And by using so many sophisticated tests and procedures, they inevitably and unwittingly acquire a laboratory-oriented rather than a patient-oriented mindset. Contributing to this mindset, incidentally, are the health maintenance organizations that force physicians to care for a maximum number of patients, in a minimal number of minutes, for the lowest number of dollars.

That ain’t all:

The bottom line is this: While modern medical technology has greatly enhanced our ability to diagnose and treat disease, it has also promoted laziness–especially mental laziness–among many physicians. Habitual reliance on sophisticated medical gadgetry for diagnosis prevents physicians from using the most sophisticated, intricate machine they’ll ever and always have–the brain.

Tough stuff, but I think it is important for all of us to read the whole thing. Dr. Fred says, in essence, that the art of medicine is being tossed overboard. He goes into some of the societal causes of the problem about which he is warning and suggests some remedies.

I thank him for his courage in bringing this cause for concern to the attention of his colleagues and through the wonders of computer-downloading and linking, to all of us.

HT:Gerry Sotomayor