Two studies challenge traditional criteria for a “good” doctor

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What makes a good doctor in the United States?

Certainly one that graduates from a prestigious American medical school. And one that’s also pretty good at the sciences, like physics and chemistry.

But two recent studies suggest we should think more broadly — both figuratively and literally.

A study published last week in Academic Medicine, the journal of the Association of American Medical Colleges, says students who majored in humanities and social sciences performed just as well in medical school as students who took traditional hard science classes.

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Another study published Tuesday in the journal Health Affairs says foreign-born doctors trained overseas actually achieved lower patient death rates than American born, American medical school graduates.

As any pre-med student can attest, getting into medical school in America  requires you to ace your physics and organic chemistry classes, and score well on the Medical College Admissions Test, the dreaded MCATs. However, Mt. Sinai School of Medicine offers a unique program that allows a small number of students who studied humanities and social sciences to bypass those criteria and attend med school.

The Academic Medicine study compared outcomes for 85 students in the Humanities and Medicine Program with those of 606 traditionally prepared classmates from the graduating classes of 2004 through 2009, and found that their academic performance in medical school was equivalent.

“There’s no question,” study author Dr. Nathan Kase told the New York Times. “The default pathway is: Well, how did they do on the MCAT? How did they do on organic chemistry? What was their grade-point average?”

“That excludes a lot of kids,” said Dr. Kase, who founded the Mount Sinai program in 1987 when he was dean of the medical school, and who is now dean emeritus and a professor of obstetrics and gynecology. “But it also diminishes; it makes science into an obstacle rather than something that is an insight into the biology of human disease.”

The idea behind the program is that a humanities education might make a future doctor … well, more human. That a good doctor treats both the disease and the patient.

From the Times: “For decades, the medical profession has debated whether pre-med courses and admission tests produce doctors who know their alkyl halides but lack the sense of mission and interpersonal skills to become well-rounded, caring, inquisitive healers.”

Some experts say medical schools tend to emphasize technical skill over emotional competence. Helping students cope with the rigors of their profession in medical school might help prevent disruptive behavior long after they graduate, they believe.

A 2005 study published in the New England Journal of Medicine concluded “disciplinary action among practicing physicians by medical boards was strongly associated with unprofessional behavior in medical school. … Professionalism should have a central role in medical academies and throughout one’s medical career.”

So maybe a little art and literature sophomore year couldn’t hurt.

As Americans, we tend to distrust anything foreign, with the possible exception of cars and luxury goods. That’s especially true of doctors — if we had the choice of a doctor who graduated from Harvard University or China’s top medical school, who do you think will win out?

Rest assured, that Chinese doctor is just as qualified to treat patients as that Harvard grad, according to the Health Affairs study.

The study analyzed 244,153 hospitalizations of patients with congestive heart failure or acute heart attack in Pennsylvania who were treated by either a U.S.-trained or foreign-trained doctor who specialized in family medicine, internal medicine or cardiology. The composition of the 6,113 doctors in the study closely mirrors national figures, with graduates of U.S. medical schools accounting for approximately 75 percent of the study group and graduates of international schools 25 percent.

The study found that patients treated by foreign-trained doctors suffered from significantly lower mortality rates than U.S. medical school graduates. Interestingly enough, American-born doctors who trained overseas performed the worst.

Perhaps American medical schools don’t enjoy a monopoly on producing high-quality physicians after all.

Both studies seem to make the argument that we should broaden our pool of potential doctors if anything to help alleviate the shortage of physicians in this country.

“These findings bring attention to foreign-trained doctors and the valuable role they have played in responding to the nation’s physician shortage,” said Dr. John J. Norcini, president and chief executive officer of the Foundation for Advancement of International Medical Education and Research (FAIMER) and lead author of the study.

“U.S. medical schools are doing their part by expanding for the first time in 30 years, but the number of graduate training programs has not increased proportionately,” Dr. Norcini said. “If this continues, the current physician shortages will persist and the numbers of foreign-trained doctors will likely decrease significantly.”

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Thomas Lee

By Thomas Lee

Thomas Lee was the Minnesota Bureau Chief for MedCityNews.
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