Medical Education today
IT’S NOT TOO LATE:
A DOZEN IMPORTANT TOPICS TOO OFTEN NEGLECTED IN MEDICAL TRAINING Philip R. Lee, MD, Steve Heilig, MPH, and Gordon Fung, MD, PhD Note: In honor of the late Phil Lee, MD, UCSF Chancellor Emeritus and so much more, who died recently (his obituary appeared in our last issue), we are reprinting this article he co-authored for us years ago. There have been varying degrees of advances regarding some of these topics; but in any event it is a list worth keeping in mind as medical education evolves with the times. We know UCSF is a leader in this regard and in at least some way we can all thank Phil for that.
Medical Education is filled with important topics, and as knowledge increases, it is ever more difficult to “triage” what is most essential. Thus it is problematic to suggest that even more be taught in those finite years of formal medical education. However, there is also much evidence that historically, some important topics have been too often neglected. What follows is a somewhat subjective list—but one based upon research, reports and experience.
1. ADDICTION: The AMA long ago called drug abuse our nation’s number one public health problem, and our opioid abuse epidemic sadly seems to confirm that. The addicted are not just the stereotypical street junkie, but everyday patients misusing legal drugs such as alcohol, tobacco, and prescription medications. Co-diagnoses of depression and other psychiatric issues are also often neglected. Many MDs are not very knowledgeable about addiction and are uncomfortable addressing it.
2. NUTRITION AND COMPLEMENTARY THERAPIES: Many patients can benefit from improvements in what they eat, and many utilize nutritional supplements and other “alternative” or “complementary” approaches most physicians know little about —and patients often suspect that. Physicians should become informed about and counsel their patients regarding nutrition. 26
SAN FRANCISCO MARIN MEDICINE
3. SEXUALITY: How comfortable is the average MD in talking about sexual practices and health? Homosexuality? Sexual dysfunction? Sexually transmitted infections? Contraception? Taking the time to delve into the “uncomfortable” realms of sexuality can not only strengthen rapport but will allow an MD to address specific health needs that tend to go unrecognized.
4. PAIN: Pain, particularly chronic pain, is often under-treated in this country, particularly toward the end of life. On the reverse side of the equation is the epidemic of prescription drug abuse, which often requires a delicate balance of needs. Much improvement in measuring and treating pain has taken place in recent years; more physicians need to become current on such skills.
5. END-OF-LIFE CARE: Medicine is not only about “cure,” but also about caring for patients when that is no longer an option. Palliative care is a growing discipline with great rewards. Physicians need to know how to help ease patients (and their loved ones) into a palliative mode, to use therapies and medications in optimal ways as death approaches, and to work with skilled hospice and other such professionals. 6. PHYSICAL FITNESS: We all know exercise is good. Our bodies are built to be used vigorously. But too many people are sedentary, which is reflected in our nation’s obesity problem. How many MDs are able to effectively address and motivate patients towards fitness and weight loss?
JANUARY/FEBRUARY/MARCH 2021
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