Lament Over Education; or, I'm Going Through a Little Blue Period of Sorts...

I have become convinced that (perhaps unbeknownst to itself) this country doesn't give a flying frigging rat's patooty about education.

Worse: I think a lot of people here actually see being educated as a negative - at best, an "elitist" goal; at worst, a useless endeavor; and somewhere in between, an embarrassing obligation.

Someone please tell me I am wrong and am just going through a little slump triggered by thoughts of being on call every other night at the end of next month. Please. Someone please reassure me that all the propaganda about reading to our children isn't just empty hypocrisy in light of how little we end up reading as adults.

Here's what's behind my momentary cynicism. American politics, for one thing. And for another, American pre-medical education. Both worlds, incidentally, highly competitive, centered around defeating opponents and making oneself appear irresistible despite the reality of one's qualifications. And both worlds ones in which a solid grounding in the humanities AS WELL AS the sciences - in other words, a well-rounded education - seems grossly undervalued.

Let's leave politics alone right now; there's no shortage of verbiage on it all across cyberspace. But what of becoming a doctor?  What of pre-medical education?  Why are we still wondering what that educational path should consist of, after discussing it, criticizing it, revamping it, defending it, and criticizing it yet again, for the last hundred years?

I believe all doctors should be well-educated people who appreciate the value of a truly liberal education. But a lot of doctors echo in spirit what one thoracic surgeon once said when the patient was surprised to learn she hadn't read an author that the patient had been discussing with me as I placed monitors before administering the anesthetic. The surgeon said to the patient, a little acridly, "No, I was busy reading things that would actually be helpful to you." I wanted to make a little sound of incredulous protest but I held my tongue. I was surprised, though, by the intensity of my own resentment of her remark. I felt personally affronted.

Let me tell you, my having had to learn organic chemistry has NOT been helpful to my patients, and I've forgotten it all. All of it. Hours of effort, sweat, and tears - gone. Calculus is NOT helpful to my patients either (though I did use some arithmetic once trying to calculate how much bicarb to give somebody in an extreme state of acidosis). The work in medical school is do-able for anyone who is reasonably intelligent, interested in the material, and willing to work very, very hard. It was certainly easier than organic chemistry for me, and more relevant...though a lot of what we learn in medical school never, ever comes up again in clinical practice (unless you're an anesthesiologist; then it comes up every day). Whatever you end up choosing, though, chances are having gotten an A in orgo was no more predictive of your being a good doctor than getting a B or a C, and getting a B or a C no less predictive than getting an A. 

Don't get me wrong; I believe a strong education in science is integral to medical study and of vital importance regardless of one's chosen profession.  But encouraging intense focus on hard sciences, for a secondary goal (admission to med school) rather than for the sake of science itself, to the exclusion of the humanities, selects for a very particular (competitive, self-interested, often arrogant, and at times, decidedly un-empathetic) type of student - often, for students who get really good at shutting themselves up in rooms with their noses in textbooks away from the rest of teeming, suffering humanity. 

Authors Jeffrey Gross, Corina Mommaerts, David Earl, and Raymond De Vries couldn't have painted a more accurate picture when they wrote in their paper for the journal Academic Medicine,

"The requirements established by medical school admission committees and the courses and tests used to weed out those who are not qualified to become physicians do more than lay the groundwork for the rigors of medical school - they also create a premedical student culture with a distinctive set of norms and values.  One does not have to believe in the existence of the premed syndrome - excessive concern with grades, extreme competitiveness, and lack of sociability - to acknowledge that during the premedical years, students learn more than information from their textbooks and teachers."

If medical students end up forging effective relationships with members of suffering humanity, understanding the ramifications of their patients' conditions, and negotiating the often complex journey from clinical evaluation to clinical decision, it's not only because of those hours of isolation spent memorizing facts that they won't be applying in the practice of their art anyway. It's because they learned, in the course of their journey into adulthood, how to participate in story and relationship - how to understand, evaluate, discern, and communicate. The ones that aren't afraid to touch their patients on the first day on the wards already have something that can't be taught - but that can be learned.

I'm with Lewis Thomas: let's stop encouraging the formation of stereotypical "pre-meds" (carbon-based life forms) and start going for real people (flesh and blood and, if we're lucky, soul). He wrote, "I have a suggestion, requiring for its implementation the following announcement from the deans of all the medical schools: henceforth, any applicant who is self-labeled as a premed, distinguishable by his course selection from his classmates, will have his dossier placed in a third stack of three. Membership in a premedical society will, by itself, be grounds for rejection."

Huzzah, I say. Let's do it. Then maybe after another hundred years there will have been enough talk and revamping of medical education that we'll actually be nurturing physicians-to-be who, instead of making "strategic" pre-med choices to project the best "image," will be making genuinely self-edifying choices to be the best human beings they can be - and thus the best doctors.