The post-pandemic doctor

The Indian Express     16th July 2021     Save    
QEP Pocket Notes

Context: Covid should catalyse changes in medical education, orient it towards scientific sensibility, compassion.

Issues with the current model of medical education: The Covid-19 pandemic could provide the catalytic spark for more reforms by throwing light on many areas that medical education must address.

  • Reductionist approach: 
    • Major reforms in Western medical education began after the Flexner report of 1910 advocated structured, science-based and laboratory supported learning, replacing the apprenticeship model.
    • However, Western models imposed the rigidity of a reductionist approach that increasingly focused on partitioning the human body into organs, tissues, cells and sub-cellular structures.
  • Disconnect from the real world: Indian medical colleges, usually located in an urban ambience and linked to tertiary care hospitals, were disconnected from the real-world functioning of a multi-layered health system.
  • Rush for information (Infodemic): The rush for information during the pandemic has removed the inadequate protective filters, with unreviewed publications getting circulated as preprints.
  • Lack of adequate capacity for interpretation and building research design: 
    • Without adequate research capabilities, inappropriate tests and ineffective medicines are prescribed by doctors in the misguided belief that they are doing good to their patients.
    • Apparently, promising anti-hypertensive and anti-arrhythmic drugs even caused harm, despite appealing biological rationale.
    • For e.g. During the Covid pandemic, drugs like hydroxychloroquine failed when put to clinical trials.
    • This also leads to a situation where doctors develop a naïve belief that a positive test always means the presence of disease and a negative test signifies its absence, further leading to the piling up of wasteful tests.

Way Forward:

  • Building a multi-disciplinary, socially responsive model of education: In 2010, an independent global panel, The Commission on Health Professional Education in the Twenty-First Century, advocated a multi-disciplinary, socially responsive model of education.
  • Imparting good research design and interpretation: Medical education must teach the essential principles of epidemiology and statistics that underlie good research design and interpretation.
    • Doctors should judge a research study for both internal validity (how true are the reported results likely to be) and external validity (how applicable are the recommendations to their patients or population).
  • Promote and provide skills on telemedicine: Medical education must impart the needed technical and social skills to make teleconsultations effective and safe.
    • The growth of telemedicine requires that medical students be trained to efficiently evaluate patient data and make competent management decisions, even from a distance.
    • Telemedicine may involve engagement with the patient, an attendant or with a primary care team member.
  • Imparting skills of effective communication: Precise, accurate, jargon-free, confident and clear communication is needed in such interactions.
    • Even when the doctor in a hazmat suit appears an alien, caring communication is possible through the tone of voice, well-chosen words that convey compassion and even non-verbal gestures to show care.
    • The public health pioneer Livingston Trudeau once said the duty of a physician is “to cure sometimes, to relieve often, to comfort always”.
QEP Pocket Notes