Monday, January 28, 2008

Harvard Med

Lake Worth, Florida - I take along a book on my trips. For this trip, I chose Harvard Med: The Story Behind America’s Premier Medical School and the Making of America’s Doctors (Adams Media, 1996).

I’m not a Harvard med man. I went to Duke. But I knew the author, John Lagone, a journalist who died last year in his 70’s of lymphocytic lymphoma. John worked for newspapers and wrote 15 books on social, medical, and technology issues. One of his books, for the Smithsonian, The Way Things Work, became a best seller. John also reviewed scores of health-related books for the New York Times.

Harvard Med recounts a year in the life of a Harvard Medical School class. John describes the mix, backgrounds, skills, drives, and dreams of incoming students. He focuses on the culture of the school - its history, attitudes, biases, strengths, and ambience, “It is, “ he says, “and is likely to remain a haven for 3Ms – male medical magistri, gowned gurus who are far more scholar, researcher and specialist than empathetic, readily available healers – and for the students who want to emulate them.” It is not, he says again and again, not an ideal breeding round for primary care physicians.

In one chapter “Science is Easy, Humanity is Hard.” John notes how hard it is to insert compassion into course work. The problems, he observes, are dominance of science and technology, massive amounts of hard facts to be absorbed, sheer constraints of time, and realities of where rewards lie in our high tech health system. It is not an environment conducive to teaching primary care. Most training takes place in hospital acute care pressure cookers. Most outpatient training occurs in clinics at one of Harvard’s twenty hospitals, which serve poor and disenfranchised minorities many of whom are struggling to learn English. This may not be ideal training ground for caring for mainstream Americans.

Don’t misread me. John is a huge fan of Harvard Med, its eminence, its world class faculty, and its reputation as a research facility. He is just saying much of the Harvard students’ medical education occurs in a tertiary, indeed quaternary, referral hospital setting.

As I read John’s fine book, I’m reminded the more things change, the more the rhetoric heats up about health reform, the more things remain the same. The emphasis in American medicine remains on acute care, technological fixes, and research breakthroughs. In these areas reside the missionsof Harvard Medical School, and it does them superbly. But these missions leave little time for primary care. For aspiring primary care physicians, the rewards, incentives, peer approval, and personal gratification are not there.

1 comment:

epistemocrat said...

"For aspiring primary care physicians, the rewards, incentives, peer approval, and personal gratification are not there."

As one of the above mentioned students, I could not agree more. Somehow, we must turn our healthcare system upside down ... keep up the great work with this blog!