Sunday, April 8, 2012

Producing A Primary Physician Polymath: No Miracles among Friends Please
Someone who is knowledgeable in variety of subjects: a person of great and diversified learning.
Definition of Polymath
It may be as important for aspiring physicians to understand patients’ social, environmental, and personal characteristics and complex health care systems as to grasp basic biological processes.
Robert Kaplan, PhD, Jason Satterfield, PhD, and Raynard Kington, MD, PhD, “Building a Better Physician- the Case for the New MCAT,” New England Journal of Medicine,  April 5, 2012
April 8, 2012 – In this week’s New England Journal of Medicine, three PhDs (one with an MD) say  the new MCAT (Medical College Admissions Test) may  produce a new breed of physician.
The authors ask, Why change the need for a new MCAT?  

Because, say the authors,  "Evidence indicates that behavioral and social factors profoundly affect health – as both determinants and key factors in preventive and therapeutic interventions.” 
Citing a report by the Association of American Medical Colleges, the authors say,
“Health is influenced by biology, genetics, behavior, interpersonal relationships, cultural, and physical environment.”
True enough,  but none of this is new.   Learning the interrelations and lessons of these things comes down to learning by growing up in one’s cultural environment and experiencing life by interacting with one’s fellow human beings.   

It was always so.  It will continue to be.  There are few young people of genius, and wisdom comes with age.
I suppose  you could pick and build a “better physician" through psychological testing, identifying those steeped in the humanities and liberal arts,   then drilling into them  the nuances and disciplines of the social sciences.  

I, for one, harbor doubts.
Maybe you can select those students likely to be amenable to learning the fundamentals of these core behavioral and social issues. The authors highlight these theme  by presenting the hypothetical case of a 76 year old woman with recent weight loss, insomnia, and knee pain with a complicated behavioral, social, and familial history.   To understand and address her problems, they assert, a primary care physician would have to grasp and conquer these prickly, tricky, and often subjective issues:
·        Medical non-adherence (causes, interventions)

·        Mental health (depression, anxiety, bereavement or greed)

·        Psychosocial stress and coping

·        Alcohol and drug abuse

·        Social support, family dynamics

·        Complementary and alternative medicine 

·        Spirituality

·        Health Literacy

·        Patient education and counseling

·        Prevention and screening 

·        Chronic disease management

·        Geriatric assessment and treatment adaptions

·        Health policy and insurance coverage
Perhaps so.  But understanding and coping with these things is intuitive and experiential and comes with territory of treating patients.   Even if one selected students comfortable with these issues, they would modify how they feel as they go through the medical education and practice process.   They would learn our  culture tends to reward narrow specialists rather than broad-based generalists, that there is not time in a practice day to master all of these disciplines,   that very few of us are capable of become polymaths  or  renaissance men and women, equally knowledgeable in a variety of subjects.  Besides, there are very few polymaths at age 21 to 25.  That identity evolves later.
As  I read the article,  I thought of one of my  favorite books,  No Miracles Among Friends, (1960) by  Sir Heneage  Ogilvie, an English surgeon  who assembled a travelling  group of fellow surgeons  to talk about the importance of experience, leisure, judgment, and the human heritage.
To illustrate his point, he recounted listening to Frank Lahey, M.D., the surgeon who founded the Lacey Clinic speak. Lahey often told this little Bible Story.
“During the early years of the first century the faithful disciples wandered far and wide preaching and making converts.   One day, St. Peter and St. Paul both arrived at an inn in Jerusalem on the same night, weary and footsore.  They called for wine and refreshed themselves, and then fell into the argument common to travelers as to who should pay the reckoning.  Peter suggested   throwing the dice. Paul fetched them, shook the box and  tossed a four and a five.  He handed the box to Peter, who shook, and threw two sevens , Paul gave him a long look, and said sadly, “Peter, old man, no miracles among friends, please."
We may be able to select physicians destined to be polymaths, but  the results are unlikely to produce   a new crop of  Renaissance  man and women.
Tweet:   Three authors in April 5 NEJM  say a new MCAT might help select medical students who will become broadly based in the social sciences

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