What is your education level?

[bhsmte]

Well, to be fair, Modern Medicine functions by Evidence Based Medicine (EBM). EBM is arguably not scientific at all, although a form of Empiricism. This is largely forced by the nature of Medical Ethics, that studies with negative outcomes can never be ethically repeated, and thus all are treated as non-falsifiable. Each study is treated as a non-repeatable piece of data. The studies are then given different Evidence classes, essentially graded as to worth, and plugged into arcane statistical analyses to determine which conclusion should be given more weight and has a better confidence interval - thus which result can then be treated as best practice. In the classic Popper-style paradigm, EBM is non-falsiable, non-repeatable and this is in fact why it is called Evidence-Based and not Scientific Medicine. My medical school always said Medicine was more of an art than a science.

Here is an interesting piece on it. I also have some articles from the AMA on the difference between Science and Medicine if you are interested.

Medicine: Science or Art?

Being in healthcare for a long time, I would say most would agree, medicine is part art and part science.

I think they would also agree, it has moved towards being more focused on "evidence based" care for quite some time though.

 

[OldWiseGuy]

Well, to be fair, Modern Medicine functions by Evidence Based Medicine (EBM). EBM is arguably not scientific at all, although a form of Empiricism. This is largely forced by the nature of Medical Ethics, that studies with negative outcomes can never be ethically repeated, and thus all are treated as non-falsifiable. Each study is treated as a non-repeatable piece of data. The studies are then given different Evidence classes, essentially graded as to worth, and plugged into arcane statistical analyses to determine which conclusion should be given more weight and has a better confidence interval - thus which result can then be treated as best practice. In the classic Popper-style paradigm, EBM is non-falsiable, non-repeatable and this is in fact why it is called Evidence-Based and not Scientific Medicine. My medical school always said Medicine was more of an art than a science.

Here is an interesting piece on it. I also have some articles from the AMA on the difference between Science and Medicine if you are interested.

Medicine: Science or Art?

My doctors have all been 'scientists' in that they focus only on the efficacy of the medications and ignore the side effects of such. In fact when I mention them their eyes glaze over and they mimic the three monkeys with their hands: Hear, see, and speak no 'evil' (evil = anything that sheds even a slight negative glimmer on their prescribed meds).

 

[jayem]

I don't understand the impetus to premed. Medical school is long enough as is, and does it really change anything? It doesn't seem as if premed need be anything medically related, so why on earth do it?

Attending college before medical school is largely a tradition. It's based on the idea that a physician should be a broadly educated and erudite person. It started in the early 20th century as a result of the Flexner Report. American medical education had been dominated by for-profit medical schools of widely varying, but generally poor quality. There was no standardization, admission standards were non-existent, and state regulation of medical training was spotty. Abraham Flexner, an educator, did a very influential study of medical schools, which recommended much more rigorous didactics, and much stricter standards for student admissions. Which should include a college education. That's become the traditional American model which has been followed ever since. And as you know, (even though our country was founded in rebellion against established authority,) we Americans are strongly wedded to our traditions. Here's a link:

https://ualearn.blackboard.com/bbcs....201240/readings/Ludmerer-Flexner-AcadMed.pdf

My country doesn't expect a premed. We have six years of medical school, followed by a 2 year internship and 2 year community service. So it takes 10 years to be registered as a plain general practitioner or medical officer. The first two years of medical school partially incorporates study of Chemistry, Physics, Biology and Sociology in general and a little Greek and Latin for medical nomenclature though.

We have something like that. There are some 6 year programs that combine undergrad and medical school. Students are accepted after high school and receive both a bachelors and medical degree at graduation. The academic years are extended into the summers. Premed courses are taken in the first 2 years, though some clinical exposure is included. If you know with certainty that medical training is your calling, then this path saves time and money.

 

[Quid est Veritas?]

There seems to be confusion as to what I mean, which is understandable as even some doctors don't really understand EBM.

EBM has revolutionised Medicine, but it has not made it more 'scientific'. Cochrane and Feinstein, two of the framers of EBM, were instrumental in it not being called Scientific Medicine, as some initially wanted it to be called. Evidence-Based practice is increasing, because it is useful and a good thing, but it should be understood in context.

The art of Medicine is not just in bedside manner, but also in which treatments to employ or drug regimens to choose. EBM suggests what is 'Evidence-Based Practice', but it is an heuristic technique. It suggests what should be followed, but by no means says this is therefore correct. As I said, Medical studies cannot be repeated or disprove other studies. Even if a study found just a slight increase in morbidity, ethically it can't be repeated since you are then negatively impacting some participants' health. It is the problem of non-maleficence. Much medical practice thus hinges on flimsy evidence of one or two small studies, so really should not be taken as absolute gospel. You can't just say Evidence says this and slavishly follow the guidelines, for that would make you a poor doctor. The evidence needs to be weighed and assessed based on the patient in front of you, for on occasion you would need to throw in your lot based on weaker evidence or against it.
Sometimes it is clear cut and definitive though, such as with the efficacy of Aspirin or Statins.

Good examples here are with Digoxin, which shows no decrease in mortality by Evidence-Based means, but which is still employed for symptomatic relief. It increases the cardiac output, so in sick patients that require it, by inductive reasoning it should increase life-expectancy, and EBM has not altered this understanding. So there is a lot of disagreement.
Similarly antidepressants, which Kitsch showed mostly had effectivity that could not be confidently said to be beyond Secondary Placebo effect (except Sertraline). The confidence interval is slim. So do you prescribe them or not, as they have significant side effects?

Or in my own field, Cricoid Pressure. This is pressing on the cricoid cartilage during Anaesthesia to prevent passive regurgitation of stomach content into the lungs. It is used worldwide based on 1 study done in pregnant patients. It cannot be repeated, because that showed a protective factor - yet cricoid pressure distorts the airway, making intubation more difficult; requires pressure of 10 mN, which no one really knows if sufficient is given; can cause oesophageal tears if patient actively wretches; 40% of patients the oesophagus is not behind the cricoid anyway; etc. The study was also done in pregnant patients that have decreased lower oesophageal sphincter tone, so we don't even know if it works at all in non-pregnant patients.
So EBM says to give cricoid pressure, but should you? You need to look at each patient and decide if you think these risks outweigh the presumed benefits, or not. Whether this specific patient would benefit in your opinion. In other fields studies could be done, and oblique approaches like cadaver studies can shed light on it, but Evidence alone can't tell you. This is the Art of Medicine.

 

[Quid est Veritas?]

My doctors have all been 'scientists' in that they focus only on the efficacy of the medications and ignore the side effects of such. In fact when I mention them their eyes glaze over and they mimic the three monkeys with their hands: Hear, see, and speak no 'evil' (evil = anything that sheds even a slight negative glimmer on their prescribed meds).

This happens. If people with dangerously high cholesterol for instance, come around complaining of muscle cramps from their statins, what are you going to do? Statins extend life expectancy significantly and there really is no other show in town. You can basically give analgesia, advise lifestyle modifications, monitor the lipid levels, and shrug your shoulders.
Other times you can substitute meds or alter the formulations, but this is not always possible.

Medicine is not magic. We can't solve all problems.

 

[OldWiseGuy]

This happens. If people with dangerously high cholesterol for instance, come around complaining of muscle cramps from their statins, what are you going to do? Statins extend life expectancy significantly and there really is no other show in town. You can basically give analgesia, advise lifestyle modifications, monitor the lipid levels, and shrug your shoulders.
Other times you can substitute meds or alter the formulations, but this is not always possible.

Medicine is not magic. We can't solve all problems.

I am proactive about it, which has helped.

 

[Christie insb]

I am just curious what the average education level is on this site, so I decided to make a poll. In the comments feel free to expand if it what type of education.

Master's in Social Work. Master's level education is the most common answer (the mode?) I would not expect that, especially because the group includes people still in school.

 

[Christie insb]

I don't understand the impetus to premed. Medical school is long enough as is, and does it really change anything? It doesn't seem as if premed need be anything medically related, so why on earth do it?

My country doesn't expect a premed. We have six years of medical school, followed by a 2 year internship and 2 year community service. So it takes 10 years to be registered as a plain general practitioner or medical officer. The first two years of medical school partially incorporates study of Chemistry, Physics, Biology and Sociology in general and a little Greek and Latin for medical nomenclature though.

I hold an MBChB which is roughly equivalent of an MD, and I am registered to practice Medicine as such in Canada. I have an additional qualification in Anaesthesia, although I am still in the process of becoming a full fellow of the College, which entails doing an MMed.

So are you saying you can enter medical school directly from high school? I would like my doctor to have a more well-rounded education. But as much as I see little difference between U.S. citizens and Canadian citizens, I know the higher education idea is different.

 

[Quid est Veritas?]

So are you saying you can enter medical school directly from high school? I would like my doctor to have a more well-rounded education. But as much as I see little difference between U.S. citizens and Canadian citizens, I know the higher education idea is different.

You misconstrue. I am South African. MBChB-type degrees are granted by the UK and some commonwealth countries, so I just mentioned that I am also registered to practice Medicine in Canada to illustrate the equivalency to an MD. South Africa, the UK, Australia, India, etc. have programmes to enter medical school directly from high school if your grades are good enough, and medically relevant BSc courses that act as a pre-med if not. Some in the US however insist on pre-med education, which need not be medically related at all.
I don't see why studying something unrelated would make one a better doctor though, and the end result would be someone with less actual time studying medicine by the time they enter unsupervised practice.

 

[grasping the after wind]

This happens. If people with dangerously high cholesterol for instance, come around complaining of muscle cramps from their statins, what are you going to do? Statins extend life expectancy significantly and there really is no other show in town. You can basically give analgesia, advise lifestyle modifications, monitor the lipid levels, and shrug your shoulders.
Other times you can substitute meds or alter the formulations, but this is not always possible.

Medicine is not magic. We can't solve all problems.

Unfortunately for me and others that have experienced the same, some physicians I dealt with in the past dispensed drugs as their first solution to any physical problem. IMO they were predisposed to do so even if the problem was minor or not an impending danger but the side effects might be major and immediate. I now frequent a physician that allows me to ask questions and defers to my knowledge of my own body( I have lived with it for 63 years and am much more intimately acquainted with it than anyone else on the planet. ) . Even so a recently tried medication that was probably not essential at all in treating the minor blood pressure problem I have (genetic btw as my father who was 5'11 and weighed 150 lbs and was quite physically fit also had this problem) led to a bout of gout. The rhyming was unintended. I blame myself not the doctor for this as it is my responsibility more than the doctor's to monitor my body and my meds. I was neglectful in not noticing that my level of uric acid, clearly shown in my regular yearly testing, was suddenly high normal when it was never at that level before and in not reading the side effects of the medicine one of which was to block the elimination of uric acid leading to the possibility of gout. One should not expect a doctor to notice things about oneself that one does not bring to that doctor's attention.

As for my ed level, Master's

 

[bhsmte]

Unfortunately for me and others that have experienced the same, some physicians I dealt with in the past dispensed drugs as their first solution to any physical problem. IMO they were predisposed to do so even if the problem was minor or not an impending danger but the side effects might be major and immediate. I now frequent a physician that allows me to ask questions and defers to my knowledge of my own body( I have lived with it for 63 years and am much more intimately acquainted with it than anyone else on the planet. ) . Even so a recently tried medication that was probably not essential at all in treating the minor blood pressure problem I have (genetic btw as my father who was 5'11 and weighed 150 lbs and was quite physically fit also had this problem) led to a bout of gout. The rhyming was unintended. I blame myself not the doctor for this as it is my responsibility more than the doctor's to monitor my body and my meds. I was neglectful in not noticing that my level of uric acid, clearly shown in my regular yearly testing, was suddenly high normal when it was never at that level before and in not reading the side effects of the medicine one of which was to block the elimination of uric acid leading to the possibility of gout. One should not expect a doctor to notice things about oneself that one does not bring to that doctor's attention.

As for my ed level, Master's

Agree in general and you are correct, there are a good deal of docs, who get prescription happy. There are also a fair amount of docs, who really know very little about fitness and nutrition, which is also an issue.

The other reality is, diseases are typically not cured, they are controlled, which is something many do not realize. Sometimes medication is the best method to create this control, sometimes it is life style changes and many times a blend of both.

 

[grasping the after wind]

Agree in general and you are correct, there are a good deal of docs, who get prescription happy. There are also a fair amount of docs, who really know very little about fitness and nutrition, which is also an issue.

The other reality is, diseases are typically not cured, they are controlled, which is something many do not realize. Sometimes medication is the best method to create this control, sometimes it is life style changes and many times a blend of both.

Cannot disagree with anything you said. Some things are incurable and cures are less profitable than treatments, as they are one time things where treatments continue to provide income. So treatments garner more attention from those in the wellness industry that are seeking to continue profiting from unwellness. I would expect we will always see an emphasis on treatment over curing unless a cure could somehow be made to incur a continuing charge and the cure removed or the disease reinstated for delinquency in payment. . In the end, Jim Morrison was correct even if people do not want to accept it so obsessing over how to prolong life is a fruitless endeavor.

 

[bhsmte]

Cannot disagree with anything you said. Some things are incurable and cures are less profitable than treatments, as they are one time things where treatments continue to provide income. So treatments garner more attention from those in the wellness industry that are seeking to continue profiting from unwellness. I would expect we will always see an emphasis on treatment over curing unless a cure could somehow be made to incur a continuing charge and the cure removed or the disease reinstated for delinquency in payment. . In the end, Jim Morrison was correct even if people do not want to accept it so obsessing over how to prolong life is a fruitless endeavor.

Well, if you look at the major disease states that impact quality of life and life expectancy; heart disease, diabetes, cancer, bowl diseases, renal diseases etc., these are typically diseases that have to be controlled and kept at bay, vs them being completely wiped out. Cancer, is the one exception, that is eradicated in some cases and if caught quickly, but the risk of return, is always higher with these folks.

To come up with a cure for these diseases, with the complex physiology and genetics that comes into play, is a tad difficult to say the least.

 

[grasping the after wind]

Well, if you look at the major disease states that impact quality of life and life expectancy; heart disease, diabetes, cancer, bowl diseases, renal diseases etc., these are typically diseases that have to be controlled and kept at bay, vs them being completely wiped out. Cancer, is the one exception, that is eradicated in some cases and if caught quickly, but the risk of return, is always higher with these folks.

To come up with a cure for these diseases, with the complex physiology and genetics that comes into play, is a tad difficult to say the least.

I am unfamiliar with bowl diseases but the others you mentioned,even Cancer in some cases,
can be caused by lifestyle choices. There is great lipservice paid to preventative medicine but not much by way of actual practice of it.Then again if one lives long enough something will give out. So one chooses between enjoyments. Some choose to enjoy more health and longer life others choose to enjoy the moment. Unfortunately that is not a universal condition as many don't get to choose but have things forced upon them by nature or by chance.

 

[GrowingSmaller]

I dropped out of secularism and took up faith.

 

[Landon Caeli]

I dropped out of preschool.

 

[Paidiske]

BSc (majored in genetics and immunology), MDiv, Advanced Diploma of Ministry.

I appreciated the comment upthread about not approaching biology like an engineer. It was very difficult for me to learn not to approach theology like a scientist!

 

[Mountainmanbob]

Dropped out of college a few times.
(Some college).

Owner of a few businesses that was cause for some self-education.

Thrown into the political light. That was a rough education. Learning what is not taught in school.

Retired and happy up top the mountain.
It's been a long ride.

M-Bob