From: hrubin@pop.stat.purdue.edu (Herman Rubin)
Newsgroups: sci.med
Subject: Re: Questions for MDs
Date: 31 Jul 92 19:26:45 GMT
Organization: Purdue University Statistics Department

In article <15903@pitt.UUCP> km@cs.pitt.edu (Ken Mitchum) writes:
>In article <55403@mentor.cc.purdue.edu> hrubin@pop.stat.purdue.edu (Herman Rubin) writes:
>>In article <15851@pitt.UUCP> km@cs.pitt.edu (Ken Mitchum) writes:

>>			....................

>>>Training is a side issue. I have no objection to cutting down on
>>>intern and resident hours, if the number of years of training is
>>>increased to make up for it. You can't learn the same amount
>>>working 40 hour weeks as working 80 hour weeks.

>>One can even raise the question as to whether one learns more in
>>80 hour weeks than in 40 hour weeks, or less.  

>>But in any case, the amount of training should be totally irrelevant.
>>We should not be at all interested in time served as a student or an
>>apprentice or whatever.  It is the knowledge and ability which is what
>>should be considered.

>Herman, again, you are talking about a subject of which you know
>absolutely nothing. The knowledge a medical student has when then
>MD is granted at the end of medical school is very minimal. The
>real learning comes in internship and residency (and possibly
>fellowship) and you learn medicine only one way: by seeing and
>caring for patients. 

This may or may not be true.  But instead of seeing 10,000 patients,
one could have videotapes of a few hundred and seeing a few hundred.
One does not learn very much by seeing the hundredth patient with 
the same symptoms.  "Any fool can learn from his own experience;
the wise man learns from the experience of others."  I agree with
the second clause, but not necessarily with the first.

The really bright person needs very little experience to develop
the understanding.  And one does not get understanding by memorizing
books; the understanding is what counts, and it matters not one bit
to the patient how it was obtained.

			.....................

>TIME is also important because there are some diseases you only see
>rarely, and if training is abbreviated, you won't run into them. There
>are several diseases that I have only seen once, and if my training
>had been abbreviated, I would have missed them. 

There are probably a large number of diseases you have never seen.
If your training went on until you had seen all known diseases, you
would never have advanced to the stage of practicing medicine.  We
should be using modern technology to increase your experience.

As for deciding when "enough is enough," it should not be done by
counting hours or years.  

>There are aspects of medical training that really are hazing, and 
>these should be elliminated, but the time spent in training is not
>one of them. The time element varies quite a bit between specialties,
>and this is natural: the specialties that rarely deal with emergencies
>and think-on-your-feet situations have far less grueling schedules. 

Again, for emergency situations, it is not the time spent which 
counts, but the knowledge, ability, and the development of reflex.
The patient does not care how many hours you spent practicing, but
how well you can do it.  All criteria should be "practical" in this
sense, not counting hours or credits.

>Herman, I know that you would like to be treated by a doctor who
>sits in a library and doesn't waste his/her time touching people,
>but I wouldn't. I have known a few physicians like that and without
>exception they are idiots.

The intelligent person understands his (no sexist remarks, please)
capabilities and deficiencies.  I would expect an intelligent 
physician to know when more practice is needed, and I would hope
that the establishment provides ways of getting it, although I
have my considerable doubts.

When people come to me with problems, I can often tell them how
the numerical analysis will work, although I may never have done
a problem of that type.  On other problems, I may not be able to
do this, but I can limit the promising avenues, although I am
always aware that some I have decided are not promising may be.
On some others, extensive "playing around" with the data may be
needed before obtaining any useful results.

-- 
Herman Rubin, Dept. of Statistics, Purdue Univ., West Lafayette IN47907-1399
Phone: (317)494-6054
hrubin@pop.stat.purdue.edu (Internet, bitnet)  
{purdue,pur-ee}!pop.stat!hrubin(UUCP)
Newsgroups: sci.med