21st Century Skills is Bogus


I saw this article which is suppose to show the training of doctors is so antiquated. I don’t buy it.  It criticizes our computer skills?  It embraces the technology while begging for more emotional intelligence? Well, those two are diametrically opposed.  Let’s have some fun with this.  In the article it says more than 20 doctors of all ages and specialties were asked about the skill they wished they had learned (or learned about in more detail) in medical school. Not a large number but here are their answers with my thoughts in parenthesis:

  1. Data Science and Statistics – they want to learn how to “collect data about a large patient population and connect that to outcomes in order to understand disease and improve treatment.” (Really?  What about that one patient right in front of you? Big Data is killing medicine as much as it is helping)
  2. Nutrition and Disease Prevention-  fewer than 25 percent of doctors say they got sufficient education to give nutritional or fitness advice to a patient. (This may not be a bad thing!  Look at the nutritionists who still spew the party line of low fat, high carb diets)
  3. Ultrasound Training – ? (not sure what to even comment on this.  Of all the things need this dude thinks we need more ultrasound training?)
  4. Information Technology 101- Mia Finkelston, a medical director and practicing physician at Online Care Group, said she wished she’d learned basic word-processing skills, and shortcuts such as how to copy and paste in different formats. “It would have saved me time on so many levels.” (Sorry, can’t stop laughing.  Trouble with copy and paste?  And you are the medical director? Figures.)
  5. Communications and Empathy – The most effective doctors understand how to communicate with patients. That doesn’t mean rattling off a diagnosis and sending them home. It requires picking up on the subtle indications that a patient has not understood something, or is too upset to take in information. (Empathy correlates with time.  The more you are rushed as a doctor the less empathy you have.  The reverse is true unless you a total douche of a person, of which there are many doctors like that out there)
  6. Personal Finance – The average doctor today graduates with a massive $166,750 in medical school debt. It’s now imperative that doctors learn to manage their money, or they risk drowning in debt. Several recent medical school graduates said they could benefit from some formal education about how to use the latest web and mobile tools to manage their finances. (Here’s a tip.  Go to community college and then the cheapest college you can find for the last two years.  Then move to Texas, get residency, and go to medical school for $16K a year.  Now you have $64 in debt. Then you can choose a specialty based on what you like versus what it will pay you).
  7. Management and Leadership – “And yet there is almost no training on how to succeed in the working world,” she said. Chen said she would have benefited from basic management skills, such as providing feedback and motivating others, as well as tips on how to collaborate and manage projects. (You don’t need this because some administrator will do this for you while they push you to see more patients).

These extra skills are just that…extra.  Read a book on finances.  Read a book on management and leadership. Read a book on nutrition. There are tons of great ones.  You want to communicate better? Find a job that has more time with patients.  Want to learn technology? Make sure it is technology that helps patient care and not built for billing.  Leave medical school alone because it is about learning medicine and getting you ass kicked.  Both are the best skills out there.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  6 comments for “21st Century Skills is Bogus

  1. Perry
    October 24, 2015 at 6:23 pm

    C’mon guys, get with the program. We are NOT taking care of patients here. We are doing data entry and checking off boxes in a computer, we are coding appropriately, and we are getting paid
    #[email protected]%& (so we need to know how to budget so we can retire sometime in the next millenium), we are managing populations and physician extenders, all the while trying to convince the patients (that we’re supposed to be taking care of) that we give a hoot. The old days are gone…

  2. Steve O'
    October 24, 2015 at 11:25 am

    #1) See what there is to be seen.
    #2) Do what there is to be done.
    #3) Do the next indicated thing now.

    Those are all you need to learn. It has taken me years.

    I got the merry little giggles from:

    [We need] ways to sustain empathy and provide reassurance to patients,” said David Scales, a resident physician of internal medicine from the Cambridge Health Alliance in Massachusetts and a graduate of Yale Medical School. “And that goes beyond trying to teach doctors how to be nice people.

    He doesn’t know yet. Most things you learn in medical school are only partially true – and some are absolutely incorrect. All medical school does is offer you sufficient information not to drown while you start taking care of patients.
    It’s too early to climb the Ivory Parrot Tower and start regurgitating memorized nonsense that you picked up three years ago from someone’s bull-filled research paper in the New England Journal of Arrogance. That’s what has brought us the Sewage Sluice from On High that is killing medicine.
    Until you cure it, don’t brag about it. And residents should be seen and not heard – not that they should be mistreated, but they should be one-way sponges, grabbing at EVERY practice opportunity that they can. ESPECIALLY we Internal Medicine doctors. Other specialties may have the luxury of saying – no, I really don’t need to know about that. Our damn profession means we have to know about EVERYTHING, and should out to our bro’s in Family Practice who need to know Everything Times Three.
    Empathy and reassurance? “I’ve treated your condition many times before, and almost always got great outcomes.” THAT is empathy and reassurance. Learning about sharing ‘n’ caring from the ol’ book (or ol’ website) ain’t nada.

  3. Bill Ameen MD
    October 24, 2015 at 10:39 am

    Data and statistics was my most boring subject in medical school (even now my eyes glaze over when I see the phrase “p greater than or equal to…”). I definitely agree that financial management and nutrition are important. But maybe above all, medical students need to learn skills such as suturing, abscess drainage, hemorrhoid-incision, skin biopsy, joint aspiration and injection, trigger-point injection, etc. Procedures pay well. All the young doctors I see going into practice refer out everything involving putting gloves on.

    • Steve O'
      October 24, 2015 at 11:43 am

      Get this, get this – it’s priceless.
      In my worthless experience, people who can’t fall asleep with a new CPAP – ICD-10 Cant Sleep With Shit Strapped To Face (initial encounter) I suppose – do well with a week of quetiapine 25mg. I’ve never seen anyone do that and fail to bond with their CPAP. I’ve never had a bad outcome. I’m only looking at a sample size of twenty-five or so, but 25/25 is nearly 100%, by my reckoning. But it’s not published, so it’s not data-driven.
      But in my shop, quetiapine is for “Mental Health Only.” I need to send a referral to Mental Health for a week’s worth of quetiapine. The nurse practitioner (and it just so happened to be a nurse practitioner, nobody get huffy about this) rejected my idea, gave a month’s worth of 1mg. bedtime lorazepam and…………..ordered a sleep study! YAY!
      I need to learn the 21’st century skill of not giving a damn. Working on this. May need to do a sabbatical at the DMV.

      • Bill Ameen MD
        October 24, 2015 at 2:52 pm

        In addition to being overridden by your NP, you work in a place where you can’t write Seroquel or have to send to Mental Health? Sad times, dude. When I retired last year I had dozens of patients taking something to help them sleep, whether Ambien or lorazepam or an anti-psychotic. (My philosophy was that when you live in a trailer in an unquiet neighborhood you need all the help you can get in order to sleep so you can work in your crap job the next day.) Of course, the scared young doctors who took over for me took everybody off “addictive” substances, in addition to eschewing procedures; the patient volume has dropped significantly, entailing hundreds of thousands of dollars in losses this

  4. Dr Bonz
    October 24, 2015 at 8:04 am

    Doug: This is absolutely comical! Medical school is only 4 years. There are only so many hours in each of those 365 day years. There is SO much more to learn in MEDICINE each year and trying to cram this drivel into them, only takes away from learning what a doctor REALLY needs to know. Do patients REALLY want a doctor who is good at management, finance, and people skills or do they want someone who knows MEDICINE who can save their life when the chips are down?

    “Doc, my chest still hurts and I am still short of breath, but MAN do you have some serious COPY AND PASTING skills!”

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