Doctor Bashing

Here we go again. Doctor bashing is a tried and true way to bring up a hidden agenda, and this article takes one of the standard approaches, claiming inadequate education and training.

They studied 4 and 6 week medical student clerkships and concluded: “it seems physicians’ and medical students’ education about obesity is often limited and inadequate, and historically has been received from sources outside of their formal medical school education”.

Here’s my conclusion: Despite the fact that the role of the clerkship is to give every medical student a view of real patient care in each specialty, FP clerkships managed to find time between patient visits to teach over 3/4 of the students about obesity and it’s comorbid conditions, as well as diet and weight loss for obesity (what little is known). They did not often add to the previous classroom education on medications for weight loss, meds that cause weight gain, and bariatric surgery. They also didn’t teach obesity bias. Perhaps in this day and age the effect of subconscious biases of all types are taught in the classroom, but if not I’m sure they are still teaching in all clerkships that the art of diagnosis does not include jumping to conclusions.

These types of articles are common in the lay press, and AAFP generally doesn’t publish at a much higher level. They leave so many questions unanswered. Why do they exclude our entire education and training? Why do they denigrate learning on one’s own in a field where a doctorate is awarded and we are supposed to have learned enough to know how to fill in the gaps and keep up to date? Is FP the only clinical clerkship where these issues can or should be addressed? Often the topics for articles like this are so universal that they are literally covered in nearly all aspects of our education and training, and the criticism is merely that there is no set course with the particular topic in it’s name. And most importantly, who benefits from this type of doctor bashing?

Well Contrave is kind of new in Canada where I practice so I thought it might be that. Our Contrave paid physician dinner had an expert tell us how useless lifestyle change is and presented as settled science what little we know about the process of satiety that it may work on. (Please comment on your experience with this med.) When I looked it up and realized the US has had it a few years I then looked further and found out there are several more new meds coming down the pipeline. To take these author’s conclusions literally, none of us now practicing will ever learn anything about them. But we’ll make sure the young do even before they’ve been proven. I’m just glad I learned somewhere in my medical curriculum, (though I can’t say exactly where so maybe I didn’t really learn), never to be the first or last to adopt a new treatment.

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Bridget Reidy MD

Bridget Reidy is an FP practicing near Victoria, British Columbia who abhors hypocrisy, waste, euphemisms, and useless bureaucrats, ie inauthentic medicine. She was a board certified FP with a certificate of additional qualifications in palliaitive care, no longer because, MOC. She did her residency in rural Marquette Michigan in the eighties, and spent her career mostly in the US in a variety of settings, emergency, urgent care, family practice - including locums on reservations, prisons and medicaid mills, and housecall practice - including work as a hospice medical director. Now she owns and runs a solo cottage industry style family practice, typical of Canadain FP's. She is on the advisory board of The Medical Post, Canada's newsletter for physicians, and a member of BC GP's for reform. 

  3 comments for “Doctor Bashing

  1. BF
    July 21, 2019 at 9:07 pm

    You want to hear about agenda? Why aren’t they talking about nurse practitioners training. It is more and more clear that they are trying to replace doctors with the cheaper options. They try to confuse the public by giving us names like providers and practitioners, and try to remove reference to Doctor/MD/DO. But in the article they don’t mention that a nurse can hang her shingle after “less than 2 years of online coursework”. Did that FNP get proper training on obesity? There’s and agenda for you. Don’t mention that a doctor gets 2 years of coursework with an additional MINIMUM of 5 years of supervised hands on training, because that would be an inconvenient truth…

  2. NN
    July 18, 2019 at 10:12 am

    The purpose in performing the study was honorable. I think it is important to assess aspects of a residency program’s curricula and determine if the material taught is not only current, but thorough. But as I read through the article, the comments by the lead author of the study make me question his objectivity.

    “For him, it was eye-opening to see that most clerkship directors identified lack of time as the primary barrier to teaching obesity topics, only to discover that even those clerkships with additional weeks of training cited time constraints.”

    “It was really all about attitude. The clerkship directors who thought it was important content put the obesity topics into their clerkships. Too many clerkship directors were just not prioritizing this issue,” said Holman.”

    He doesn’t clarify if that lack of time is related to metrics or some other mandatory issue outside of medicine. Why is that relevant? Because he seems to be almost dismissive of that excuse when it is a legitimate one. It may not be that the directors are not prioritizing the issue, it is perhaps that they can’t. To compare one program to another is invalid if one does not understand the issue of the time constraints and how they might vary from program to program.

    Bottom line is he appears to be drawing conclusions that perhaps should not be drawn without more clarity being provided regarding the parameters of the study.

    It is issues like this that annoy me about the quality of studies being performed today. They are published as if they are credible when the work is incomplete. I’m no research or study guru, but it just seems sloppy to me.

  3. arthur gindin
    July 17, 2019 at 2:18 pm

    As I remember the quote: “Be not the first to try or the last to let the old aside.”

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