Well, At Least We Cared!

As major universities continue to crank out heavily indebted graduates increasingly incapable of self-sufficiency or even independent thought, so our medical schools are trying to customize their graduates to care for them.  Or rather, their fragile self-esteem.

Not content with bothering the rest of us with their ill-informed views on gun control, medical academicians now want to venture into the psychedelic, ever-fluid adventures of social justice as proper realms of study and interference by near-future providers (one hesitates to honor them with “physician”).  This sort of stupidity has been long building, at least back to 1992.  On my second day of medical school, we had a long morning of lectures in the main auditorium with the obvious intent of getting our minds right.  Our class was harangued by a “panel of the aggrieved,” including an angry feminist (I know, redundant), a fiercely proud gay man, and a black pulmonologist.  The feminist told us all how bad things had gotten in medicine for women, and less than total respect and awe on the part of males in the class would not be tolerated.  The gay man told us all about his rights and how none of us were allowed to have a contrary opinion regarding his community’s proclivities, and any such utterance should be grounds to reconsider our fitness for medicine.  The pulmonologist described for us how rampant was racism in Gainesville, Florida where a local bank had actually the effrontery to require proof of income prior to granting him, a black man, a home mortgage.  I left for lunch having not yet cut the first cadaver, trembling with the “woke” knowledge of my misogynistic, homophobic, racist guilt now laid bare in this mini-reeducation camp.  It was in fact an insulting, pointless show that wasted time, bred resentment, and inspired more than a few wry remarks.  Years later, the self-important extortionist morons at the American Board of Family Medicine have been pushing, as part of their MOC protection racket, “CULTURAL COMPETENCY,” as a way I suppose to make their weaker minded victims feel part of the greater planetary effort.  What it actually represents is cultural egalitarianism designed to take us all down a notch and foster some hemispheric humility. 

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Good efforts all, but you can’t really get a cultural revolution going without getting the kids to hit the streets, waving their little red books.  The best way forward is via medical school curricula, where you marry the twin interests of 1) filling impressionable minds with trusted sources, and 2) making their grades and thereby their future economic prospects dependent on absorbing social justice platitudes.  Stanley Goldfarb M.D., a former medical school curricula dean and author of this WSJ piece says, “The traditional American model of medical training, which has been emulated around the world, emphasizes a scientific approach to treatment and subjects students to rigorous classroom instruction … [which] produced a technically proficient and responsible physician corps for the U.S.”  Clearly this author didn’t pass his CULTURAL COMPETENCY work from the ABFM, or he would know that “American” and “U.S” are not terms appropriate for academic association.  Dr. Goldfarb:  “The influential critic Ivan Illich called the medical industry an instrument of ‘pain, sickness, and death,’ and sought to reorder the field toward an egalitarian social purpose.”  Precisely.  Medical schools now want students to be proficient in the topics of homelessness, climate change, and the critical if nebulous “diversity.” 

Goldfarb contrasts our “current administrator-rich, policy-heavy, form-over-function approach at every level of American education” while “oncologists, cardiologists, surgeons and other medical specialists are in short supply.”  Never mind knowing exactly how to manage an aortic dissection, when your community’s carbon footprint needs attention. 

Over at the (ahem) Scientific American, they have a different view.  Authors and pediatric specialists Paquette and Patel argue that medical school grads have training in “philosophy, bioethics, public health and law” that makes them qualified to address social factors in order to pursue greater population health:  “Physicians should act to prevent the root causes of illness and improve health.”  Their article worries about “patients who are at risk for worse care and outcomes because they lack access to transportation or medications—or simply because of where they live.” 

Academicians like this will push for goals laudable and otherwise through politics, which includes the indoctrination of their students.  There is a fine line along a tricky course, wherein a teacher should seek to impart knowledge and values to a student, but I think this has already gone full over into ideological indoctrination.  Encouraging students ignorant in gun use, climate science, or real estate economics to start proclaiming, pronouncing, and parading on topics in which they have no expertise will only further degrade a profession already in great peril.  The author’s “incorporating principles of social justice, public health and population health” will produce benighted products made more malleable for government control, through which they will seek to further order society.  They will fail of course, but along the way actual medical care will get worse, and more intelligent types will seek to avoid this fruitless work.  What sort of healthy person would want to enter into a life of nagging others? 

A great many of my medical school classmates could wipe the floor with me come exam day, and yet a great many of those could not be trusted to watch my dog overnight, so lacking in common sense were they, that somehow the dog would’ve been caught on fire.  Even in 1992, a great many of them were “feelings-fueled” once they looked up from the microscope.    “Woke” medial students will be even dumber, screeching at honest citizens about the truth behind transgender biology and the need for more taxpayer subsidy of public toilets for the homeless.  This is all politics, and medical schools should shun it like the plague it will encourage. 

Well at least we cared!Which all reminds me of one final story.  Adam Nicolson’s “Seize the Fire” is an excellent telling of the Battle of Trafalgar in 1805, in which the British Royal Navy utterly destroyed the French fleet.  The battle was no contest.  The author explains in detail that the typical French naval officer was expected to be proficient, in courtly protocols, sword fencing, and dancing.  His British counterparts were ruthlessly schooled in navigation, ship handling, and gunnery.  Form does not trump function when it counts.

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Pat Conrad MD

Pat Conrad is a full-time rural ER doc on the Florida Gulf Coast. After serving as a carrier naval flight officer, he graduated from the University of Florida College of Medicine, and the Tallahassee Family Medicine residency program. His commentary has appeared in Medical Economics and at AuthenticMedicine.com . Conrad’s work stresses individual freedom and autonomy as the crucial foundation for medical excellence, is wary of all collective solutions, and recognizes that the vast majority of poisonous snakebites are concurrent with alcohol consumption. 

  8 comments for “Well, At Least We Cared!

  1. Aaron M Levine
    October 23, 2019 at 6:25 pm

    I used to be on a credentials committee. I had a couple of graduates of Havana Medical Schools. I could not copy their transcripts to get the actual course titles. There were courses on Socialism and health care. How capitalism endangers health.

    I took some CME to renew my Michigan license. It required CMEs on LGBT health care. I recognize there are some differences, but a sick person is a sick person.

  2. Ben
    October 21, 2019 at 4:10 pm

    Funny,
    In 1994, after 5 years of practice I moved. I too, as a white male was asked for proof of income for a home mortgage. This despite having a 50% cash down payment and tax returns from the 5 prior years that put me solidly in the camp of the successful. Does every affront to people that are now not white males feel as though as it is an -ism? Maybe the majority of time it is just life sucks, and jerks are out there, and stuff happens. I hate to say how many times I have been insulted, threatened, ripped off, and mistreated. For the record, the high school I went to, I was a minority student, yet still worked my way through college and lived at home. And then because I worked and lived at home, was denied any aid for medical school because I was not independent. So the proof of income I find funny because I also was asked for that and did not interpret that as unusual, and given what happened just 10 years later, to avoid accusations of redlining the banks realized they did not need that and just handed the mortgage over to Fanny Mae and the taxpayers and we got the great financial crisis and great recession. Just sayin

    • Steve O'
      October 21, 2019 at 6:56 pm

      I see in our withering society a growing manifesto, to treat all people as things. The new wave of artificial intelligence, the Internet of Things, will allow you to be treated as your refrigerator is treated. Perhaps worse; for who has suspicion and contempt towards a refrigerator?

      Some, but not all, of people who have long been placed in boxes and called “things” – race things and gender things and whatnot – are mortified by such perversion of “equality,” that we can all be disposed of with equal degrees of summary contempt.

      The few – and indeed not all – of those who claim authority to insult, threaten, rip off, and mistreat others by some virtue of societal cruelty – are perhaps more disgusting to those of us who have made our own way by virtue and character, not by the sort of things they have willingly become. The resentful wish to enslave you by making you resentful, just as they are.

      It is all part of the same evil. That a few – indeed not all – believe in the absurdity of their own cruelty is pitiful. There will always be those sort of people. But we are stronger.

      • Pat
        October 21, 2019 at 10:32 pm

        Nice points.

  3. Arthur Gindin
    October 21, 2019 at 1:48 pm

    Great piece. So sorry things have degenerated over the years (I graduated in 1959).

  4. WWW
    October 21, 2019 at 1:17 pm

    Pat, I’m shocked . . . You can actually talk like this these days ?! SO not PC. In most venues, you would get massive push back but maybe not here. Keep it coming.

  5. Steve O'
    October 21, 2019 at 1:02 pm

    Got a giggle out of this:

    “The traditional American model of medical training, which has been emulated around the world, emphasizes a scientific approach to treatment and subjects students to rigorous classroom instruction … [which] produced a technically proficient and responsible physician corps for the U.S.”

    The true traditional American model of medical training was full in force up until Flexner’s odd but helpful report on Medical Education. Students sat in lecture halls memorizing garbage. There was a brief lull in idiocy for a few decades. It is back in force. Garbage never sleeps.
    How can it be different? We should borrow ideas from military theorists all over the world who think about what war should be, to consider what a much more benign and affirmative thing, medical education, could be. Higher-level military training involves understanding doctrine. This can be accomplished in medical education.
    Translated into medical principles:

    the fundamental set of principles that guides medical providers as they pursue diagnostic and treatment objectives. They range from the policies and procedures put in place by a particular specialty to the perspectives and techniques taught to new members during training.RAND
    Doctrine is defined as ‘fundamental principles by which medical providers guide their actions in support of objectives. It is authoritative but requires judgement in application.’NATO

    (loosely adapted)
    Modern militaries attempt to develop coherent principles in doctrine. Modern medicine, most especially American medicine, has given up on the optimistic concept that these things can be reasoned and studied. What is left is a mish-mash of trendy groupthink memes about medicine. There is nothing but pessimism in American universities that anything can be taught, or learned.
    One of the greatest problems is throughout American approaches to doctrine. Fredrick the Great once said “War is not an affair of chance. A great deal of knowledge, study, and meditation is necessary to conduct it well.” American medical education offers the pretense of knowledge, study and medication, by shallow learning and study, mimicry and regurgitation.
    A quote attributed to a German officer after World War II “One of the serious problems in planning the fight against American doctrine, is that the Americans do not read their manuals, nor do they feel any obligation to follow their doctrine.” Our military, like our medical schools, praise principles but do not teach them. Students and residents are left without a firm architecture and foundation by which to build their own medical techniques.
    What do we have instead? you can’t really get a cultural revolution going without getting the kids to hit the streets. I found this phrase grimly amusing, as NYU Medical School, not at all different from any other medical school, has students and residents hitting the pavement – from 36 stories high. (See suicides from jumping and hanging. Medical Education should act to deter suicide. But like everything else, it is co-opted into the messages that seem to come from nowhere, mean nothing, and go nowhere.
    Students are without a sense that medicine means anything, goes anywhere, produces anything of value to the self or even the patients. It has become a grey, mechanized entity. Why?
    Without going on and on, look at the principle of Auftragstaktik, long a cause of superiority in Prussian and German military doctrine. It is “is a form of military tactics where the emphasis is on the outcome of a mission rather than the specific means of achieving it. ” (Wikipedia.) Think about that, and realize that in American medical education, we are racing in full retreat towards obedience to tactics rather than accomplishing cure. It will only get worse – exponentially worse. I have seen it over my career.

  6. PW
    October 21, 2019 at 9:47 am

    We have more SJWs than needed right now. We need good doctors.

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