Naked Science Forum

Life Sciences => Physiology & Medicine => Topic started by: Pmb on 08/10/2013 16:31:52

Title: Is the quality of doctors coming out of medical school falling?
Post by: Pmb on 08/10/2013 16:31:52
My experience with doctors over the last 13 years has been leaning towards people becoming doctors for the prestige and money much more than actually wanting to reduce the suffering of their patients. Has anybody noticed a trend like this besides myself? It seems as if the doctors that they're pumping out are not the brightest bulbs in the box either. The nonsense I hear coming out of the mouths of some doctors scares the hell out of me.
Title: Re: Is the quality of doctors coming out of medical school falling?
Post by: chris on 09/10/2013 09:31:07
I can speak only for the UK, and I work at one of the best university teaching hospitals in the world, so I think my sample cross-section is likely to be heavily biased, so I'd better not comment. The young people I see are superb, albeit heavily indebted...
Title: Re: Is the quality of doctors coming out of medical school falling?
Post by: Pmb on 11/10/2013 16:00:27
Quote from: chris
The young people I see are superb, albeit heavily indebted...
Thank you. However Iím not clear on how that addresses the point at hand. Can you clarify for me please?  E.g. what do you mean by and in what sense does ďsuperbĒ relate to whether theyíre becoming doctors, not for the prestige and/or money but because they have a genuine desire to heal and reduce suffering?

My motivations on this point are no secret since I've started threads on this subject in this forum before. Iíd be more than happy to clarify this in a PM to you if you wish. But from now on that part of my life will remain private.

The following is from Opiod Therapy for Chronic Pain by Jane C. Ballantyne, M.D., and Jianren Mao, M.D., Ph.D., The New England Journal of Medicine, Nov. 13, 2003. From page 1943
The recognition that opioid therapy can relieve pain and improve mood and functioning
in many patients with chronic pain has led experts on pain to recommend that such patients not be denied opioids.
Despite this recommendation, many physicians remain uncertain about prescribing opioids to treat chronic pain and do not prescribe them.
Letís not take that in a vacuum though. Letís look at the real life consequences of choosing not to treat a patientís pain. I live in Massachusetts. In this state there exists no requirement for any doctor to treat a patients pain. So they have no compulsion of ignoring the problem all together. To me thatís shameful. Itís also the reason why a new bill has been introduced which, if elected to a law, will require doctors to manage and treat pain on a timely basis.

So letís look at what happens when the doctor refuses to treat their patientís chronic pain. See  NCCAM Review Analyzes Evidence on Brain Effects from Chronic Pain and Mind and Body Approaches at
It suggests that chronic pain affects the anatomy of the brain and impairs certain nerve pathways, leading to a ďnegative feedback loopĒ that results in more pain and accompanying emotional and reasoning problems.
Every single doctors Iíve seen before last week didnít show any understanding of this fact. Itís very clear to patients, not doctors. The reality is more than they have shown me that they can comprehend. I know from actual experience how insidious this can be. If youíd like Iíll explain in detail an actual horrific result of what the effects of prolonged untreated pain can do to a person. Iíll be using myself as a particular case history but I need to keep it private.
Title: Re: Is the quality of doctors coming out of medical school falling?
Post by: Pmb on 13/10/2013 10:58:33
From the lack of responses may I assume that this thread is dead?
Title: Re: Is the quality of doctors coming out of medical school falling?
Post by: Ophiolite on 13/10/2013 18:52:07
pmb, you create a dilemma for members - at least for this one. From my knowledge of your history on other forums, I understand that you have had many difficulties in relation to health. Your experiences have been particular ones and have, quite naturally, informed your thinking on the matter. It would be difficult for you not to have a very secure perspective on the matter.

I can understand some members being reluctant to post an objective view out of concern it could cause you mental pain in addition to your physical pain. It is difficult to ignore this aspect when you append the note "Currently disabled from chronic pain" to your particulars. I sense you are looking for some kind of affirmation that your doctors are as large a part of your health problems as the problems themselves. I don't think that is a productive road for any of us to go down.

That's my two cents worth. I suspect the lack of a response is more out of concern for you, than through lack of interest.
Title: Re: Is the quality of doctors coming out of medical school falling?
Post by: CliffordK on 29/10/2013 00:30:47
It is my belief that physicians in general are a group of people who are extremely egocentric.  They can rely on extensive training.  But, perhaps get too stuck with having the right answers themselves.  They can be quick to blame nursing staff for following their own instructions.

There is effort to encourage better doctor/patient relations, but it is difficult when doctors find themselves scheduling only a few minutes with each patient.  They may also leave little time for extra research and followup.
Title: Re: Is the quality of doctors coming out of medical school falling?
Post by: cheryl j on 29/10/2013 13:37:24
In some ways, this is a political question, not so much about aptitude or knowledge, but competing goals or pressures from different sections of society. There is the patient who is in pain, but pain is difficult to measure and evaluate. If a person has appendicitis, you can press on their abdomen, and one person will squirm uncomfortably and another will scream in agony, even if they are at the stage in their disease process. There is the risk of addiction and dependency and  withdrawal in treating long term chronic pain. It's a side effect of the drug, not a defect in the patient, a risk and side effect that may be acceptable if there is no other way the patient can function and live a normal life - the same way liver dysfunction or bone marrow suppression might be an acceptable risk if a medication is required and there are no alternatives. Finally there are pressures from outside the medical system. Opioid abuse and addiction is a huge social problem in some areas. Addiction rates are supposedly high as 30%, 40%, even 80% in some isolated communities and Native reserves in Northern Ontario. That's almost hard to believe - they must be shipping it in by the truck load.  But unlike illicit drugs, it has to be coming from some point in the legitimate chain between pharmacies, doctors, and patients, even if it's by theft or diversion.

If you're wondering, well, why is that my problem? You're right, it shouldn't be, and it creates huge inconveniences for patients with pain. Society hasn't figured out how to control theft and diversion, and in all honesty has tried to simply minimize it by controlling it on the supply end, that is, by urging doctors to prescribe narcotics as little as possible.Oxycontin was completely taken off the market in Canada in 2012.  Most doctors in my area only prescribe narcotics now for palliative care and in small amounts for acute pain, like knee surgery. Some doctors even have a blanket "no narcotics" policy, and if the patient doesn't like it, they can choose another family physician or can be referred to a pain clinic who will handle that aspect of their medical care, which might not be a bad idea. Pain probably should be like any other specialty of medicine.
Title: Re: Is the quality of doctors coming out of medical school falling?
Post by: SimpleEngineer on 29/10/2013 15:38:52
I would like to throw a curve ball in there..

If a teacher passes a student who gets 80% of an exam set by that teacher then the student is 20% worse than teacher

If that student becomes a teacher and passes his student with 80% of an exam he set then this student is 20% worse again.

so in 1 repetition we now have a student that is 20% worse than his teacher, and 36% worse than his teachers teacher.

80% is a high pass, it is typically 40% ... so potentially up to 84% worse in 1 repetition.. 

Okay this is not very realistic.. but apply this across the educational system where teachers are writing exams for teachers, much of the time without significant input from experts in the fields.. add onto this exam boards (made up of teachers) making exams to sell to schools fighting for the highest pass rates (making the exams easier).. and the entire educational system becomes a race for the bottom.. and is why.. the last person i interviewed for a position could not read simple instructions and could barely write out reports. (lets not talk about his maths ability or lack thereof)