11 ms·

Medical schools do not prepare students to care for autistic or disabled people

174 points by wjb3 3y ago

micromacrofoot 3y ago
sometimes it feels like medical school doesn’t even prepare students to talk to people
- LtWorf 3y ago
  In sweden they teach them to underestimate what people complain about, and when in doubt send them home and if they come back try to do something about it.
- amelius 3y ago
  yes, you might as well talk to an LLM, but that is where we are heading anyway https://www.advisory.com/daily-briefing/2023/05/02/chatgpt-empathy https://www.advisory.com/daily-briefing/2023/05/02/chatgpt-e...
- 082349872349872 3y ago
  I once chatted with an older doctor while we were both waiting for an oil change, and his theory was that while at least 80% of people who wanted to become doctors stood a chance of having a reasonable bedside manner when they started med school, between med school and the residency they had it all beaten out of them until only 5% retained any semblance of it.
  - ProllyInfamous 3y ago
    I got a California "recommendation" once, from a gentleman physician approaching his 80's. When I asked him why he chose this particular "pot doc" persona, he asked me: >"Have you ever heard of `the elephant graveyard`?" His defeated demeanor still haunts me, often (and this was 15+ years ago — he's likely deceased).
- nradov 3y ago
  Medical schools hire Standardized Patients specifically to prepare students on how to talk to people. https://cisl.stanford.edu/standardized-patient-program/for-standardized-patients.html https://cisl.stanford.edu/standardized-patient-program/for-s... Of course, some students learn these skills better than others. And even doctors who have good communication skills are under so much pressure to see more patients that they may not have time to talk much. If they only have 8 minutes with a patient then they have to get right to the point instead of letting the patient ramble on.
egberts1 3y ago
Unless these medical students have some immersion exposure into the physically-challenged (including Deaf) or mentally-challenged communities, this trend of ignorance shall continue.
Podgajski 3y ago
I’ve told doctors countless times the medication’s they used to treat my Asperger’s and my bipolar disorder schizoaffective type, make me ill weak and caused me pain. But they never listen to me. So this is not even about people with serious mental handicaps. They don’t listen to patients in general. But that’s true for people with mental illness They think every pain or issue we have is solely our heads. But I also recently had a friend mother who went to the doctor because her ankles were swelling and she had some other issues. They took a blood test and didn’t tell her. Her kidney function was with stage 3B kidney failure. It was two weeks until my friend showed me the labs and I told her to go back and force him to take more test. I don’t know what’s going on in medicine if this is something new or is this something old but medical school shouldn’t cost as much as it does if they’re putting out doctors like these.
- toldyouso2022 3y ago
  Profit and loss incentives make it so that if you are competent you get clients and you keep going, if you aren't you lose money and fail. With central banking we have destroyed this system and in the case of medicine not only there is a lot of central banking interference but here is also a guild system that limits the supply of doctors, so bad doctors don't fail and with time you get more and more bad Doctors. Things will only get worse
  - jMyles 3y ago
    Absolutely. Nowhere is the perversion of incentives more clear than in places where we hope people will act from their heart and their genuine concern, because they are out-competed by the economic forces of easy, cheap, fast money. This phenomenon is also visible with regard to single-use plastics, as much a stretch as that may seem: why buy things that can be re-used indefinitely, and passed on to next generations, when money is such a hot potato? Better (rationally) to trade money for cheap plastic things from the other side of the world.
  - cjbgkagh 3y ago
    Doctors being bad at their jobs predates central banking, take the long held obsession with blood letting as just one example. Fixing finance will not fix doctors. If doctors want people to listen to them they need people to believe they’re very smart, and getting pulled into the mire of the specifics of people’s conditions would just result with both the patient and doctor finding out they don’t know enough and that’s bad for business.
Trasmatta 3y ago
They also don't teach them how to care for people with Type 1 diabetes. There are so many horror stories about how awful hospitalization is for T1Ds. So many doctors and nurses don't understand the complexity of treating the disease, or respect the patient's ability to treat it themselves while in the hospital. Not to mention how common misdiagnoses are: I was diagnosed as T2, when I was clearly T1. They didn't even do an antibody test, all because I was an adult. So many people (including doctors) still have the dangerous idea that T1D only manifests in kids. I'm terrified of being hospitalized for that reason. I'll sign whatever paperwork needed in order to self treat with my CGM and pump. I've been doing this for 12 years, no doctor is going to be about to do it better. This also scares me in terms of inpatient mental health facilities. They often don't even give you access to your own insulin and testing supplies. Which is a recipe for feeling much worse after leaving then entering.
- paulcole 3y ago
  > I was diagnosed as T2, when I was clearly T1. They didn't even do an antibody test, all because I was an adult. Same. I was about 30, long distance runner and bike rider. Went from 170 pounds to 130 over about 4 months. Doctor shrugged and was like, “You must be addicted to carbs. It’s type 2 here’s metformin. Start eating better.” I have since found 2 doctors who I like quite a bit. But I now know that I’m the only one on planet Earth who truly cares about my health. It should’ve been obvious from the start, but it wasn’t. Now I know. If I want to be healthy, it’s on me to get there.
  - Trasmatta 3y ago
    > But I now know that I’m the only one on planet Earth who truly cares about my health. It should’ve been obvious from the start, but it wasn’t. Now I know. If I want to be healthy, it’s on me to get there. This is especially true for T1D. You don't just go to the doctor twice a year and have them prescribe a set medication dosage you take every day. You have to constantly adjust and factor it into every decision, every hour, of every day, for the rest of your life. I'm exhausted.
    - 3y ago
ChrisMarshallNY 3y ago
Also, substance abuse (including alcohol). I think they get about two hours' training, in twelve years of school.
- ProllyInfamous 3y ago
  At least during the first year, we all had some form of chemical addiction(s). Did we need any more training than personal sin/sacrifice?
brcmthrowaway 3y ago
Most people go into medicine because of the money and status
- araes 3y ago
  A caveat to this would be that "caring for the autistic and/or disabled" is generally not viewed as "high status" in human society. If you have a disabled child, a lot of the time, the other children don't wanna hang out. If you're a disabled young adult, nobody probably wants to date you (or at least a very limited subset). You're already below 7-8 on hot or not for most. If you're a disabled adult, a lot of time, people don't "really" wanna deal with your needs (work/home/businesses) If you're a disabled elderly, you're probably in a home. Plus, a lot of societies for (pretty much since humans existed) have shunned the disabled as untouchables / failures / curses / diseased / bad-genetics / unlucky And in human society, "high status" often correlates with "expensive" or "high wealth". Also "pretty" or "desirable".
- neilv 3y ago
  Easy big money right now is actually the techbro field. Becoming a doctor just for the money would be the hard-mode way to do it. (Grueling pre-med weed-outs, med school applications, med school, residency competition, residency, specializations, etc.) Doctors do have status/respect, deservedly. Techbro stereotype is that of overpaid dimwit, from how we assume that big paychecks confer intellectual status, and confidently open our mouths on topics that other people actually know.
  - pants2 3y ago
    The tech bro stereotype has only emerged in the past couple of decades, and even so is mostly isolated to the United States. Doctors are still the go-to "money and status" profession for most of the world.
- TriangleEdge 3y ago
  How do you quantify what a good doctor is, and how do you erect barriers to filter them in?
markx2 3y ago
I qualified as a nurse - Registered Nurse Mental Handicap - RNMH - here in the UK in 1989. Many of those I cared for needed regular blood tests. Esp those prescribed lithium and other anti-convulsants so that the drug regime was within therapeutic limits. There is, for example, a patient called John. He needs a blood test. He comes into a room with a person he has never met, to be subjected to something he is unfamilar with and, unsurprisngly, get agitated and refuses. This happened again and again and again. We, as a group of nurses say "Hey, let us do the blood sampling, we know the person, we can time it right, we know this person" This idea was opposed 100% because DOCTORS KNOW BEST.
- lmpdev 3y ago
  I wonder if effective psychiatric wards are more egalitarian in that way
- forinti 3y ago
  The variety of people who comment on HN is truly wonderful.
- 082349872349872 3y ago
  Surely you've seen: https://www.youtube.com/watch?v=7-a2QBfFQeA https://www.youtube.com/watch?v=7-a2QBfFQeA ? (Steve Martin — subdural hematoma)
  - throwup238 3y ago
    Damn for a second I thought Steve Martin had released a new single called “Subdural Hematoma” and got excited. (He’s a professional Banjoist!)
    - 082349872349872 3y ago
      Wouldn't that be "Subdural Hemiola"? :-P (I'm more of a dobro than banjo fan...)
- stevehawk 3y ago
s5300 3y ago
[dead]
deleted 3y ago
[deleted]
charred_patina 3y ago
No offense, but what do medical schools prepare you for? I know very few people who have ever said "yeah I have a really great doctor", and then it's only because they spent time searching and learning to navigate the system. When I go to the mechanic (honest ones) will tell me everything wrong with my car. When I go to the doctor, unless I do outside research and proffer solutions, they just send me home. On a related note, I think a big part of the anti-vax phenomenon is how many people end up seeking care outside of the medical system because it's so broken. People find holistic solutions like diet and exercise and end up falling down a conspiracy pipeline.
- cratermoon 3y ago
  > what do medical schools prepare you for? Applying differential diagnosis and standard-of-care treatments.
- jmye 3y ago
  I mean, your body is slightly more complicated than your car. If your issue is highly specialized, assuming your PCP or family med doctor will be able to figure it out is like thinking your car mechanic can fix your airplane, just because an engine is an engine. I’d also note that cost incentives in healthcare are badly misaligned (commercial and Medicare, and generally for most other single-payer systems). There’s a reason your doctor usually only spends a few minutes with you before running out to spend a few minutes with someone else.
  - charred_patina 3y ago
    I have wondered why we even need primary care doctors when it seems like if you really need treatment, you see a specialist. Not to be the "disruptive technology will fix X industry" guy, but wouldn't it make sense to have nurses and techs just run a diagnostic on you and feed it into a computer, which can spit out a list of possible causes, which you then take to a specialist? I don't really know much about this stuff so I'm genuinely curious why our system seems to suck so bad from the outside.
    - 3y ago
cratermoon 3y ago
Or women's unique health issues either, really.
- lotsoweiners 3y ago
  Do you mean just from a primary care prospective and avoiding OBGYN? Also, I wonder what the difference between male and female PCPs is in that regard.
  - cratermoon 3y ago
    Not even OB-Gyn practitioners are trained for a woman-centered point of view. See for example the "The Miracle of Birth" segment from Monty Python's The Meaning of Life.
slibhb 3y ago
> Oliver McGowan was 18 years old when he was hospitalized in England with recurrent seizures and pneumonia. He was autistic, and he and his parents had one specific request for the medical team: no antipsychotic medications. When he had taken them in the past, they made his seizures worse and had devastating effects on his mood. Despite the family’s vehement protests, doctors gave him an antipsychotic. A few days later, Oliver suffered a lethal neurological side effect. A week later, he was taken off life support. An inquest into his death found that the drug had led to the rapid deterioration. I don't see what this has to do with autism. Also, I understand that receiving medical care can be alienating but I'm not sure there's a way to fix that. It's real hard (impossible?) to train people to be kind, patient, and empathetic. Being honest and not making medical errors are probably more important training targets for doctors, nurses, and other medical professionals (and more achievable).
- crote 3y ago
  People with more severe autism can be really tricky to deal with. According to [0] the medical staff gave him medication he was known to be allergic to in order to sedate him. [1] says he arrived at the hospital scared and agitated and was physically restrained. The staff decided to deal with this by pumping him full of sedatives rather than actually addressing the source of his anxiety. If the staff had been given proper training into dealing with neuro-atypical patients, there would have been no need for sedation. [0]: https://www.bbc.com/news/uk-england-bristol-54602417 https://www.bbc.com/news/uk-england-bristol-54602417 [1]: https://www.bristolpost.co.uk/news/bristol-news/full-story-day-oliver-mcgowan-1474471 https://www.bristolpost.co.uk/news/bristol-news/full-story-d...
  - graphe 3y ago
    >If the staff had been given proper training into dealing with neuro-atypical patients, there would have been no need for sedation. If people are given anti violence courses would it certainly stop violence? Doesn't matter if they have autism or not, doctors in their panic with or without training may make medical misfortune occur.
    - 3y ago
dimal 3y ago
I get the feeling that doctors aren’t really trained for more than half of the stuff they need to know. Trauma informed care is a joke, yet a huge proportion of people have a history of multiple adverse childhood experiences, and these have very real effects on health. And any chronic illness that doesn’t have an easy biomarker is a complete unknown to most doctors. They just throw up their hands and say the bloodwork is normal, you must be fine. I don’t know how doctors can be trained for twelve years and have so little understanding of health. And yet they have such confidence in their abilities.
- steve_adams_86 3y ago
  Part of the challenge of bringing mental health into physical health, I think, is that it introduces a vast number of non-verifiable variables into an already incredibly complex system. While it might be a good idea, it asks a tremendous amount from a practice which often can’t keep up with demands as it is. I know a paradigm shift and rethinking could resolve that to a degree, but it’s quite antithetical to western medicine. It’s like asking programmers to embrace non-deterministic programming languages when you’re already deploying to non-deterministic platforms. It would seem like total chaos, I think.
  - dimal 3y ago
    I don’t think it’s antithetical to Western medicine. It’s antithetical to mass produced, industrialized medicine. Those aren’t the same thing. I only want them to use the scientific method on each individual patient. That’s all. They don’t seem interested in it though. They don’t seem to be able to think for themselves and reason on their own. They like acute diseases and disorders. Here’s a virus, and we kill it with this medicine. Here's a bacteria and we kill it with this medicine. Here’s a tumor and we cut it out. Anything more complex and they don’t have any interest in it. If they want to treat the patients they actually have, they need to learn how to do this other work. The other option is we just accept that they don’t have any interest in this type of complexity, and say OK, that’s fine, but they no longer have a monopoly on medicine. We find other ways of certifying other branches of science to treat people with these things. There are a lot of people who are already treating these things well. I go to a nutritionist who is amazing and has helped me more than any other doctor. She’s not anti-science or using crackpot theories. She’s still scientific. But my insurance won’t cover the because the MDs have a monopoly on that.
bloopernova 3y ago
My wife is autistic, and has hyper mobile Ehlers-Danlos syndrome. She's had nurses accuse her of pill seeking while one or more joints have been dislocated. It seems as if a large part of the world's (professional) empathy was drained during the COVID-19 pandemic and I'm not sure it's ever coming back.
- operatingthetan 3y ago
  >It seems as if a large part of the world's (professional) empathy was drained during the COVID-19 pandemic and I'm not sure it's ever coming back. People are going to retire and the empathy will replenish!
- tbrownaw 3y ago
  > accuse her of pill seeking I thought that was more of a war-on-drugs thing and pre-dated covid by quite a bit.
- ghufran_syed 3y ago
  She should find a doctor she likes and stick with that doctor - apparently, “if you like your doctor you can keep your doctor” (with obvious extension to that doctor’s nurses,techs, clerks etc) If that statement is not true, perhaps we should consider what changes in the system might might make it more or less true over time?
- RecycledEle 3y ago
  I assume you are in the USA. If you are not, I apologize. If we changed the US Constitution so that every person has the individual right to import, purchase, own, redistribute, manufacture, and use anything that is vaguely medical without any taxation, restriction, or tracking from any source whatsoever... Then we could just buy our meds from Cipla and be done with most of the corrupt American healthcare system.
ThinkBeat 3y ago
To play the devils advocate. What should the medical schools remove from the curriculum to accommodate this? It is not like they have part of a semester that that is just waiting to be filled. It is already stuffed to the gills. There are 100s probably 1000s of things that should be added in order for doctors to be better prepared for one scenario or another. Being autistic I would like to see this added, but at the same time I have no idea what they could remove. They could keep adding semesters until they got it all covered by that is probably not going to work either. They have a set schedule. You want to push something in, you gotta take something out.
- WarOnPrivacy 3y ago
  > What should the medical schools remove from the curriculum to accommodate this? I vote they remove the part of the curriculum that pointlessly makes residents work zillion-hour, sleep deprived shifts - one after the other, for years.
  - cfu28 3y ago
    That’s residency, which is after medical school.
- SkyPuncher 3y ago
  > It is not like they have part of a semester that that is just waiting to be filled. It is already stuffed to the gills. Oh, how I wish this were true. I'm married to an MD. Went through the med school/residency journey with her. Soooooooooo much waste and BS in the process. In direct response to your question, 4th year of med school is essentially a joke. During the first half of the year, everyone is distracted by residency interviews and applications. During the second half of the year, no one really cares because they're ready to peace out. My wife's entire 4th year could have been dropped and she would have lost absolutely nothing. The reality is medical schools primary metric is percentage of students placed into residency. More prestigious schools care about more prestigious placements, but placement is a must. The primary, almost exclusive, means of ranking resident candidates is test scores. For most med schools, that means they don't actually care about providing their students with any practical skills. They only care about succeeding on a handful of standardized exams. In fact, I've seen schools kick students out with exams failures so they can artificially keep residency match rates high.
duffpkg 3y ago
I don't dispute the headline but this article is a total mess. First referring to the US health system but then citing anecdotes from the english health system. It then mingles US healthcare and dentistry. The US health system is as different from the UK health system as different can be and in the US dentistry is a fundamentally separate industry and education tract that has absolutely no connection to healthcare whatsoever. In the US I can speak first hand as a former hospital executive that a lot more can be done to improve treatment paths for people with a wide variety of mental health diseases. Medical school can play a role but residency programs are a much more important element, at least in terms of how US doctors are trained. From history the best way to do this is to create a specific health system focused on treating those patients and to lead by example. I am not aware of such an effort but there may be one.
at_a_remove 3y ago
Medical schools do not prepare students for a lot of shit. I have a rather rare metabolic disorder, a subtle one with a lot of complications. I had to fight to get the correct tests done, I had to fight people who got constellations of symptoms wrong, older people with MDs who didn't want to listen to some kid. The tests came back: they were wrong. (This was all prior to all of this information being available on the Intarwebz; I had to learn everything from books) I still have to check the meds I am prescribed. I have to deal with doctors whose pupils visibly twitch when scanning my chart -- they mysteriously excuse themselves for a bit and return, "I see it says here you have ..." Others simply pass the buck on treatment. I had a hematologist client-dump me on the answering machine. It's hard enough to treat the bulk of the boring patients. If you're on the edge, well, they simply don't have experience. Most doctors won't ever see someone like me. If doctors were some other species who lived to be a few hundred years old, they would have the experience. I'm reminded of that recent Slate Star Codex parable about the alchemists and the dying prince. It's just too much to ask from mere mortals. The flip side of this is me recognizing doctors as mere mortals and not just going with everything like a lamb.
- deleted 3y ago
  [deleted]
calamari4065 3y ago
Honestly this has less to do with training and more about the catastrophically understaffed and overworked healthcare system. There are not enough nurses on shift at any given time, and patients like this are difficult and require a lot of one-on-one care. Hospitals won't or can't bring on additional staff to care for these cases. It's already nearly impossible for a nurse to round on all their patients, so sometimes they use sedatives so that they can care for everyone else. Which is clearly a very bad thing to do, but when your options are sit with one patient who only needs social/psychological support or caring for a dozen or three other people, it's a much more difficult call. The problem is staffing and pay, not training. Nurses are trained to deal with difficult situations. Maybe not this specifically, but part of the job is recognizing an unusual situation and dealing with it rationally. But after being burnt out for so long, rationality gets lost. And not to excuse these doctors, when family tells you not to use a particular drug, you DO NOT DO THAT. And this is why: you kill people.
hereme888 3y ago
Medical school is not supposed to prepare anyone for specialized care. It's only to help students gain enough knowledge and experience for residency. Here's the breakdown (this is meant as an exaggeration and a joke, to illustrate the point): - First 2 years of med school: mostly academic teaching so you don't kill anyone when you show up in an actual hospital. - Third year of med school: (jokingly) you can look and touch, but even the nurses are keeping an eye on you. You just contaminated your hands by touching your beard, get out of the room! - 4th year of med school: did you talk with the new patient? What do you think? Student: "He was a little odd, otherwise he's here for a checkup." Doctor: "He's autistic..." Student: "Oh...I had a feeling he was." Residency: how to actually do something for patients in general. Fellowship: how to actually do something for complex medical conditions. Residency is what's supposed to prepare people to operate in their respective fields. And then comes fellowship for specialized care. For anyone who wants to complain about what doctors should or should not learn during medical school: first go learn what the curriculum does teach, then ask yourself if you're even mildly qualified to make those judgements based on your understanding of healthcare, and then maybe you could comment on what would have to be left out of education to accommodate for X, because the curriculum is already super bloated and a firehose of information.
- tetramer 3y ago
  I'll finish up my fellowship this summer and it will have been a solid 10 years from when I started medical school. The vast majority of people have no idea what goes into medical training (even my own parents remain confused) - and that's okay, there's no need for everyone to know these ins-and-outs, but when we're passing judgment on the medical curriculum and adding additional things, it does become important. You can talk about adding a class in medical school addressing neurodivergence and disability, but how do you really address that spectrum of diversity in a single class? And what aspects do you really retain a decade out when patients with neurodivergence can be relatively rare (depending on your specialty)? In the end, I think the best learning comes from seeing patients (especially, again, as the spectrum of what these patients experience is so diverse and individual). I am always grateful to patients who provide guidance along with parents or caregivers and nurses who had often cared for that patient before for their advice on how to approach a specific patient, along with individual behavior plans if in place.
deadbabe 3y ago
I wonder if there’s some opportunity for AI to help with guiding care for special needs individuals.
ghufran_syed 3y ago
How is this different from giving a patient a drug that they say they are allergic to? Doesn’t seem to have anything to do with the patient being autistic
Perenti 3y ago
I've had quite a lot of medical treatments, due to terrible luck and universal health care. In my experience (3 continents, 6 countries) medical training does not prepare students for people. For people with communication issues, sensory issues or disability it has to be even worse.
thomastjeffery 3y ago
Autism and ADHD are, by far, the most thoroughly studied mental disorders. They are also the most thoroughly undiagnosed, untreated, and ignored. Sprinkle the hyper-politicization of stimulant medication on top, and you get what we have today: hell. Imagine if the wheelchair store was at the top of a staircase. Imagine if the glasses flashed bright lights into your eyes every time you tried a frame on. Imagine you broke your leg, and your physician told you with a straight face, "I think it might be a sprain. I'm going to prescribe you a mild painkiller, and see if that helps." There's a shortage of crutches, and we don't want to risk getting you dependent on those anyway. Think I'm being heavy-handed here? Just read any collection of first-hand ADHD diagnosis. If anything, it's worse.
- eilefsen 3y ago
  Even with a diagnosis from an age of 12 (!!!), and testimonies from teachers and parents going even further back, I was still being stonewalled for months on getting medication as an adult. This was after they took my diagnosis (demanded a redo, came to a conclusion after 2 appointments and discharged me) and i regained it at a neuropsychiatry clinic (ADHD and Autism specialist). The only thing that broke through was outside help from a municipal caregiver, he prescribed it immediately when she called. This shit is not incompetence, it is malice. It is on fucking purpose.
siva7 3y ago
Many important topics are competing for the limited teaching time available in med school. Special care isn't the professional duty of a medical doctor and therefore doesn't belong in the core curriculum.
- eilefsen 3y ago
  special care is literally the job of a doctor.
growingkittens 3y ago
It all needs to be reimagined. There needs to be more than one level of doctor. No decision should be left solely to one doctor: human health is too complex for our current level of technology. At the patient level, there is the doctor that interacts directly with the patient. There should be a doctor whose sole purpose is to observe and support; to consult on patient cases, contact specialists, research cases, etc. There should be a doctor who manages a patient's overall health - but like a teacher with students, there should be a limit to the number of patients they can manage at a time. Then there should be a doctor who reviews this process. Specialists should focus not on direct patient interactions, but on supporting general care doctors in the technicalities of their specialty and guiding them through cases. These different types of doctors would have training based on the role they want to fill in patient care. Doctors who interact directly with patients could have focused training in collecting information and other subjects related to the article at hand.
aristofun 3y ago
Let's face it - modern medical schools do not prepare students to care for anybody. They prepare them to do the paperwork and follow bureaucracy. Sometimes, if you're lucky, you find a doctor who is capable of caring despite that.

174 points by wjb3 3y ago

micromacrofoot 3y ago

sometimes it feels like medical school doesn’t even prepare students to talk to people

LtWorf 3y ago
In sweden they teach them to underestimate what people complain about, and when in doubt send them home and if they come back try to do something about it.
amelius 3y ago
yes, you might as well talk to an LLM, but that is where we are heading anyway https://www.advisory.com/daily-briefing/2023/05/02/chatgpt-empathy https://www.advisory.com/daily-briefing/2023/05/02/chatgpt-e...
082349872349872 3y ago
I once chatted with an older doctor while we were both waiting for an oil change, and his theory was that while at least 80% of people who wanted to become doctors stood a chance of having a reasonable bedside manner when they started med school, between med school and the residency they had it all beaten out of them until only 5% retained any semblance of it.
- ProllyInfamous 3y ago
  I got a California "recommendation" once, from a gentleman physician approaching his 80's. When I asked him why he chose this particular "pot doc" persona, he asked me: >"Have you ever heard of `the elephant graveyard`?" His defeated demeanor still haunts me, often (and this was 15+ years ago — he's likely deceased).
nradov 3y ago
Medical schools hire Standardized Patients specifically to prepare students on how to talk to people. https://cisl.stanford.edu/standardized-patient-program/for-standardized-patients.html https://cisl.stanford.edu/standardized-patient-program/for-s... Of course, some students learn these skills better than others. And even doctors who have good communication skills are under so much pressure to see more patients that they may not have time to talk much. If they only have 8 minutes with a patient then they have to get right to the point instead of letting the patient ramble on.

egberts1 3y ago

Unless these medical students have some immersion exposure into the physically-challenged (including Deaf) or mentally-challenged communities, this trend of ignorance shall continue.

Podgajski 3y ago

I’ve told doctors countless times the medication’s they used to treat my Asperger’s and my bipolar disorder schizoaffective type, make me ill weak and caused me pain. But they never listen to me. So this is not even about people with serious mental handicaps. They don’t listen to patients in general. But that’s true for people with mental illness They think every pain or issue we have is solely our heads. But I also recently had a friend mother who went to the doctor because her ankles were swelling and she had some other issues. They took a blood test and didn’t tell her. Her kidney function was with stage 3B kidney failure. It was two weeks until my friend showed me the labs and I told her to go back and force him to take more test. I don’t know what’s going on in medicine if this is something new or is this something old but medical school shouldn’t cost as much as it does if they’re putting out doctors like these.

toldyouso2022 3y ago
Profit and loss incentives make it so that if you are competent you get clients and you keep going, if you aren't you lose money and fail. With central banking we have destroyed this system and in the case of medicine not only there is a lot of central banking interference but here is also a guild system that limits the supply of doctors, so bad doctors don't fail and with time you get more and more bad Doctors. Things will only get worse
- jMyles 3y ago
  Absolutely. Nowhere is the perversion of incentives more clear than in places where we hope people will act from their heart and their genuine concern, because they are out-competed by the economic forces of easy, cheap, fast money. This phenomenon is also visible with regard to single-use plastics, as much a stretch as that may seem: why buy things that can be re-used indefinitely, and passed on to next generations, when money is such a hot potato? Better (rationally) to trade money for cheap plastic things from the other side of the world.
- cjbgkagh 3y ago
  Doctors being bad at their jobs predates central banking, take the long held obsession with blood letting as just one example. Fixing finance will not fix doctors. If doctors want people to listen to them they need people to believe they’re very smart, and getting pulled into the mire of the specifics of people’s conditions would just result with both the patient and doctor finding out they don’t know enough and that’s bad for business.

Trasmatta 3y ago

They also don't teach them how to care for people with Type 1 diabetes. There are so many horror stories about how awful hospitalization is for T1Ds. So many doctors and nurses don't understand the complexity of treating the disease, or respect the patient's ability to treat it themselves while in the hospital. Not to mention how common misdiagnoses are: I was diagnosed as T2, when I was clearly T1. They didn't even do an antibody test, all because I was an adult. So many people (including doctors) still have the dangerous idea that T1D only manifests in kids. I'm terrified of being hospitalized for that reason. I'll sign whatever paperwork needed in order to self treat with my CGM and pump. I've been doing this for 12 years, no doctor is going to be about to do it better. This also scares me in terms of inpatient mental health facilities. They often don't even give you access to your own insulin and testing supplies. Which is a recipe for feeling much worse after leaving then entering.

paulcole 3y ago
> I was diagnosed as T2, when I was clearly T1. They didn't even do an antibody test, all because I was an adult. Same. I was about 30, long distance runner and bike rider. Went from 170 pounds to 130 over about 4 months. Doctor shrugged and was like, “You must be addicted to carbs. It’s type 2 here’s metformin. Start eating better.” I have since found 2 doctors who I like quite a bit. But I now know that I’m the only one on planet Earth who truly cares about my health. It should’ve been obvious from the start, but it wasn’t. Now I know. If I want to be healthy, it’s on me to get there.
- Trasmatta 3y ago
  > But I now know that I’m the only one on planet Earth who truly cares about my health. It should’ve been obvious from the start, but it wasn’t. Now I know. If I want to be healthy, it’s on me to get there. This is especially true for T1D. You don't just go to the doctor twice a year and have them prescribe a set medication dosage you take every day. You have to constantly adjust and factor it into every decision, every hour, of every day, for the rest of your life. I'm exhausted.
  - 3y ago

ChrisMarshallNY 3y ago

Also, substance abuse (including alcohol). I think they get about two hours' training, in twelve years of school.

ProllyInfamous 3y ago
At least during the first year, we all had some form of chemical addiction(s). Did we need any more training than personal sin/sacrifice?

brcmthrowaway 3y ago

Most people go into medicine because of the money and status

araes 3y ago
A caveat to this would be that "caring for the autistic and/or disabled" is generally not viewed as "high status" in human society. If you have a disabled child, a lot of the time, the other children don't wanna hang out. If you're a disabled young adult, nobody probably wants to date you (or at least a very limited subset). You're already below 7-8 on hot or not for most. If you're a disabled adult, a lot of time, people don't "really" wanna deal with your needs (work/home/businesses) If you're a disabled elderly, you're probably in a home. Plus, a lot of societies for (pretty much since humans existed) have shunned the disabled as untouchables / failures / curses / diseased / bad-genetics / unlucky And in human society, "high status" often correlates with "expensive" or "high wealth". Also "pretty" or "desirable".
neilv 3y ago
Easy big money right now is actually the techbro field. Becoming a doctor just for the money would be the hard-mode way to do it. (Grueling pre-med weed-outs, med school applications, med school, residency competition, residency, specializations, etc.) Doctors do have status/respect, deservedly. Techbro stereotype is that of overpaid dimwit, from how we assume that big paychecks confer intellectual status, and confidently open our mouths on topics that other people actually know.
- pants2 3y ago
  The tech bro stereotype has only emerged in the past couple of decades, and even so is mostly isolated to the United States. Doctors are still the go-to "money and status" profession for most of the world.
TriangleEdge 3y ago
How do you quantify what a good doctor is, and how do you erect barriers to filter them in?

markx2 3y ago

I qualified as a nurse - Registered Nurse Mental Handicap - RNMH - here in the UK in 1989. Many of those I cared for needed regular blood tests. Esp those prescribed lithium and other anti-convulsants so that the drug regime was within therapeutic limits. There is, for example, a patient called John. He needs a blood test. He comes into a room with a person he has never met, to be subjected to something he is unfamilar with and, unsurprisngly, get agitated and refuses. This happened again and again and again. We, as a group of nurses say "Hey, let us do the blood sampling, we know the person, we can time it right, we know this person" This idea was opposed 100% because DOCTORS KNOW BEST.

lmpdev 3y ago
I wonder if effective psychiatric wards are more egalitarian in that way
forinti 3y ago
The variety of people who comment on HN is truly wonderful.
082349872349872 3y ago
Surely you've seen: https://www.youtube.com/watch?v=7-a2QBfFQeA https://www.youtube.com/watch?v=7-a2QBfFQeA ? (Steve Martin — subdural hematoma)
- throwup238 3y ago
  Damn for a second I thought Steve Martin had released a new single called “Subdural Hematoma” and got excited. (He’s a professional Banjoist!)
  - 082349872349872 3y ago
    Wouldn't that be "Subdural Hemiola"? :-P (I'm more of a dobro than banjo fan...)
stevehawk 3y ago

s5300 3y ago

[dead]

deleted 3y ago

[deleted]

charred_patina 3y ago

No offense, but what do medical schools prepare you for? I know very few people who have ever said "yeah I have a really great doctor", and then it's only because they spent time searching and learning to navigate the system. When I go to the mechanic (honest ones) will tell me everything wrong with my car. When I go to the doctor, unless I do outside research and proffer solutions, they just send me home. On a related note, I think a big part of the anti-vax phenomenon is how many people end up seeking care outside of the medical system because it's so broken. People find holistic solutions like diet and exercise and end up falling down a conspiracy pipeline.

cratermoon 3y ago
> what do medical schools prepare you for? Applying differential diagnosis and standard-of-care treatments.
jmye 3y ago
I mean, your body is slightly more complicated than your car. If your issue is highly specialized, assuming your PCP or family med doctor will be able to figure it out is like thinking your car mechanic can fix your airplane, just because an engine is an engine. I’d also note that cost incentives in healthcare are badly misaligned (commercial and Medicare, and generally for most other single-payer systems). There’s a reason your doctor usually only spends a few minutes with you before running out to spend a few minutes with someone else.
- charred_patina 3y ago
  I have wondered why we even need primary care doctors when it seems like if you really need treatment, you see a specialist. Not to be the "disruptive technology will fix X industry" guy, but wouldn't it make sense to have nurses and techs just run a diagnostic on you and feed it into a computer, which can spit out a list of possible causes, which you then take to a specialist? I don't really know much about this stuff so I'm genuinely curious why our system seems to suck so bad from the outside.
  - 3y ago

cratermoon 3y ago

Or women's unique health issues either, really.

lotsoweiners 3y ago
Do you mean just from a primary care prospective and avoiding OBGYN? Also, I wonder what the difference between male and female PCPs is in that regard.
- cratermoon 3y ago
  Not even OB-Gyn practitioners are trained for a woman-centered point of view. See for example the "The Miracle of Birth" segment from Monty Python's The Meaning of Life.

slibhb 3y ago

> Oliver McGowan was 18 years old when he was hospitalized in England with recurrent seizures and pneumonia. He was autistic, and he and his parents had one specific request for the medical team: no antipsychotic medications. When he had taken them in the past, they made his seizures worse and had devastating effects on his mood. Despite the family’s vehement protests, doctors gave him an antipsychotic. A few days later, Oliver suffered a lethal neurological side effect. A week later, he was taken off life support. An inquest into his death found that the drug had led to the rapid deterioration. I don't see what this has to do with autism. Also, I understand that receiving medical care can be alienating but I'm not sure there's a way to fix that. It's real hard (impossible?) to train people to be kind, patient, and empathetic. Being honest and not making medical errors are probably more important training targets for doctors, nurses, and other medical professionals (and more achievable).

crote 3y ago
People with more severe autism can be really tricky to deal with. According to [0] the medical staff gave him medication he was known to be allergic to in order to sedate him. [1] says he arrived at the hospital scared and agitated and was physically restrained. The staff decided to deal with this by pumping him full of sedatives rather than actually addressing the source of his anxiety. If the staff had been given proper training into dealing with neuro-atypical patients, there would have been no need for sedation. [0]: https://www.bbc.com/news/uk-england-bristol-54602417 https://www.bbc.com/news/uk-england-bristol-54602417 [1]: https://www.bristolpost.co.uk/news/bristol-news/full-story-day-oliver-mcgowan-1474471 https://www.bristolpost.co.uk/news/bristol-news/full-story-d...
- graphe 3y ago
  >If the staff had been given proper training into dealing with neuro-atypical patients, there would have been no need for sedation. If people are given anti violence courses would it certainly stop violence? Doesn't matter if they have autism or not, doctors in their panic with or without training may make medical misfortune occur.
  - 3y ago

dimal 3y ago

I get the feeling that doctors aren’t really trained for more than half of the stuff they need to know. Trauma informed care is a joke, yet a huge proportion of people have a history of multiple adverse childhood experiences, and these have very real effects on health. And any chronic illness that doesn’t have an easy biomarker is a complete unknown to most doctors. They just throw up their hands and say the bloodwork is normal, you must be fine. I don’t know how doctors can be trained for twelve years and have so little understanding of health. And yet they have such confidence in their abilities.

steve_adams_86 3y ago
Part of the challenge of bringing mental health into physical health, I think, is that it introduces a vast number of non-verifiable variables into an already incredibly complex system. While it might be a good idea, it asks a tremendous amount from a practice which often can’t keep up with demands as it is. I know a paradigm shift and rethinking could resolve that to a degree, but it’s quite antithetical to western medicine. It’s like asking programmers to embrace non-deterministic programming languages when you’re already deploying to non-deterministic platforms. It would seem like total chaos, I think.
- dimal 3y ago
  I don’t think it’s antithetical to Western medicine. It’s antithetical to mass produced, industrialized medicine. Those aren’t the same thing. I only want them to use the scientific method on each individual patient. That’s all. They don’t seem interested in it though. They don’t seem to be able to think for themselves and reason on their own. They like acute diseases and disorders. Here’s a virus, and we kill it with this medicine. Here's a bacteria and we kill it with this medicine. Here’s a tumor and we cut it out. Anything more complex and they don’t have any interest in it. If they want to treat the patients they actually have, they need to learn how to do this other work. The other option is we just accept that they don’t have any interest in this type of complexity, and say OK, that’s fine, but they no longer have a monopoly on medicine. We find other ways of certifying other branches of science to treat people with these things. There are a lot of people who are already treating these things well. I go to a nutritionist who is amazing and has helped me more than any other doctor. She’s not anti-science or using crackpot theories. She’s still scientific. But my insurance won’t cover the because the MDs have a monopoly on that.

bloopernova 3y ago

My wife is autistic, and has hyper mobile Ehlers-Danlos syndrome. She's had nurses accuse her of pill seeking while one or more joints have been dislocated. It seems as if a large part of the world's (professional) empathy was drained during the COVID-19 pandemic and I'm not sure it's ever coming back.

operatingthetan 3y ago
>It seems as if a large part of the world's (professional) empathy was drained during the COVID-19 pandemic and I'm not sure it's ever coming back. People are going to retire and the empathy will replenish!
tbrownaw 3y ago
> accuse her of pill seeking I thought that was more of a war-on-drugs thing and pre-dated covid by quite a bit.
ghufran_syed 3y ago
She should find a doctor she likes and stick with that doctor - apparently, “if you like your doctor you can keep your doctor” (with obvious extension to that doctor’s nurses,techs, clerks etc) If that statement is not true, perhaps we should consider what changes in the system might might make it more or less true over time?
RecycledEle 3y ago
I assume you are in the USA. If you are not, I apologize. If we changed the US Constitution so that every person has the individual right to import, purchase, own, redistribute, manufacture, and use anything that is vaguely medical without any taxation, restriction, or tracking from any source whatsoever... Then we could just buy our meds from Cipla and be done with most of the corrupt American healthcare system.

ThinkBeat 3y ago

To play the devils advocate. What should the medical schools remove from the curriculum to accommodate this? It is not like they have part of a semester that that is just waiting to be filled. It is already stuffed to the gills. There are 100s probably 1000s of things that should be added in order for doctors to be better prepared for one scenario or another. Being autistic I would like to see this added, but at the same time I have no idea what they could remove. They could keep adding semesters until they got it all covered by that is probably not going to work either. They have a set schedule. You want to push something in, you gotta take something out.

WarOnPrivacy 3y ago
> What should the medical schools remove from the curriculum to accommodate this? I vote they remove the part of the curriculum that pointlessly makes residents work zillion-hour, sleep deprived shifts - one after the other, for years.
- cfu28 3y ago
  That’s residency, which is after medical school.
SkyPuncher 3y ago
> It is not like they have part of a semester that that is just waiting to be filled. It is already stuffed to the gills. Oh, how I wish this were true. I'm married to an MD. Went through the med school/residency journey with her. Soooooooooo much waste and BS in the process. In direct response to your question, 4th year of med school is essentially a joke. During the first half of the year, everyone is distracted by residency interviews and applications. During the second half of the year, no one really cares because they're ready to peace out. My wife's entire 4th year could have been dropped and she would have lost absolutely nothing. The reality is medical schools primary metric is percentage of students placed into residency. More prestigious schools care about more prestigious placements, but placement is a must. The primary, almost exclusive, means of ranking resident candidates is test scores. For most med schools, that means they don't actually care about providing their students with any practical skills. They only care about succeeding on a handful of standardized exams. In fact, I've seen schools kick students out with exams failures so they can artificially keep residency match rates high.

duffpkg 3y ago

I don't dispute the headline but this article is a total mess. First referring to the US health system but then citing anecdotes from the english health system. It then mingles US healthcare and dentistry. The US health system is as different from the UK health system as different can be and in the US dentistry is a fundamentally separate industry and education tract that has absolutely no connection to healthcare whatsoever. In the US I can speak first hand as a former hospital executive that a lot more can be done to improve treatment paths for people with a wide variety of mental health diseases. Medical school can play a role but residency programs are a much more important element, at least in terms of how US doctors are trained. From history the best way to do this is to create a specific health system focused on treating those patients and to lead by example. I am not aware of such an effort but there may be one.

at_a_remove 3y ago

Medical schools do not prepare students for a lot of shit. I have a rather rare metabolic disorder, a subtle one with a lot of complications. I had to fight to get the correct tests done, I had to fight people who got constellations of symptoms wrong, older people with MDs who didn't want to listen to some kid. The tests came back: they were wrong. (This was all prior to all of this information being available on the Intarwebz; I had to learn everything from books) I still have to check the meds I am prescribed. I have to deal with doctors whose pupils visibly twitch when scanning my chart -- they mysteriously excuse themselves for a bit and return, "I see it says here you have ..." Others simply pass the buck on treatment. I had a hematologist client-dump me on the answering machine. It's hard enough to treat the bulk of the boring patients. If you're on the edge, well, they simply don't have experience. Most doctors won't ever see someone like me. If doctors were some other species who lived to be a few hundred years old, they would have the experience. I'm reminded of that recent Slate Star Codex parable about the alchemists and the dying prince. It's just too much to ask from mere mortals. The flip side of this is me recognizing doctors as mere mortals and not just going with everything like a lamb.

deleted 3y ago
[deleted]

calamari4065 3y ago

Honestly this has less to do with training and more about the catastrophically understaffed and overworked healthcare system. There are not enough nurses on shift at any given time, and patients like this are difficult and require a lot of one-on-one care. Hospitals won't or can't bring on additional staff to care for these cases. It's already nearly impossible for a nurse to round on all their patients, so sometimes they use sedatives so that they can care for everyone else. Which is clearly a very bad thing to do, but when your options are sit with one patient who only needs social/psychological support or caring for a dozen or three other people, it's a much more difficult call. The problem is staffing and pay, not training. Nurses are trained to deal with difficult situations. Maybe not this specifically, but part of the job is recognizing an unusual situation and dealing with it rationally. But after being burnt out for so long, rationality gets lost. And not to excuse these doctors, when family tells you not to use a particular drug, you DO NOT DO THAT. And this is why: you kill people.

hereme888 3y ago

Medical school is not supposed to prepare anyone for specialized care. It's only to help students gain enough knowledge and experience for residency. Here's the breakdown (this is meant as an exaggeration and a joke, to illustrate the point): - First 2 years of med school: mostly academic teaching so you don't kill anyone when you show up in an actual hospital. - Third year of med school: (jokingly) you can look and touch, but even the nurses are keeping an eye on you. You just contaminated your hands by touching your beard, get out of the room! - 4th year of med school: did you talk with the new patient? What do you think? Student: "He was a little odd, otherwise he's here for a checkup." Doctor: "He's autistic..." Student: "Oh...I had a feeling he was." Residency: how to actually do something for patients in general. Fellowship: how to actually do something for complex medical conditions. Residency is what's supposed to prepare people to operate in their respective fields. And then comes fellowship for specialized care. For anyone who wants to complain about what doctors should or should not learn during medical school: first go learn what the curriculum does teach, then ask yourself if you're even mildly qualified to make those judgements based on your understanding of healthcare, and then maybe you could comment on what would have to be left out of education to accommodate for X, because the curriculum is already super bloated and a firehose of information.

tetramer 3y ago
I'll finish up my fellowship this summer and it will have been a solid 10 years from when I started medical school. The vast majority of people have no idea what goes into medical training (even my own parents remain confused) - and that's okay, there's no need for everyone to know these ins-and-outs, but when we're passing judgment on the medical curriculum and adding additional things, it does become important. You can talk about adding a class in medical school addressing neurodivergence and disability, but how do you really address that spectrum of diversity in a single class? And what aspects do you really retain a decade out when patients with neurodivergence can be relatively rare (depending on your specialty)? In the end, I think the best learning comes from seeing patients (especially, again, as the spectrum of what these patients experience is so diverse and individual). I am always grateful to patients who provide guidance along with parents or caregivers and nurses who had often cared for that patient before for their advice on how to approach a specific patient, along with individual behavior plans if in place.

deadbabe 3y ago

I wonder if there’s some opportunity for AI to help with guiding care for special needs individuals.

ghufran_syed 3y ago

How is this different from giving a patient a drug that they say they are allergic to? Doesn’t seem to have anything to do with the patient being autistic

Perenti 3y ago

I've had quite a lot of medical treatments, due to terrible luck and universal health care. In my experience (3 continents, 6 countries) medical training does not prepare students for people. For people with communication issues, sensory issues or disability it has to be even worse.

thomastjeffery 3y ago

Autism and ADHD are, by far, the most thoroughly studied mental disorders. They are also the most thoroughly undiagnosed, untreated, and ignored. Sprinkle the hyper-politicization of stimulant medication on top, and you get what we have today: hell. Imagine if the wheelchair store was at the top of a staircase. Imagine if the glasses flashed bright lights into your eyes every time you tried a frame on. Imagine you broke your leg, and your physician told you with a straight face, "I think it might be a sprain. I'm going to prescribe you a mild painkiller, and see if that helps." There's a shortage of crutches, and we don't want to risk getting you dependent on those anyway. Think I'm being heavy-handed here? Just read any collection of first-hand ADHD diagnosis. If anything, it's worse.

eilefsen 3y ago
Even with a diagnosis from an age of 12 (!!!), and testimonies from teachers and parents going even further back, I was still being stonewalled for months on getting medication as an adult. This was after they took my diagnosis (demanded a redo, came to a conclusion after 2 appointments and discharged me) and i regained it at a neuropsychiatry clinic (ADHD and Autism specialist). The only thing that broke through was outside help from a municipal caregiver, he prescribed it immediately when she called. This shit is not incompetence, it is malice. It is on fucking purpose.

siva7 3y ago

Many important topics are competing for the limited teaching time available in med school. Special care isn't the professional duty of a medical doctor and therefore doesn't belong in the core curriculum.

eilefsen 3y ago
special care is literally the job of a doctor.

growingkittens 3y ago

It all needs to be reimagined. There needs to be more than one level of doctor. No decision should be left solely to one doctor: human health is too complex for our current level of technology. At the patient level, there is the doctor that interacts directly with the patient. There should be a doctor whose sole purpose is to observe and support; to consult on patient cases, contact specialists, research cases, etc. There should be a doctor who manages a patient's overall health - but like a teacher with students, there should be a limit to the number of patients they can manage at a time. Then there should be a doctor who reviews this process. Specialists should focus not on direct patient interactions, but on supporting general care doctors in the technicalities of their specialty and guiding them through cases. These different types of doctors would have training based on the role they want to fill in patient care. Doctors who interact directly with patients could have focused training in collecting information and other subjects related to the article at hand.

aristofun 3y ago

Let's face it - modern medical schools do not prepare students to care for anybody. They prepare them to do the paperwork and follow bureaucracy. Sometimes, if you're lucky, you find a doctor who is capable of caring despite that.