If you want to go to Medical schools in the US, you have to take a test called an MCAT. It is to try to figure out if you are smart enough to be a doc or something like that. I’m not sure, since I predate that test.

At least in the past doctors were trained scientists: Yes, medicine was an art, where judgment and hunches based on your previous knowledge of the patient helped diagnose the person, and individually crafting the treatment for someone you know was the heart of the matter.

But to do this, you needed a scientific point of view: something that included a mild skepticism of the “experts” data, a big skepticism on the magic of medicine, and a cool headed logic that allowed you to be objective when things outside your control fell apart.

Traditionally, medicine is about diagnosing and treating a sick person.

But no more. Now the experts have decided that doctors are to be nannies. They will run your “medical home” and make sure you get all your tests and take your pills.

It doesn’t take a hard headed doc to do this: you need someone more obedient to authority who will be able to check everything on the checklist, so that the powers that be will be happy.

And, just in case a cool headed smart scientific student might actually get into the profession, the latest idea is to change the MCAT test to emphasize non scientific studies.

From the AAFP website:

Preliminary recommendations for a new version of the Medical College Admission Test, or MCAT, include key changes to the content and format of the current MCAT that can help medical schools select students who are more likely to go into family medicine and primary care, say AAFP medical educators.According to a March 31 news release from the Association of American Medical Colleges, or AAMC, the proposed recommendations call for testing the behavioral and social sciences concepts that underlie students’ capacity to learn about the human and social issues of medicine.

Translation: The “human and social issues” mean an emphasis on preventive medicine, not diagnosing people who are sick. It also means that the students will be more responsive to “social issues”, such as the need to ration medicine and follow guidelines that one may or may not agree with.

The revamped recommendations also propose revising the current verbal section of the MCAT to test the way examinees reason through passages in ethics and philosophy, cross-cultural studies, population health, and other subjects, thus communicating the need for students to read broadly in preparation for their medical education

A student with four years of discussing the great books might be prepared both intellectually and psychologically to become a great doctor, but one who takes courses in “gender studies” and other watered down courses that are given in many of our universities will simply not be either mature enough or  knowledgeable enough or even disciplined enough in studying to get through medical school.

So, by testing for “behavioral and social sciences”, you are lowering your standards to allow students who learned to regurgitate political correctness to get into medical school.

I’m not saying that a person doesn’t need a good ability to be sympathetic and empathetic to be a doctor, but I am saying that such talent cannot be taught, nor measured on a test.

Once you start testing with the idea to admit only those students who test high in the softer social “sciences”, what you will get are students who fit into the newfangled mold of efficient business/cost effective medicine.

You will get students who believe that “experts” can “analyze” a dozen flawed studies and who are willing to “implement the guidelines”, not students who know how to detect if the study is statistically meaningful.

You will get students who go along with the bureaucrats who refuse to authorize treatment for a patients because the patient doesn’t fit their “scientific” criteria, not students who put the patient’s wellbeing first.

For example, when it comes to expensive treatment such as dialyzing grandmom who is 65 and who might only live half a dozen more years on dialysis, well, your training in the importance of the community’s welfare will make you willing to go along with “experts” such as these in the NYTimes article that tell you we can’t afford to keep grannie alive a few more years,  so we’ll just let them die, hiding what we’re doing with the Orwellian language of medical ethics.

“Instead of saying that a patient is withdrawing from dialysis or agreeing not to start it, these specialists say the patient has chosen “medical management without dialysis.”

Ah, but why does the AAFP go along with this agenda? When I joined the AAFP, the idea was to get the best brains to become family docs, but now, it seems, they want to change the profession to make it easier for less qualified people to become family docs.

Nowadays, the AAFP, who is supposed to represent family docs, is actually run by a bunch of docs who are gung ho about Obama care and getting us to become the Nanny docs of the “Medical home” concept, where instead of seeing doc and getting treatment when you’re sick, you’ll see a “health care provider” (who you probably never met before) who will snoop into your electronic chart, pop up a window and remind you that you need x y and Z.

This is supposed to improve the status of Family doctors?

Wendy Biggs, assistant director of the AAFP Division of Medical Education, agreed.

“We know some demographic and educational factors that appear to predict whether a medical student will enter primary care, such as female gender, having a rural background or attending a publicly funded medical school,” she told AAFP News Now.

Well, the reason the “female gender” tends to go into primary care is that the long training and the hours away from the family in specialties like surgery make being happily married and having a family difficult.  If your aim is to increase the number of docs in rural areas, you might want to give out more scholarships, not look for them in less presigious “publicly funded medical schools”. Lots of folks don’t want a low paying rural job when they owe half a a million dollars for their education loans. Indeed, one reason I could afford to work in African and then in rural medicine was because I trained with the help of a scholarship, not a loan.

And try giving rural doctors support: Decent reimbursement, (rural docs are paid less), reimbursement for deadbeats who don’t pay their bills, and specialist coverage. And the most important item:  time off.

Actually if you really want more docs in rural areas, I know lots of local Pinoy docs who will gladly work in isolated rural areas if you sponsor them and their spouses for green cards.

But to water down medicine by emphasizing non scientific abilities isn’t going to help, unless, of course, you want docs who make the Washington bureaucrats happier than their patients.


Nancy Reyes is a retired physician living in the rural Philippines.

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