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Patient-Centered
Learning Vs. Institutional Centered Learning
Shaun
Kerry, M.D.
Diplomate,
American Board of Psychiatry and Neurology
I learned far more about
the practice of medicine AFTER I left medical
school than in the classroom. I let my patients
teach me, and they loved me for it.
A
critical problem with institutional learning
is that the information taught within the institution
is accepted as God-given truth. Many
patients, who are concerned with their conditions,
will frequently present information about their
illnesses to their physicians.
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If
this information contradicts what the doctor has learned within
the confines of the institution (i.e. medical school),
the patient is considered wrong, and devalued.
A better alternative, is PATIENT-
CENTERED LEARNING. By listening to the
patient's stories starting very early in one's
training, the patient becomes the focus. This
model has powerful implications. The student
would be free to do web based literature research
on the patient's condition, which would take
him far beyond medical school programming. Additionally
he could devote much deserved time to the patients
and explore non-drug, nutritional, and life-style
therapies for their conditions.
Doctors are the third
leading cause of death in the U.S. according
to the July 26, 2000 issue of the Journal
of the American Medical Association, Vol.
284. The actual statistics are probably
higher, due to treatments that harm, rather
than help patients. An over-reliance
on prescription medication is the primary
cause of such fatalities. The new model
would allow the student to change that pattern
of negligence.
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Volume
322 of the British Medical Journal, published
on February 24th 2001, presented a study that attempted
to ascertain what patients want from their doctors. The
responses were not surprising. They were things
that we - doctors included - have known for decades. Simply
knowing them, however, has not been enough to effect
change. |
Patients
want better communication. Instead of receiving
a physical examination or a prescription,
patients would rather spend precious time with their doctors discussing
their conditions and hearing about ways to stay healthy. The
researchers identified three specific areas that patients
want their doctors to emphasize: communication, partnership
and health promotion. More than three-quarters of respondents
wanted visits with their doctor to focus on:
- communication
between themselves and the doctor.
- open discussion of their feelings about treatments
in order to
reach cooperative
decisions
- learning
about ways in which they can improve their
health or prevent future illness
- Fewer wanted an examination (63%) and only a quarter
of those surveyed wanted a prescription.
Doctors
know what patients want, but their mindset
is deeply ingrained into their character. They
feel that they deserve to earn a high income
after enduring a tortuous educational process. Rigid
institutional requirements drastically reduce
the supply of doctors, which equates to less
time spent with each patient. This reduced
supply of doctors also serves to increase the
cost of their services. The lengthy,
institutional, fact-stuffing process produces
a mental rigidity that prevents these physicians
from adapting to alternative styles of practice. They
feel like they need to give their patients
something of value in the short time that they
spend interacting. This thing of value
is usually a prescription.
The
non-institutional, patient-centered educational
plan would produce an abundant supply of compassionate, innovative, prevention-oriented
doctors at an extremely low cost. Additionally,
the pace of medical research would be sharply
accelerated.
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