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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.

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.

Volume 322 of the British Medical Journal, published on February 24th 2001, presented the results of 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.