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Academic medicine needs teeth
- Rod MacQueen (27 April 2004)
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Dr. Welby is dead
- Irene Mazis, Rod MacQueen (10 January 2007)
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Rod MacQueen, Clinical Director, Drug & Alcohol Services Bloomfield Hospital, Forest Rd, Orange 2800, Australia
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Dear Editor, My experience tells me that more of the same will not do. After a grounding in general practice over 16 years in the one rural town, I gradually shifted into the fields of mental health and alcohol & drug problems. I am now an addiction physician and work in a mixed clinical, teaching, research and management role. I am not the first to note, but maybe the first to note here, that many doctors are NOT ABLE to treat the increasingly common problems seen in primary care. These include but are not confines to depression, anxiety (especially social anxiety) alcohol excess, other drug problems, chronic pain, and, in fact, many other complex problems. Health systems are good at managing the problems of the 1960s, the problems the current managers and teachers fear or perhaps already suffer with, but not the problems of the young, poor and disempowered. In some of these fields, particularly alcohol problems, benzodiazepine and prescription opiate addiction, too often the doctors ARE the problem (see eg [1]). 10 minute GP consultations, and 2.4 day stays in a hospital bed, hardly serve to promote the science and art of managing complex and often chronic problems well. This approach is designed to prop up a fragmented, technology oriented illness treatment system through which some are helped and most are disadvantaged. I, and many colleagues, have argued with medical deans and the Australian Medical Council that this is not acceptable - to no avail. Universities are preoccupied (perhaps rightly, in the current political climate) with financial matters, first and foremost. On-line teaching, the apparent saviour of medical education, will only worsen the issue - good medical practice needs to be demonstrated, empathy needs to be taught, engagement does not occur on-line, and good data, though essential, is the least important part of medical education. Some years ago, I was part of a committee that recommended that mental health never be taught in tertiary care settings - it is still the norm since it is convenient and cheap. It serves only to scare students away and ensure they are never exposed to those mental health problems which are the most common presentations in general practice. It is rather symptomatic of the whole training problem. I now have a teaching position in Psychological Medicine, which includes alcohol & drug problems, and I hope to convince a few more people that training in the setting where most doctors will work, seeing the issues that they will see, is the only logical way of teaching. Let them become specialists, those who will, but let them first be good generalists. A good generalist/GP is not an accident, or a failed specialist, but the object of our efforts, surely. I am not sure what I can do to help this issue, but this letter is to express my view and offer such help and support as I can to ensure our profession remains relevant and promotes better health for all. [1] Martyres, RF; Clode, D; Burns, JM; (2004): Seeking drugs or seeking help? Escalating “doctor shopping” by young heroin users before fatal overdose. MJA; 180 (5): 211-214 Competing interests: None declared |
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Irene Mazis, research home, Rod MacQueen
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I wonder if part of our growing problem with better health care is not related to the growing aging population and dwindling number of doctors and nurses and other health care professionals. After following the course of many debates on health care issues, e.g. the "pharmaceutical corruption" debates, I am beginning to consider the possibility of lack of adequate and knowledgeable medical care as the primary problem in adverse reactions, suicide and harm. The theory that profit-mongering drug developments, such as Prozac and other SSRIs lead to suicide because of akathisia for example, may be true for the duration process of loading the drug, but not an intrinsic quality of the drug itself. Many other examples of prescribing drugs with little monitoring may be worth examining. If I could suggest something toward the solution of this economic and demographic problem, I would say that collaboration in practical and financial care of patients, between hospitals and drug companies may benefit both parties. Competing interests: None declared |
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