Medicine And Books

Who Has Seen a Blood Sugar? Reflections on Medical Education

BMJ 1997; 314 doi: (Published 29 March 1997) Cite this as: BMJ 1997;314:985
  1. Julian Tudor Hart, retired general practitioner
  1. Gelli Deg, Penmaen, Swansea SA3 2HH

    Frank Davidoff / American College of Physicians, £33, pp 226 / ISBN 0 943126 47 9

    As George Silver, a great North American educationist, once remarked, medical education cannot lead medical practice: practice leads education. He was talking about the foundations, not interior decoration. Medical schools certainly influence the fine points of decoration, but they don't change the building. Which is as it should be, as this building has a social function and does not belong only to doctors.

    This uncomfortable truth is well illustrated by Frank Davidoff, editor of Annals of Internal Medicine, a former senior vice president for education at the American College for Physicians, and, judging from the cover, still a fairly young man. His essays are worth reading, and I learnt something from almost all of them. They aim at the fascinating magpie style of Lewis Thomas and Stephen Jay Gould, which can't be bad, but, rating each on a scale of zero to four stars, I found they reached a mean of only 0.95 (range 0-3).

    Seen from what remains of the NHS, American medical practice, for all its dazzling technology, and the educators who serve it seem to be voices from the past rather than guides to the future–though this perception may change if the NHS continues to move backwards socially while continuing to advance technically. I found only three references of any kind to time or continuity–key concepts that we must impart to medical students for comprehension of health, illness, and medical care as comprehensible stories about lifelong health rather than isolated episodes of illness. Without these, educators just go on wringing their hands about the human irrelevance of so many of their graduates once they enter practice.

    Though we could do much better, the NHS is still generally organised to reinforce perception of continuing care as a story framing clinical events and making them comprehensible, and reform of medical education goes rapidly with the grain. American practice still reifies disease as an opportunity for episodic transactions. Medical education can neither prevent nor correct this fundamental cause of professional alienation, and, to most British readers, Davidoff's attempts to tinker with symptoms may seem largely irrelevant.

    Rating: *

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