Making Doctors Human
Universities revise both preparation and curricula for med schools
... Alcoholics, down-and-outers, weren't
supposed to have eyes that sparkled. Mary's
did... Iwanted to hold her, to tell herthat a
bad dream was ending, that we were going
to make her problem our problem. But we
weren't. She had come to the wrongplace to
be helped. The emergency room would pro-
vide only "episodic" care focusing on to-
day's symptoms. Livers, not lives ...
a Baltimore hospital one frosty
eith Ablow encountered Mary in
night during his first year at the
Johns Hopkins Medical School.
As an assignment for an innova-
tive ethics course, he and other first-year
students spent the night in the emergency
room and later wrote essays describing
their experiences. What struck Ablow was
how the interns and residents
were interested only in treat-
ing Mary's symptoms, coldly ig-
noring the problems that actu-
ally caused her alcoholism. "As
doctors, where was their com-
passion?" Ablow wrote.
Four years later, at Ab-
low's graduation, Hopkins dean
Richard Ross mentioned the es-
say and said he had been pon-
dering the question. In his com-
mencement speech last June
Ross urged the new M.D.'s to
guard against "a progressive
loss of appreciation of patients
as human beings." Watch out,
he said, "for the early signs of
this malignant syndrome ...
and take corrective action."
Curricula that stress caring
as well as competence have
been prescribed at a small but
growing number of American
medical schools. In a movement
dubbed "medical humanism,"
respected medical colleges from
Harvard to Hopkins to Case
Western Reserve are chang-
ing their teaching methods
or liberalizing admissions re-
quirements. The movement has
spread to undergraduate pro-
grams at such schools as the
State Universityof NewYorkat
Stony Brook, Northwestern
and UCLA, where premed stu-
dents are encouraged to take Early trea
fewer science courses and sample more lib-
eral arts.
The call for medical humanism comes
during acrisis for medical education. Appli-
cations to the nation's 127 medical schools
have dropped 26 percent since 1975, and
projections indicate that the class entering
this fall is off another 10 percent compared
with last year. Moreover, those applying
have lower grade-point averages. "I worry
that we'll have insufficient talent available
to maintain anywhere near the size of pro-
grams that we have now," says Dr. August
Swanson, vice president for academic af-
fairs of the Association of American Medi-
cal Colleges (AAMC).
Medical educators have offered a num-
ber of diagnoses for this decline. Soaring
educational costs are prohibitive for some;
the average student who borrows money is
$34,000 in debt after med school. At the
same time, the profession appears less lu-
crative down the line. Malpractice suits are
more common and more expensive, which
means insurance premiums have risen
sharply. More doctors now work as salaried
employees of health-maintenance organi-
zations or other corporate entities, rather
than as entrepreneurs with few limits on
potential income. The negative word has
spread: when the AAMC last year surveyed
agroup of students who chose not to apply to
med school despite high MCAT scores,
many said they had been steered away by
disenchanted older physicians. The mes-
sage, says Leon E. Rosenberg, dean of the
Yale School of Medicine, is that medicine
has suffered a "fall from grace."
Less bio/chem: In an effort to
restore the luster of their medi-
cal schools, many universities
are making changes at the un-
dergraduate level. Perhaps the
most fundamental shift, says
Sandra Burner, an assistant
vice provost at Stony Brook, is
that "the thrust of the top medi-
cal schools is more and more
toward [admitting] the liberal-
arts student rather than the
bio/chem major who has taken
all the bio/chem courses he can
take." At Stony Brook, for in-
stance, the new Scholars for
Medicine program will guaran-
tee early admission to medical
school for 10 premed juniors
each year. Those selected can
then spend their senior year
taking whatever courses inter-
est them without fretting about
getting into med school.
So far, student reaction to
these changes is oddly mixed.
Some are dubious about their
colleges' motives in expand-
ing early-admissions programs.
"The bad thing is that kids will
be deciding to go to medical
school before they know what
t it's really like," says Jerry Sa-
nacora, a med student at Stony
Brook. "It will be prenatal
premed." Others say the shifts
HAEL SANDS confuse the application process.
patients Alyssa Gladstone, a Northwest-
NEWSWEEK ON CAMPUS 39
MCK
tment: Case Western's Kirsten Ecklund with
SEPTEMBER 1987