Originally published October 16, 2003

CNN.com - Stanford sets new policy for med students - Oct. 16, 2003

I don’t have tons of respect for physicians as a rule. My background has afforded me an intimate view of medical and academic curricula…and although I don’t profess to have completed both of these courses of study…I know enough to know the “point” of each one.

A good clinician is not an academic. He or she uses direct and indirect techniques which require a certain level of feel and intuition to develop a set of parameters. For instance, heart rate is elevated…liver feels enlarged, confirmed by x-ray, etc. Based upon these parameters, a differential diagnosis is developed. This is rote memorizaton. Parameters 1, 2, and 3 means that it could be diagnosis 1, 2, 3, 4, or 5. Then they order predefined tests to rule out diagnoses so that they can, by a process of elimination, arrive at a diagnosis. It’s, in my opinion, more of an art of observation and less of a critical thinking exercise.

I have respect for clinicians in the same way that I respect auto mechanics. But no more.

Academics actually create new knowledge. They develop new techniques. They add to our understanding of the world around us. That requires a tremendous amount of intellect and creativity. At least to be a good one (there are a lot of hacks out there in all fields who simply do derivative work…there is no doubt about that).

But to see Stanford requiring their medical students to delve into the realm of academia gives me a new found respect for these docs. Rather that simply living in the “what”…these docs are now being forced to understand “why” and “how”. As such, they will be able to be more creative in their thinking and in their care…they’ll be able to solve bigger problems…and to think more critically. This allows me to think that perhaps medicine will now begin to address etiology rather than symptomology.

And if this is the case, we’ll all be the beneficiaries.