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Why Bother Learning Something We'll Lose?

Jeffreywonoprabowo72x721Jeff Wonoprabowo -- During high school I took three years of Spanish. I thoroughly enjoyed it and really wanted to spend a year abroad to become fluent with the language. Unfortunately, when I got to college, I desperately wanted to finish in four years. My year abroad ended being sacrificed. In my final year, I did take Spanish 101 and 102, more for the fact I knew they would be easy A's.

Two years removed from graduation, I'm sad to say that I feel I wasted all that time studying Spanish. I haven't used it at all. Sure, I might remember some words and phrases here and there. I can probably still conjugate the present tense of most regular verbs. But I can't remember the vocabulary. I turn on Spanish television and I get nothing. Well, the actors are pretty dramatic, so I suppose I can get something.

The other day I was standing in line at the Argentinean Consulate when the lady behind me started talking to me in Spanish. I looked at her, puzzled. She repeated her question. I tried to piece together what she was saying but the only thing I got was "Koreano." I assumed she was asking if I was Korean. Well, I finally apologized and told her I couldn't speak Spanish after which the conversation ensued in English. But I couldn't help feeling frustrated that I couldn't even understand a simple question after more than 3 years of Spanish classes.

Language is just one of the things that you have to use, or else you lose it. And this got me thinking about medical training. This year, as with most first year medical students across this country, I took General Anatomy. As far as I know, I won't have any anatomy classes during second year. But Step 1 of the USMLE exam will cover General Anatomy. It worries me that I will go through an entire year without ever having an Anatomy lecture. I guess I am going to have to continually review myself whenever I find myself with that elusive "free time."

I also thought about the practice of medicine. This year, I heard a talk by a cardiology resident. He said that while he was tempted to go into surgery, he found the clinical skills of surgeons to be lacking. Most wouldn't be able to properly auscultate a patient. He had chosen cardiology because the cardiologists he had witnessed all impressed him with their clinical abilities.

One could debate the merits of having surgeons equally competent in wielding a stethoscope as they are with scalpels. It is probably not really important for surgeons to retain this skill. After all, they are called in to do their specific job -- to cut open a patient and fix an immediate problem. If a patient requires auscultation, then his or her internist should be able to do this or refer the patient to a cardiologist.

But doesn't it seem like a waste of time, money, and -- well -- medical training to just let a skill atrophy? Would time in medical school be better spent training students in the specific specialties they are interested in? Why bother teaching a student proper auscultation skills if the student is heading into Ophthalmology? I wonder, is there a better way to train our doctors of tomorrow?

In his book, Complications: A Surgeon's Notes on an Imperfect Science, Dr. Atul Gawande writes of Shouldice Hospital in Ontario, Canada. The surgeons there are experts at hernia repairs. That is all they do. Day in and day out, the doctors do nothing else but repair hernias. What may be surprising to most American medical students is the backgrounds of those who operate at this clinic. A few of them have never even completed a surgical residency. But they have trained extensively at repairing hernias. This clinic, Dr. Gawande writes, has a far higher success rate for their operations than any other place in the world. Why? Because they only do one thing, and they do it amazingly. Can this be applied to medical school to cut down on the massive amounts of information that medical students are force-fed each day?

July 30, 2008 in Jeff Wonoprabowo | Permalink


I disagree that surgeons are merely "called in to do their specific job -- to cut open a patient and fix an immediate problem." A GOOD surgeon takes a consultation, evaluates the case, performs the procedure and then the gives the patient the same complete workup as any internist. They auscultate, percuss, and otherwise examine their patients without the need to consult for these basic procedures. Perhaps if the physical findings are irregular they will consult as indicated. I believe that such unnecessary consultations waste health care dollars, patient and consultant time, and disrupts the continuity of care that patients deserve. For these reasons I think surgeons should retain their skills with a stethoscope. I completely disagree that "one could debate the merits of having surgeons equally competent in wielding a stethoscope as they are with scalpels." Incompetence with basic medicine is costly and potentially dangerous no matter what specialty. Good surgeons practice this way every day.

Posted by: arjune | Jul 30, 2008 10:10:06 AM

I take horse-riding and classic guitar as my extra curriculum activities in med school (I am 4th year med student). And, I work hard on both...

But I wonder. When the hell can I ride horse or play classics? It is totally impossible if you are a doctor(I guess..).

Now I hate myself.

Posted by: kurt kuden | Jul 30, 2008 10:16:33 AM

Pues que lástima que te has olvidado todo lo que aprendiste de este idioma bonito, espero que algun día tengas la oportunidad pasar tiempo en el extranjero si es algo que querías tanto.

Posted by: Amy | Jul 30, 2008 5:53:39 PM

Well as much as I did forget, I did get most of your mesage, Amy! I guess I remember more than I give myself credit for?

I too, hope that one day I will get the opportunity to spend time learning Spanish more thoroughly :)

Posted by: Jeff W | Jul 30, 2008 7:23:56 PM

Jeff, get yourself a CD of "intermediate Spanish." Listen to it now and then. You'll be amazed by how much you really remember and can use. I was able to spend a year in Spain as a student and a hotel translator albeit probably before your parents were born. The CD hones my listening skills. Now I can listen in on conversations at the market and on the bus!

Posted by: witchcat | Jul 30, 2008 8:10:14 PM

I disagree, I am afraid. In Australia, there is a move to restrict anatomy teaching to med students, on the grounds that "only surgeons need that". Almost immediately, there was a change in the attitudes of med students. Anatomy is now considered optional, and not necessary until later. Maybe you agree, but I started to get ridiculous referrals and questions, which were based on the assumption that I would know the relevant anatomy.

As a general surgical trainee, I am not good at cardiac auscultation. I am not great at family medicine diagnosis and I am not wonderful at opthalmoscopic exam. However, I know all these things are important, and I am proud to know the basics. I know when I listen to a chest and it sounds wrong. I know when I think I should hear a murmur, but can't. And I can send those patients to see someone more practised than I. It is ok that my skills haven't developed fully, but it is not ok for me not to know what is important to look after my patients.

Language is a great metaphor. I used to live in Germany and spoke fluent German. Now I am not so good. However, I know the nuts and bolts, and can construct a clear basic sentence. In fact, I only try simple stuff, so in some ways I am easier to understand than before. Hopefully, that is the way I work as a surgeon.

Posted by: DrCris | Aug 3, 2008 8:01:30 PM

Hi all, I am a junior in college and I will be applying to medical school next summer. Just curious about kurt kuden's comment...you are still expected to have time for extracurriculars when you are in medical school?? I hardly have time for extra curriculars in college! I like music. I play piano, oboe, and guitar. And I like to draw portraits here and there. But I only have time for this in the summer. When the semester starts I do not even go out on weekends. I can't believe they still expect that out of you in med school...I thought all that stuff about clubs and activities would be over when you got into med school.

Posted by: Mary | Aug 4, 2008 1:13:31 PM

Contrary to common belief, Mary - We can still have a social life. Filled with music and art and any other crap you want in your life. It can all be there. I got inspired when I walked into one of our Paediatrician's office last year. His room was full of art. The one thing he loved besides medicine. He said he dint have time for it at home (wife and kids and stuff). So he brings it to work (he usually stays back a while after working hours locked up in his office). Extremely interesting character he was. :)

Posted by: Kareema | Aug 6, 2008 12:44:38 AM

Mary, if you are a junior in college and have no time, other than in summer, to pursue your interests then you are working way too hard. Life has to be balanced or you will not survive, let alone enjoy your work. And when you're in a demanding profession such as Medicine, you have to enjoy your work. Take some time off and go out once in a while and never let go of your music - personally, the piano is the one thing that gives me solace whenever I'm stressed. Medicine is by no means the end to your social and extra-curricular life.

Posted by: Sam | Aug 6, 2008 7:50:49 AM

Hi, I'm from Mexico, and now I'm doing my social service... I do speak spanish and that's not my problem...Hablo muy bien español. :-)... but while I was on primary school I studied English, and now I don't practice it all...
I have to recognize that I'm making a big effort to write this post, for example... and I can't speak "fluently" like I used to.
On the other hand, while I was on the third year of medical school I took French on saturday's morning, for almost 10 months, I did finished French Basics, but now... 3 years later after finishing med school and after doing my intership, I just remember a few words on french, and I can't speak it well. I have seen movies in french, and I can't understand what are they saying, and the worst of all is that I can't write a good sentence.
That's too bad, because I dedicated a lot of time to french, and now is something that "I lost it, because I didn't use it".
I hope it doesn't happen the same with my new skills that I learned while I was on my internship (like reading an EKG, sewing quickly an opened injury, putting a catheter easily... )but I'm almost sure that if I don't practice what I've learned, this new knowledge is going to atrophy... :-(

Posted by: Melissa D.A. | Aug 6, 2008 4:44:59 PM

Doctors are people, not machines...all these other skills make you a more rounded person, which makes you at least a far more interesting dinner guest. As for the 80% of medicine we learn in med school that we'll no doubt forget by the time we make it to the heady heights of consultancy, I guess we learn them for 2 main reasons:
1) If we didn't learn them, we'd never know we were interested in them.
2) Learning them gives us a broad knowledge base from which to specialise.
Just my tuppence. By the by, I sympathise with the language aspect - when I went into med school, I was semi-fluent in French; nowadays, I'd probably embarass myself trying to say hello! I do hope you find time later to relearn Spanish.

Posted by: Lucia | Aug 13, 2008 10:13:09 AM

hi....i thot exactly the same thing in my first year of medicine...but now in my final year i can say with all confidence that if ur basics are thorough med and surg become a lot easier to understand, retain and apply.....u cant remember all that u study in med school but first year has a magical touch to it in matters of long term memory...u know sumthing similar to the way in which we all still remember our nursery rhymes but cant even remember what we studied for poetry in 6th std...with the application of basics and a bit of logical thinking we can save ourselves from many sticky situations....all said and done it is still difficult to digest this with the hope that it will be useful some day...best of luck..

Posted by: aman | Aug 18, 2008 8:43:18 AM

Proposing that medical education should allow for less competence in the all variety of fields involved in patient care is disconcerting, in my opinion. As for the role of the physician, he or she is charged with treating the entire patient, not just a single organ or disease. The varied forms that illness affects a patient's life requires physicians, I believe, to be competent in navigating through a variety of solutions to problems unique to each and every patient.

Posted by: Landon Roussel | Aug 26, 2008 5:17:15 PM

Your spanish metaphor is not good to support the argument to dispose all not interesting subjects from medicine curricula.
First of all I am an spanish native speaker and I do not always understand argentineans they use many local variations and words of unfardo (Buenos Aires slang). That doesn't make me an unqualified spanish speaker.
My general knowledge allows me to have a conversation with an Argentinean, with some effort I can also understand some Portuguese and even Italian. Why? Because that languages share the same Latin root, and I have some knowledge of the conversation subject.
English also has some words with Latin etymology. Latin was the dominant language in the educated world before english took its place. You didn't wasted your time learning Spanish you should understand many latin and greek terms just because there are similar words in spanish. Am I wrong?

To be a good practitioner one should have a whole picture of the problem. Biological systems are very complex, by just focusing on a perceivable symptom, may not lead us to the origin of the problem.
Not consider the rest of the system may result in inducting very undesirable side effects.

Anatomy and physiology are essential subjects in the curricula. We must also be aware that knowledge about physiology is constantly changing as research delivers new discoveries. Anatomy is more or less stable, but the logical hierarchy that allow us to understand it is too simplified and changing. An infection in one organ may spread to other in a different system (metastasis is an other example) Are they part of different systems? or may be seen as one system?

To be a good practitioner one must have a good understanding of subjects like biochemistry, cell physiology, mathematics(please do note talk about statistics with a 5 individuals sample), anatomy, biological evolution theories (horizontal transfer explains how bacteria became resistant to antibiotics, does many physicians take this into account when prescribing.)

May be one should not go in depth in all subjects, but having a general picture of biological systems and medical techniques and tools is, in my humble opinion, essential. At the end one can collaborate with an expert, both should have a common language to success in communicating their knowledge.

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