What is right and what is wrong
in the training of medical doctors?

Comment: somewhere out there in medical-land there is a useful answer for many medical questions, but experience (mine at least) suggests that odds of finding a GP who knows is often slim. For someone with basic research skills, good answers tend to come better (and more cheaply!) from “Dr Google”. Also Dr Google soon shows up where the science is not settled (most issues), but doctors rarely do. Nor will they debate the evidence. 

Thor May
Adelaide, 2016

 

 

 

 

This page is an initial starter list for discussing the "Medical Doctor Education " topic. The page makes no special claim to quality, and additions are welcome. 

 

 

 

 

 

Basic contact links:

 

meetup group: http://www.meetup.com/Adelaide-Active-Thinking-Meetup/

topic suggestions: thormay@yahoo.com 

 

 

topics already discussed: http://thormay.net/unwiseideas/DiscussionTopics/DiscussionIndex.htm

 

comments: Thor May - thormay@yahoo.com ;

 

 

Thor's own websites: 1. articles at http://independent.academia.edu/ThorMay  ;

2. personal site: http://thormay.net [an ancient site with many byeways]

 

 


=>Reading list: go to the end of these notes

 

Comments on the topic by Thor:

 

1. Introduction

Firstly and emphatically, these notes are not written by doctors. Nor are they self-consciously written by medicalized “patients”, or even a patient. Input from any of the above, and for that matter input from any source is welcome. The care and maintenance of the machinery of living bodies is an ever evolving challenge, just as their patch-up and repair is when things go wrong. The professionals trained to assist with these issues have many specialities, but the best known amongst them are medical doctors. The roles of medical doctors themselves are changing too, and this is a dilemma we all have an interest in. The notes to follow are fragmentary, non-specialist, and in the view of many may contain outright errors. Nevertheless, in the very least they should constitute a few navigation points in the quest for wellbeing.

2. The state of common knowledge

Most people seem to have a fairly primitive understanding about their bodies and minds, although they don’t see it that way. This understanding is a mixture of tales from relatives and friends, simple metaphors traded to them by doctors, the odd TV program or newspaper article, an elementary mental model of how their body works, superstition, fear, and conclusions born from life experience. A subset of them have a fairly detailed knowledge of how internal combustion engines work, and another large group know a lot about how to cultivate gardens. Both of these groups abuse their bodies in ways that no mechanic or gardener would dream of.  Regardless of all of the preceding, most people are quite resistant to any change in either the understanding or management of their own bodies. This may be partly related to a fairly fatalistic view about inevitable death, and a tenacious preference for the small pleasures of instant gratification.

As a profession specialized in human bodies (rarely minds), most medical doctors acquire an extensive vocabulary to identify the components of bodies, the distortions which can occur in the function of bodies, and a pharmacopeia of drugs used to intervene in the function of bodies. There is an important distinction to be made here between what is known/understood by someone out there in medical-land and what is known/understood by the doctor you are likely to meet randomly with a particular problem. Most doctors, at least as I have encountered them over seven decades in seven countries, are technicians with a repertoire of procedures, not scientists with enquiring minds. Most have little understanding of living bodies as homeostatic and adaptive organisms. Most know almost nothing about kinesiology (the geometry of bodies in motion, and engineering stresses arising from that). Most have no better than a layman’s knowledge of body management: the regular procedures, maintenance and diet needed to keep an organism functioning efficiently. Most have no scientific understanding of the constant adaptations which will keep a human body functioning well at different stages in its life cycle. Perhaps as a consequence, the mental and physical health of doctors as a group is no better and often worse than that of the general population. All of these are issues which are put to doctors by patients, however incoherently, on a regular basis. Doctors will always offer an opinion. Overwhelmingly is little better than prejudice dressed up as science, although (like the general public) they certainly don’t see it that way.   

Well, this section has been a collection of bold and not very complimentary assertions. What evidence is there to support these assertions, and if they have validity, does the evolving education of doctors have any hope of addressing whatever shortcomings there may be?

 

3. Changing Science

a) Disagreements within medicine: Although the average patient might never guess it, medical practice across the full spectrum of the profession is a field of passionate conflict on many fronts. Soothing phrases such as “the gold standard of X” and “medical consensus is that X” conceal startling fractures of opinion and standards across time (say, a human generation), between countries and cultures, and between philosophical factions into which a patient may unknowingly stumble. I’ve encountered all of them, and learned to be wary.

b) Evidence-based versus experience based medicine: A major fault line in medical education and practice is that between so-called evidence based medicine (EBM) and judgements based on professional experience. As with most human divisions, there are fundamentalists on either wing, and a wobbly normative curve of practitioners across the range, trying to make the best use of both approaches. From the reading list below, Gorski (2013) gives a fair account of the EBM approach. Gorski is a surgeon, so almost by definition hostile to CAM (complimentary & alternative medicine, which may sometimes work for reasons unrelated to his kind of analysis). However, he does give a very useful breakdown of the proportions of medical procedures which have been shown to work/not work within conventional medicine. A very significant percentage of procedures turn out to be ineffective or even damaging when extended from experiment to general practice over time, but will persist amongst a percentage of practicing doctors.

On the other side of the fence, Klein et al (2014) discuss "What’s Wrong with Evidence-Based Medicine?" The crux of their argument is that a) an experienced practitioner can take account of factors unique to each patient, and b) even the best experimental outcomes turn on a particular group of subjects of a certain age and disposition, at a certain time and place.

c) Some limitations of experimental science: I am not a medical doctor. I did spend several decades in academic settings in close contact with people claiming to conduct research. My own doctoral dissertation was on a branch of knowledge worker productivity. This long acquaintance with the patterns of research based activity has left me with few illusions about its limitations, and the tendency of large numbers of researchers to be influenced in their research by factors extrinsic to whatever question they are researching. For example, they are influenced by funding, by personal ambition, by the academic fashions of the age (both topics and methodology), by peers and superiors, and sometimes by outright corruption (e.g. a reluctance to publish negative and inconclusive results). It is known that all of these extrinsic factors affect medical research. The newspaper report which is headed “science/research has shown that…” always makes me cringe.

Factors intrinsic to any piece of research also lead one to treat experimental outcomes with caution. Science is always a work in progress, and in some fields that progress is very conditional indeed. Broadly, any experiment is only as good as the experimental design, which turns on the inspiration of the researcher (a rare quality), the manipulation of variables, and the interpretation of results. In social sciences, the variables are almost always so numerous and diffuse that an experiment can be arranged to arrive at almost any desired conclusion. A chemist is far more constrained, and much more likely to arrive at non-contested conclusions. Most medical researchers would dearly like to be thought of as closer to chemists than social scientists in their experimental designs and procedures. Usually this ambition is based on illusion, and the real outcomes correspondingly uncertain. A human organism is host to billions of interacting elements and processes. Any intervention has uncountable “side effects” which might or might not be germane to the object of the experiment. Numerous (disputed) meta studies have claimed that the majority of experiments in medicine have failed tests of replication or design (e.g. Ioannidis 2005 ,Saey 2015). 

d) The pace of scientific discovery in the life sciences

In spite of the just outlined limitations on all research, and particularly on research directed at human diseases, the expansion of  knowledge in life sciences over the last generation has been phenomenal and accelerating by the week. The premises upon which huge amounts of medical lore have been based for generations have simply been swept away. It is certain that the vast majority of the general population, including their politicians, have almost no grasp of these changes.

More concerning perhaps is that large cohorts of medical practitioners are almost equally ignorant of major developments in life sciences. Nor is it clear that medical colleges themselves are always ahead of the game. Doctors tend to live busy lives, many have incurious minds, while the odd junket conference and pamphlets from smooth talking pharmaceutical representatives go no way towards updating their knowledge at the level required. Some will protest that they read, or scan, professional journals. This refers to a deluge of tens of thousands of specialized articles, nearly all narrowly based, and for an average doctor, barely brushed in accidental passing.

Of all the changes, research into the human genome has received major publicity, and even flamboyant political funding in the early phase when the apparently simple target of decoding it was going to “lead to a cure for all human ills within a generation”. These naïve predictions have given way to modesty, then caution as the baffling interactions of genes and thousands of proteins have set a research agenda stretching far into the future. What did become clear was that so-called medical intervention time and again amounted to brain surgery with a blunt axe.

Also at a macro level, there has been a slow surfacing of awareness about the human biome. Put this to your local GP and you are likely to get a blank stare. Yet the community of ever renewing cells which make up a human body, are merely the framework to host up to 100 times their number in bacteria, it is thought perhaps 100 trillion bacteria. That is a mind bending number, yet “bacterial protein-coding genes are 360 times more abundant than human genes” (Wikipedia 2016, The Microbiome Project), and “researchers calculated that more than 10,000 microbial species occupy the human ecosystem”. Everyone has a different species assembly, and these armies of guest influence every aspect of our being, including our minds (University of California, 2014). We could not live without these armies, and in an absolute sense they are part of our beings.

Walk into any supermarket and look at the products which for generations have been advertised to destroy/sterilize “germs”. Brain surgery with a blunt axe again. Doctors simply do not know what they are doing when they intervene clumsily in this ecosystem. They can’t because nobody yet knows (if they ever will) how the ecosystem functions in even broad detail. Not knowing of course is an open sesame for every kind of quackery. Several years ago I walked into three pharmacies to ask the resident pharmacists about probiotic replacement after a course of antibiotics (i.e. random bacterial slaughter). They all looked at me like a creature from outer space. Suddenly now pharmacies are packed with probiotic products, glibly promising nirvana.

There a many other life science discoveries which are constantly impinging upon what was thought to be established medical knowledge. To take one further example, bones are often thought to be rather simple things, though cleverly shaped. That was until somebody stumbled upon the mysteries of osteocytes. “Osteocytes (literally “bone cells”) are buried alive in bone tissue whenever bone is formed. They develop long branch-like dendritic fingers that infiltrate the tissue and reach out to interconnect with one another” … “there is now evidence that these cells might influence how your immune system works, how fat you are, how your kidney works, and even male fertility..” … “It turns out that inside your skeleton lives a network that is almost as complex as the neural network of your brain” ... “the human skeleton contains about 42 billion osteocytes” … “…end to end, we found that this network is about 175,000 kilometres long” (Buenzli and Sims 2015). Well there is obviously a lot going on with osteocytes which must have a major bearing on your health and survival. What does your doctor, any doctor, know about this stuff in the sense of controlled intervention? Nothing, zero, zilch. They can’t because nobody does yet. Brain surgery with a blunt axe again.   … and so it goes on.

 

4. Changing access to information

With a 70 year score card to draw upon for my personal use, I decided some time ago that doctors as a species (and with honourable exceptions) were highly unreliable sources of information and advice, especially on medical topics. After a review of experiences, I concluded that the level of unreliability hovered at around 80%, mitigated by a couple of standout life-saving interventions from the remaining 20%. It would be a rare medico who accepted this kind of critique, but in the end you are the only one who is going to keep yourself from harm. So has my learned caution simply been paranoia? Perhaps sometimes, but the big big difference has come from access to independent sources of information on the Internet, mainly posts from other doctors and scientists with other ideas, which I have gradually assembled into my own database.

Apart from particular personal issues evaluated by particular doctors, the medical profession as a whole is greatly influenced by prevailing medical fashions, and some of those fashions are or continue to be spectacularly wrong and damaging. With continuing scientific discovery, one expects changes to medical practice and even reversals. The major difficulty does not come from the proper use of scientific method. It comes from a human failure of scientists, medical doctors, and their institutional propagandists, not to mention the vested interests of industry. It comes from their frequent, consciously dishonest failure to admit the necessity for change based on scientific evidence, frequent attempts to persecute those who bring such evidence, and a criminal disregard for the welfare of patients who could benefit from new insights. That sounds extreme, but sadly too often it is the way things are. Across the range of scientific endeavour, we know it has always been way the things are. I have seen it in my own core research area of formal linguistics. There is the iconic case in astronomy of the wise men of Europe telling each other for 1500 years that the sun revolved around the earth, even though Ptolemy's original theory was open to challenge at the time of its proposal. By the time Galileo was able to absolutely demonstrate the error, the Christian church had built a theology around the nonsense and wanted to put him on a bonfire for upsetting orthodoxy. Nothing has changed, except that only from very recently have large numbers of aware people had access to competing information via the Internet. A genuine contest of ideas is the best possible advertisement for information democracy

For example, years ago, after research, I decided that the lipid hypothesis (“dietary fat is evil”) was crap. France, with the highest intake of dietary fat in Europe has the lowest incidence of heart disease. Ukraine, with the lowest intake of dietary fat in Europe has the highest incidence of heart disease. The more closely one studied the evidence for Ancel Keys' lipid hypothesis, the worse it looked. Its acceptance by medical practitioners was about political group think, not science. Putting that to GPs here and there, I’ve seen them literally freeze in the way the Pope or an ayatollah might if told that their god is a fiction. In 1972 the scientist, John Yudkin, published a book called “Pure, White and Deadly”. He had fingered sugar, not fat as an evil one, and that was the end of his career. He was frozen out. The wheel turns. It is worth publishing a fairly extended quotation from a current edition of The Guardian to make the point (but do read the whole article: Ian Leslie, 7 April 2016, “The Sugar Conspiracy”):

In 1980, after long consultation with some of America’s most senior nutrition scientists, the US government issued its first Dietary Guidelines. The guidelines shaped the diets of hundreds of millions of people. Doctors base their advice on them, food companies develop products to comply with them. Their influence extends beyond the US. In 1983, the UK government issued advice that closely followed the American example.

The most prominent recommendation of both governments was to cut back on saturated fats and cholesterol (this was the first time that the public had been advised to eat less of something, rather than enough of everything). Consumers dutifully obeyed. We replaced steak and sausages with pasta and rice, butter with margarine and vegetable oils, eggs with muesli, and milk with low-fat milk or orange juice. But instead of becoming healthier, we grew fatter and sicker.

Look at a graph of postwar obesity rates and it becomes clear that something changed after 1980. In the US, the line rises very gradually until, in the early 1980s, it takes off like an aeroplane. Just 12% of Americans were obese in 1950, 15% in 1980, 35% by 2000. In the UK, the line is flat for decades until the mid-1980s, at which point it also turns towards the sky. Only 6% of Britons were obese in 1980. In the next 20 years that figure more than trebled. Today, two thirds of Britons are either obese or overweight, making this the fattest country in the EU. Type 2 diabetes, closely related to obesity, has risen in tandem in both countries.

At best, we can conclude that the official guidelines did not achieve their objective; at worst, they led to a decades-long health catastrophe”.

 

5. Patient expectations

About once a year, in search of a story, some newspaper will do a poll about who people trust the most. It is a pretty silly thing to poll in a simple way. Trust whom, when, where and to do what? I might trust you not to pick-pocket my wallet, but not to fix my car. In personal relationships, folk are apt to distrust anyone who seems more sophisticated, perhaps because they lack confidence in predicting their behaviour.

All of these caveats are too hard for a newspaper story. The predictability of results from a vague questionnaire offers comfort. Used car salesmen and journalists come at the bottom, medical doctors come at the top.

Why are medical doctors so apparently trusted? The preceding article should have made clear that I am personally very cautious about trusting the medical judgement of medical doctors, though I don’t expect them to steal my wallet (in any direct way). Apparently this hesitation is not widely shared, or is it?

The small amount of published research suggests that Australians as a group still have some reservoir of confidence in medical doctors (Hardie and Critchley 2008), while public faith in medical practice in the United States has plummeted in the last half century:

“In 1966, nearly three fourths (73%) of Americans said they had great confidence in the leaders of the medical profession. In 2012, only 34% expressed this view (Harris 1966–2012). But simultaneously, trust in physicians' integrity has remained high. More than two thirds of the public (69%) rate the honesty and ethical standards of physicians as a group as “very high” or “high” (Gallup 2013) …. Today, public confidence in the U.S. health care system is low, with only 23% expressing a great deal or quite a lot of confidence in the system (Gallup 2014). We believe that the medical profession and its leaders are seen as a contributing factor.” (Blendon et al 2014).

The reasons for these apparently different national perceptions are open to debate. One reason may be sourced in economic  factors of access and cost. Australia has reasonably efficient national health care for everyone, funded by taxation, although there is pressure on consultation times as in other countries. America still has some of the worst public health care coverage amongst OECD countries in spite of recent improvements (Obamacare). In the Blendon study, the United States ranked 24th out of 29 countries in overall public trust of doctors (Blendon et al 2014).

Younger patients show significantly less trust in doctors than patients over 65. This is true both in the United States and Australia, and may reflect the much higher usage by younger patients of access to alternative sources of information such as the Internet. The age correlation with apparent (though diminishing) trust might also be influenced by one factor which I have not seen researched. This is the reaction of patients who feel powerless to contradict medical advice, whether or not it is reliable. The psychological alignment of victims in life or death situations with their tormenters has come to be known as the Stockholm syndrome. I suspect that many older patients especially may express “trust” as a psychological instrument of self-preservation.

Trust is a complicated metric when you look at it closely. There is a difference, for example, between the broad social trust existing in a certain sphere, such a national health system, and interpersonal trust which is trust in an individual accumulated over time (Pearson and Raeke 2000). The nature of modern medical practice less and less involves a long term relationship with one physician, so it is quite likely that both general social trust in the medical system and interpersonal trust between patient and doctor will suffer.

 

6. Doctors – personalities, training, practice

 

Medical doctors, male and female, come with the whole pantheon of human character types. Why wouldn’t they? We find it convenient, even efficient, to deal in stereotypes and certainly couldn’t survive without them. Therefore it is no surprise to find statements that “doctors are/do this … or this … or this”. I have played the stereotype game very liberally in this very article. Stereotypes often have a core of statistical truth. The personal problem comes in being ready to modify our stereotype, our attitude, when confronted with an individual doctor. In the case of an individual doctor, his/her problem is modifying an existing stereotype of what a “patient” is when confronted with an individual patient. On both sides of the fence, the client and the professional, we often fail to make that individual adaptation at the time of an encounter. Doctors hardly get to choose their patients (except by income), but as patients we sometimes get to choose our doctors, just as medical schools get to choose their trainees. Perhaps a major test of the potential value of  a doctor is whether they are agile in adapting their stereotypes when confronted with the idiosyncrasies of individual patients. It is downright dangerous to be seen as a statistic.

A number of years ago I entered the consulting room of a very well known medical specialist. He led a research team at Royal Melbourne Hospital, and was at the top of his career. He looked me up and down, glanced at his watch, and said “strip down to your panties and bra. I’ll be with you in a minute”. Well, I’ve been called lots of unpublishable names, but cross-dressing is not my style, and being taken for a woman was an entirely new experience. However, at the time I was doing research on formulaic language and its power to control behaviour, so his careless patter caught my attention. I asked politely if I could interview him about the use of formulaic phrases by doctors. He took this as an insult, and asked that I be transferred to another specialist for consultation. Much later I heard that Dr Michael Luxton, the doctor in question, had developed a small white lump on his throat. The white lump was a rare white melanoma. It didn’t fit stereotypes, he ignored it, and he was dead within six months.   

 

7. Medical error

- no-fault culture (?)

- enormous level of medical error / leading cause of death

 

8. What doctors mostly don’t know about (but should)

kinesiology / biomechanics

metabolism

diet

body management

teaching skills / guiding patients to medical independence

 

[more to come]

_____________________________________

 

Reading List*  (other suggestions welcome)

Note that this is an extremely eclectic reading list, and could be expanded endlessly. However there is sufficient range here to offer a taste of issues which can come into a debate about doctor training. Of course, it is also slanted by my own interest in body management.

@ TheConversation  "Medical Education" - index of entries. Recommended starting point for the topic of doctor education in Australia. TheConversation online @ https://theconversation.com/search?q=medical+education

AFP (May 20, 2015) "Elite athletes’ brains 82% faster under pressure, study finds ". The Australian online @ http://www.theaustralian.com.au/news/health-science/elite-athletes-brains-82-faster-under-pressure-study-finds/story-e6frg8y6-1227361269705

Ahmed, Tanveer (December 19, 2011) "Electronic medical records: why we should seek a second opinion". Brisbane Times online @ http://www.brisbanetimes.com.au/opinion/politics/electronic-medical-records-why-we-should-seek-a-second-opinion-20111218-1p0o3.html#ixzz1gvochmg6

Anonymous junior doctor (Tuesday 5 January 2016) "By the end of my first year as a doctor, I was ready to kill myself  - Doctor suicide is the medical profession’s grubby secret. Female doctors are twice as likely as the general population to take our own lives. – But it’s unclear why some of those dedicated to preserving life silently plot their own deaths".  http://www.theguardian.com/healthcare-network/views-from-the-nhs-frontline/2016/jan/05/doctor-suicide-hospital-nhs

Australian Government (2016) "Doctor Connect - work as a doctor in Australia". Commonwealth Department of Health online @ http://www.doctorconnect.gov.au/internet/otd/publishing.nsf/content/trainingAndEducation

Australian Government (21 June 2013) "A conversation with Professor Caroline McMillen, Pro Vice Chancellor and Vice President Research and Innovation at the University of South Australia". National Health & Medical Research Council website, online @ http://www.nhmrc.gov.au/media/podcasts/2009/conversation-professor-caroline-mcmillen

Australian Medical Association (2011) "2011 AMA Safe Hours Audit". AMA website online @ https://ama.com.au/article/2011-ama-safe-hours-audit-9 

Australian Medical Association (2011) "2011 Role of the Doctor". AMA website online @ https://ama.com.au/position-statement/role-doctor-2011 

Australian Medical Association (2016) "Becoming a doctor in Australia". AMA website online @ https://ama.com.au/careers/becoming-a-doctor

Benson, Jonathan (July 24, 2014) "Johns Hopkins to pay out $190 million in damages after gynecologist caught filming patients". Natural News website online @  http://www.naturalnews.com/046145_gynecologist_filming_patients_Johns_Hopkins.html##ixzz38TTZEgvW

Bever, Lindsey (June 11, 2014) "'I’m hella busy with C sections': sexting during surgery gets doctor suspended". Sydney Morning Herald online @ http://www.smh.com.au/world/i8217m-hella-busy-with-c-sections-sexting-during-surgery-gets-doctor-suspended-20140611-zs3h6.html#ixzz34HePg6Oj

BirdStrike, MD (October 5, 2012) "Cause of death: Defensive medicine". Emergency Physicians Monthly online @ http://www.kevinmd.com/blog/2012/10/death-defensive-medicine.html

Biswas, Ranjita (November 7, 2013) "Indians pay dear for drug reputation" [Foreign drug companies use India as a test bed for human trials] Asia Times online @ http://www.atimes.com/atimes/South_Asia/SOU-01-071113.html

Blendon, Robert J. with John M. Benson and Joachim O. Hero (2014) "Public Trust in Physicians — U.S. Medicine in International Perspective". New England Journal of Medicine, 2014; 371:1570-1572 October 23, 2014DOI: 10.1056/NEJMp1407373; available online @ http://www.nejm.org/doi/full/10.1056/NEJMp1407373

Bochenski, Natalie (June 30, 2014) "Doctors not looking after own mental health". Brisbane Times online @ http://www.brisbanetimes.com.au/queensland/doctors-not-looking-after-own-mental-health-20140629-zsq7f.html#ixzz364d7S4kF

Branco, Jorge(December 9, 2015) "Thousands of nurses assaulted in Queensland hospitals". Brisbane Times online @ http://www.brisbanetimes.com.au/queensland/thousands-of-nurses-assaulted-in-queensland-hospitals-20151209-gljsqw.html

Buenzli, Pascal and Natalie Sims (17 April 2015) "Brainy bones: the hidden complexity inside your skeleton - The network of bone cells inside your skeleton rivals your brain in terms of complexity". TheConversation online @ http://theconversation.com/brainy-bones-the-hidden-complexity-inside-your-skeleton-38713

Butt, Craig (September 10, 2015) "'Shocking beyond belief': doctors react to rampant bullying in surgical profession". Brisbane Times online @ http://www.brisbanetimes.com.au/national/health/shocking-beyond-belief-doctors-react-to-rampant-bullying-in-surgical-profession-20150910-gjjall.html

Campbell, Denis and Nicola Davison (May 29, 2012) "Illegal kidney trade on rise as demand outstrips supply". Brisbane Times online @ http://www.brisbanetimes.com.au/world/illegal-kidney-trade-on-rise-as-demand-outstrips-supply-20120528-1zfba.html#ixzz1wDgFHo2w

Corderoy, Amy (March 9, 2015) "Mental health funding crisis: doctors planning to quit over lack of resources". Sydney Morning Herald online @ http://www.smh.com.au/nsw/nsw-state-election-2015/mental-health-funding-crisis-doctors-planning-to-quit-over-lack-of-resources-20150308-13xtq0.html

Davey, Melissa (December 21, 2012) "An app a day keeps the doctor away.  First the medical centre changed our relationship with the local GP, now it's the internet". Brisbane Times online @ http://www.brisbanetimes.com.au/digital-life/smartphone-apps/an-app-a-day-keeps-the-doctor-away-20121220-2bp9s.html#ixzz2FduHL1Gj

Duff, Eamonn (June 1, 2014) "Jailed surgeon Suresh Nair may be deported after release". Sydney Morning Herald online @ http://www.smh.com.au/nsw/jailed-surgeon-suresh-nair-may-be-deported-after-release-20140531-39azc.html#ixzz33M0szLSk

Emanuel, Zeke and Topher Spiro, and Maura Calsyn (June 11, 2013) "Reducing the Cost of Defensive Medicine - The risk of being sued may cause physicians to practice what is known as defensive medicine, or the ordering of excessive and unnecessary medical tests, procedures, or further consultations done in part to protect the physician from accusations of negligence. Defensive medicine increases health care costs without improving health outcomes". Center for American Progress, online @ http://www.americanprogress.org/issues/healthcare/report/2013/06/11/65941/reducing-the-cost-of-defensive-medicine/

European Society of Cardiology (31 August 2010). "Marathon running is unlikely to cause long-term heart damage, German study shows." ScienceDaily online @ http://www.sciencedaily.com/releases/2010/08/100831073507.htm

Evershed, Nick (Tuesday 19 May 2015) "Why Australian doctors' group opposes funding for new medical school - Modelling shows the number of medical graduates is outstripping the number of postgraduate training positions in hospitals, explaining the Australian Medical Association’s concerns about a new medical school in Western Australia". The Guardian online @  http://www.theguardian.com/society/datablog/2015/may/19/why-australian-doctors-group-opposes-funding-for-new-medical-school

Fleet Street Sports (n.d.) "The Importance of Single Leg Balance". Fleet Street Sports online @ http://www.fleetfeethartford.com/sports-medicine/single-leg-balance

Friedman, Howard Steven (07/24/2013) "American Mortality Comparatively Higher Across All Age Groups". Huffington Post online @ http://www.huffingtonpost.com/howard-steven-friedman/american-mortality-compar_b_3643061.html?utm_hp_ref=world

Gigerenzer, Gerd (2014) "Risk Savvy: How To Make Good Decisions Kindle Edition". [Gigerenzer from the Max Planck Institute in Berlin has specialized in unmasking medical doctors' incomprehension of statistics. Australian doctors get particularly low marks]. Available from Amazon online @ http://www.amazon.com/Risk-Savvy-Make-Good-Decisions-ebook/dp/B00H7O86PI/ref=la_B001IGOI3K_1_1_twi_kin_2/187-9719869-8914145?s=books&ie=UTF8&qid=1459921826&sr=1-1

Girgis, Linda (Feb 20, 2015) "Why Doctors Are Losing the Public’s Trust". Physicians Weekly online @ http://www.physiciansweekly.com/doctors-losing-publics-trust/  

Gordon, Heath (30 March 2012) "How To Break A Fall In Free Running". Made Man website online @ http://www.mademan.com/mm/how-break-fall-free-running.html

Gorski, David (July 29, 2013) "The difference between science-based medicine and CAM". [Gorski is a surgeon, so almost by definition hostile to CAM (complimentary & alternative medicine, which may sometimes work for reasons unrelated to his kind of analysis). However, he does give a very useful breakdown of the proportions of medical procedures which have been shown to work/not work within conventional medicine]. Science-Based Medicine website online @ https://www.sciencebasedmedicine.org/the-difference-between-science-based-medicine-and-cam/

Green, Declan (27 February 2014) "Who is protecting health professionals from abuse and assaults? The stabbing of a neurosurgeon in Melbourne has led to calls for greater security. We have a duty to protect the medical staff working to treat patients". The Guardian online @ http://www.theguardian.com/commentisfree/2014/feb/27/who-is-protecting-health-professionals-from-abuse-and-assaults

Hardie, Elizabeth A and Christine R Critchley (2008) "Public perceptions of Australia’s doctors, hospitals and health care systems". Med J Aust 2008; 189 (4): 210-214. online @ https://www.mja.com.au/journal/2008/189/4/public-perceptions-australia-s-doctors-hospitals-and-health-care-systems

Holland, John H. (September 2014) "Complexity: A Very Short Introduction". Kindle edition online @ http://www.amazon.com/Complexity-Very-Short-Introduction-Introductions-ebook/dp/B00L4CK0M6/ref=tmm_kin_swatch_0?_encoding=UTF8&sr=&qid=

Ioannidis, John P. A. (August 30, 2005) "Why Most Published Research Findings Are False". PLoS Med 2(8): e124. doi:10.1371/journal.pmed.0020124 online @ http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0020124 

Ivory, Kimberley and Karen Scott (May 26, 2015) "Let’s stop the bullying of trainee doctors – for patients' sake". [read the comments. Very revealing] TheConversation online @ https://theconversation.com/lets-stop-the-bullying-of-trainee-doctors-for-patients-sake-42243

Joshi, Nirmal (22 February 2014) "Being a doctor was once a job with great purpose. Now it's just a business". The Guardian online @ http://www.theguardian.com/commentisfree/2014/feb/22/obamacare-reform-doctors-lost-sense-of-purpose?INTCMP=ILCNETTXT3487

Klein, Devorah E. with Gary Klein and Shawna J. Perry (MAY 23, 2014) "What’s Wrong with Evidence-Based Medicine?" Project Syndicate website online @ https://www.project-syndicate.org/commentary/devorah-e--klein-et-al-take-a-critical-look-at-a-key-component-of-health-care-reform

Kolata, Gina (June 13, 2012) "In Good Health? Thank Your 100 Trillion Bacteria". New York Times online @ http://www.nytimes.com/2012/06/14/health/human-microbiome-project-decodes-our-100-trillion-good-bacteria.html?pagewanted=all/In&_r=0

Leslie, Ian ( 7 April 2016) "The sugar conspiracy: In 1972, a British scientist sounded the alarm that sugar – and not fat – was the greatest danger to our health. But his findings were ridiculed and his reputation ruined. How did the world’s top nutrition scientists get it so wrong for so long?"  The Guardian online @ http://www.theguardian.com/society/2016/apr/07/the-sugar-conspiracy-robert-lustig-john-yudkin  

May, Thor (9 November 2011) "Choose When to Live and When to Die - Some Notes on Diet and Exercise". The Passionate Skeptic website online http://thormay.net/unwiseideas/choosewhentolive.htm

May, Thor (April 2007) "The Penis Chronicles - a tale of medical misadventure in a South Korean provincial hospital". Thor's Korea Diary online @ http://thormay.net/koreadiary/penischronicles.html

McDougall Christopher (November 2, 2011) "The Once and Future Way to Run". New York Times online @ http://www.nytimes.com/2011/11/06/magazine/running-christopher-mcdougall.html?_r=2&pagewanted=all&

McNamara, Sophie  (2012) "Does it take too long to become a doctor?". Medical Journal of Australia: Med J Aust 2012; 196 (8): 528-530, online @ https://www.mja.com.au/journal/2012/196/8/does-it-take-too-long-become-doctor 

Medew, Julia (December 30, 2012) "Doctors lament rise of private patient advocates". Brisbane Times online @ http://www.brisbanetimes.com.au/national/health/doctors-lament-rise-of-private-patient-advocates-20121229-2c0de.html#ixzz2GTyKEg2s

Mercola, Joseph (February 04 2011) "Death by Medicine: Nearly 250,000 Deaths From ONE Common Mistake: Here's How to Protect Yourself". Mercola.com medical website online @ http://articles.mercola.com/sites/articles/archive/2011/02/04/death-by-medicine-an-update.aspx

Neighmond, Patti (March 28, 2011) "Put Those Shoes On: Running Won't Kill Your Knees". National Public Radio (USA) online @ http://www.npr.org/2011/03/28/134861448/put-those-shoes-on-running-wont-kill-your-knees

Oregon State University. (31 March 2015) "Exercise largely absent from US medical school curriculum, study shows." ScienceDaily online @ http://www.sciencedaily.com/releases/2015/03/150331145142.htm

Patty, Anna (May 4, 2015) "Medical journal editor sacked and editorial committee resigns". Sydney Morning Herald online @ http://www.smh.com.au/national/medical-journal-editor-sacked-and-editorial-committee-resigns-20150503-1myr8q.html 

Pearson, Steven D and Lisa H Raeke (2000)"Patients' Trust in Physicians: Many Theories, Few Measures, and Little Data". J Gen Intern Med. 2000 Jul; 15(7): 509–513. doi:  10.1046/j.1525-1497.2000.11002.x PMCID: PMC1495476; accessible online @ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495476/

Ramachandran, V.S. and Sandra Blakeslee (1999) "Phantoms in the Brain: Probing the Mysteries of the Human Mind". [The work of V.S. Ramachandran, a neurologist who maps the relationship between the human body and neural representation, goes well beyond medicine. It really overturns several thousand years of speculation about mind-body issues in ways that the general public, most of academia, and most of the medical fraternity have not yet grasped the implications of]. Available from Amazon online @ http://www.amazon.com/Phantoms-Brain-Probing-Mysteries-Human/dp/0688172172

Reynolds, Gretchen (January 1, 2016) "A fit body leads to a fit brain". Brisbane Times online @ http://www.brisbanetimes.com.au/lifestyle/diet-and-fitness/a-fit-body-leads-to-a-fit-brain-20151231-glxnx1.html

Robinson, Ann (29 September 2014) "Five things doctors do that they shouldn’t. A new campaign hopes to persuade doctors from carrying out unnecessary – or even harmful – procedures and tests. Here are some you should watch for". The Guardian online @ http://www.theguardian.com/lifeandstyle/2014/sep/28/five-things-doctors-do-that-they-shouldnt-unecessary-procedures 

Saey, Tina Hesman (January 13, 2015) "Is redoing scientific research the best way to find truth? During replication attempts, too many studies fail to pass muster". [Also check the references at the end of the article] Science News website online @ https://www.sciencenews.org/article/redoing-scientific-research-best-way-find-truth

Smith, Alexandra (June 6, 2015) "Sydney University medical students invented patients for assignments". Sydney Morning Herald online @ http://www.smh.com.au/national/education/sydney-university-medical-students-invented-patients-for-assignments-20150605-ghgsy2

Stephens, Kim (October 2, 2013) "Hundreds killed in Queensland medical procedures". Brisbane Times online @ http://www.brisbanetimes.com.au/queensland/hundreds-killed-in-queensland-medical-procedures-20131001-2uqrm.html#ixzz2gVaQSYZW

Thibaudeau, Christian (05/14/04) "Isometrics for Mass!". t-Nation website online @ https://www.t-nation.com/training/isometrics-for-mass

Tonkin, Leigh (February 13, 2015) "Why Dr Google isn't all bad". Sydney Morning Herald online @ http://www.smh.com.au/comment/why-dr-google-isnt-all-bad-20150212-13cyw7.html

University of California, San Francisco (UCSF)(15 August 2014) "Do gut bacteria rule our minds? In an ecosystem within us, microbes evolved to sway food choices." ScienceDaily online @ http://www.sciencedaily.com/releases/2014/08/140815192240.htm

Wikipedia (2016) "Kinesiology". Wikipedia online @ https://en.wikipedia.org/wiki/Kinesiology

Wikipedia (2016) "Medical education in Australia". Wikipedia online @ https://en.wikipedia.org/wiki/Medical_education_in_Australia 

Wikipedia (2016) "The human microbiome project". Wikipedia online @ https://en.wikipedia.org/wiki/Human_Microbiome_Project 

 

 


Professional bio: Thor May has a core professional interest in cognitive linguistics, at which he has rarely succeeded in making a living. He has also, perhaps fatally in a career sense, cultivated an interest in how things work – people, brains, systems, countries, machines, whatever… In the world of daily employment he has mostly taught English as a foreign language, a stimulating activity though rarely regarded as a profession by the world at large. His PhD dissertation, Language Tangle, dealt with language teaching productivity. Thor has been teaching English to non-native speakers, training teachers and lecturing linguistics, since 1976. This work has taken him to seven countries in Oceania and East Asia, mostly with tertiary students, but with a couple of detours to teach secondary students and young children. He has trained teachers in Australia, Fiji and South Korea. In an earlier life, prior to becoming a teacher, he had a decade of finding his way out of working class origins, through unskilled jobs in Australia, New Zealand and finally England (after backpacking across Asia to England in 1972).

 


What is right and what is wrong in the training of medical doctors? ©Thor May February 2016

 

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