Good medicine


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Good medicine

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Good medicine

  1. 1. Good Medicine Dr.T.V.Rao MDWe all recognize that the “world of medicine" iscontinually evolving; the present era is characterized byan unprecedented degree of change. We have enteredanother period of transition as dramatic as the one thatoccurred at the beginning of the century." The rapidity ofchange makes it difficult to takes snapshot to show theposition of medical education within its larger framework.This raises the issue of how to plan medical education atthis moment, given that "the world of medicine" cannotbe fixed in time for closer scrutiny. Today’s thinking onMedical education evolved when Abraham Flexner, aresearch scholar at the Carnegie Foundation for theAdvancement of Teaching, undertook an assessment ofmedical education in North America, visiting all medicalschools then in operation in the United States andCanada.The power of Flexners report derived from hisemphasis on the scientific basis of medical practice, thecomprehensive nature of his survey, and the appeal ofhis message to the American public.Flexners reportfuelled change by criticizing the mediocre quality andprofit motive of many schools and teachers, theinadequate curricula and facilities at a number ofschools, and the non-scientific approach to preparationfor the profession. The 20th century has seen greater
  2. 2. changes in America in academic hospitals, researchquickly outstripped teaching in importance, and a“publish or perish”culture emerged in Americanuniversities and medical schools. Research productivitybecame the metric by which faculty accomplishmentwas judged; teaching, caring for patients, andaddressing broader public health issues were viewed asless important activities.The blind imitation of theWestern model, which perhaps suited the developednation’s situation. This obsession with the Westernmodel and standards has made our Doctors misfits inour own society and perhaps unwittingly promoted braindrain, which the Government wishes to restrict. The truthis that the medical graduate finds himself more at homeoutside the country than at home.We never documentedand analysed the medical needs of an individual and acommunity in our country, with inherent problemsplagued with population different cultures, and themental health needs were most neglected.Ourcurriculum has become static, professionals in trainingmust master both abundant theory and large bodies ofknowledge, many times old outdated curriculum is notdeleted and students are burdened with more and morerecent advances; The final test of their efforts, however,will be not what they know but what they do. Thestudents are confused with purpose of medicaleducation, the knowledge, skills, and failing to inculcatethe values of the profession in an appropriatelybalanced and integrated manner.The acquisition of skills
  3. 3. for practice Medicinerequires radical transformationalthough the dictum “see one, do one, teach one” mayhave characterized the way in which clinical skills werelearned in the past, it is now clear that for training inskills to be effective, learners at all levels must have theopportunity to compare their performance with astandard and to practice until an acceptable level ofproficiency is attained. India with rapid expansion ofMedical colleges, with shortage of competent andproductive staff for training, and admission of lessmeritorious students, finding it difficult to produce skilledDoctors. We are heading to a situation; India will haveseveral underperforming Physicians due to bad planningunreasonable curriculum loaded, with theory than withreal time practice. That medical education had toreconfigure itself in response to changing scientific,social, and economic circumstances in order to survivefrom one generation to the next which is demanding andincreasing of conflict of interest. Given that every patientdeserves the best possible care, which the politicianspromise. We are challenged to provide appropriateopportunities for experiential learning and practice whilemeeting the service demands of teaching hospitals. Theeducational mission of teaching hospitals is furthercompromised by the absence of performance standardsand assessment methods that can clearly establish thatlearners are ready to advance to the next level ofindependence and challenge. Excellence inmedicaleducation is not merely a vertical expansion,
  4. 4. and increase in number of medical colleges. Maximumimprovement of health and relief of suffering withinavailable resources should be our goal. There is thus aclear need to set up innovative models and bring aboutqualitative changes.In spite of severe criticism onseveral private medical institutions,they have becomecentres of excellence incomparable to manyGovernment Institutions which are plagued with politicalinference at every stage.When we observe severalprivate institutions, they thrived in spite of difficulties werealise, that medical institutions have their peculiarproblems and they cannot be run as a department of theGovernment. The law enforcing should create andencourage better academic parameters in establishingand running the teaching hospitals, India is heading fora divide on health care for rich and poor. TodayMedicine is rich and poorwhere you fit is yourresources.Please remember all of us need medical care,if not soon but certainly later. We Medical educatorshave great role to make the Medicine more human inspite of conflicts around