I am going to steal Lance Mannion’s category of “ideas in search of a post”. The spirit is willing to elaborate on these ideas, but the flesh is weak and does not want to pontificate tonight:

>> A significant problem with medical education is the lack of context. Some medbloggers suggest that the business of medicine ought to be a required course in medical school—while this perspective holds merit (as, indeed, healthcare is a business, though that grates against our idealistic tendencies), medical students often learn about medicine as if it is totally in a vacuum. This is why many surgeons and internists distill the social history into three topics:

• tobacco use
• alcohol use
• other substance use

In psychiatry, we delve much deeper into social history, though even we often reduce it to a few bullet points (born here, raised there, this many siblings, parents involved, possible abuse, graduated this grade, worked these jobs, married this many times, this many kids, currently living where, living with whom, relationships, financial support…).

We don’t learn that medicine is practiced within the context of economic demands. We don’t recognize that the patient may hold certain cultural beliefs (where “cultural” doesn’t necessarily refer to ethnicity) about their minds and bodies that may significantly impact his healthcare. We isolate diseases as solely conditions of an internal organ and exclude how the environment may have affected the condition and, conversely, how this condition affects how the individual interacts with the environment.

When we finally practice out in the “real world”, context whisks us off of our feet and we’re bewildered—you mean money plays a big role in healthcare? you mean medications don’t grow on trees? you mean patients don’t have endless resources to follow our recommendations to the letter? what?

>> Psychiatrists are much more attuned to human behavior than I realized. A group of residents from a variety of specialties convened this evening to learn about administrative tasks, managing conflict, team dynamics—middle management, essentially. As the speaker (a skilled administrator who is a physician) elaborated about the craft of bridging administration with medicine, I realized that so much of my training is directly related to this type of diplomacy and management of people. Many of the other residents found these concepts novel—these are issues they do not routinely consider.

This is probably totally obvious to everyone else. But just because I think about human behavior a lot doesn’t mean that everyone else does, too. (Hear that buzzing noise? It’s the lightbulb over my head flickering to life.)

>> Grand Rounds is up. This summer’s literary medblogging project (thank you, fellow blogging bards!) made it onto “Vitum’s Top V“. Sweetness.