How I’d Change Medical School

medical students in a lectureThe success stories on this blog and the personal experiences of each person reading this article are a testament to the power that lies within the individual to alter his or her health trajectory by making the right diet, exercise, and lifestyle decisions. It’s not always easy, but it’s possible, and it happens every day. All you have to do is make the choice and stick to it. But that’s the thing: you can decide for yourself to make these changes. What about others? What about society at large?

How do you change the institutions that, for better or worse, teach people how to be healthy, happy humans?

In the past, I’ve explained how I’d change grade school. I’ve gone over how I’d change gym class. And today, I’m going to tell you how I’d change medical school.

Keep in mind that these ideas are simply my opinions from my own vantage point. I’m willing to hear different perspectives on the topic.

What would I do?

Speed things up.

The first two years of medical school cover very little applied science. Instead, the focus is on basic science and memorization—of the effects of drugs, how different drugs interact with each other, how they interact with pregnancy, and so on. These are useful, but not at the cost of tacking on several extra years and waiting to let them start applying the knowledge.

A physician’s assistant (PA) needs 6 years of schooling—4 for undergrad, 2 for PA training. An MD needs 11 years—4 for undergrad, 4 for medical school, and at least 3 for residency. Not only does this slow down the process of creating new doctors, it makes it incredibly expensive. Doctors will often enter their profession deep in debt, which in turn raises the price of medical care.

I would argue that you can train a smart pre-med college grad 90% of a chosen medical specialty in under two years and have him or her be perfectly competent to begin supervised practice on real patients. After all, many diagnoses theses days are done by computer modeling anyway, not by the actual physician. Now, of course different specialties demand different training durations and not everyone will follow the same path.

Start with genetics and ancestry.

Nothing in biology makes sense except in the light of genetics and ancestry. Emphasize the reality that the vast majority of human diseases and degeneration are precipitated and exacerbated by evolutionary mismatches—conflicts between the environmental inputs our genes expect and the environmental inputs they receive. It’s not that “What did cavemen do?” is the answer to everything. It’s that thinking about the selective pressures that shaped human evolution gives doctors a very good starting position from which to discover the right answers and ask the right questions.

Emphasize sleep and circadian rhythm.

Sleep and circadian rhythm affect every single facet of health. Name a disease or health condition and you’ll find a link between it and poor sleep and circadian alignment. Fixing sleep is a big juicy piece of low-hanging fruit that will never hurt a patient—and will likely help them.

Depressed? How’s your sleep?

Gaining weight? Are you sleeping?

Blood sugar issues? Do you fall asleep to the TV playing?

If the sleep question becomes part of a doctor’s opening routine – along with the basics like blood pressure and the weight check, all other treatments and therapies will work better, or even become redundant. Imagine there’s an entire class devoted to sleep: its links to cognitive and athletic performance, how it regulates hormonal health, the connection to mood, and body composition, and immune function.

Yet it’s not only about medical school curriculums emphasizing the importance of sleep in managing a patient’s health. They should also emphasize good sleep hygiene in the students themselves. Instead of having a resident work for 18 hours straight, instead of fostering a culture of sleep deprivation and “toughing it out,” medical school should encourage adequate sleep. The costs are too great otherwise, and not just for the student. Judgment suffers when sleep-deprived. A young doctor operating on 2 hours of sleep when making life-or-death decisions about complex biological phenomena might as well be drunk. The impairment is similar, if not greater.

 

Make regular training mandatory.

Provide fitness trackers and enforce daily step counts.

Teach the major compound lifts. Enforce twice weekly strength training.

Teach proper sprinting and running form.

We meed a vanguard of lean, strong, fast, fit doctors. Even better, they should be more than just doctors. They should be fitness coaches, too. Imagine if your doctor kept a kettlebell in her examination room and could demonstrate and teach proper form. Instead of saying “get more exercise,” this type of doctor could show you exactly how to train.

Cover “the other stuff” in addition to traditional medical school curriculum.

Imagine a class devoted to the health benefits of green spaces and exposure to forests, beaches, and other natural environments. Imagine a section on Forest Bathing.

Imagine a class exploring stress—how to regulate it, how to identify it, supplements and nutrients that can help (or hurt).

Imagine a class covering nutrition that doesn’t just say “saturated fat bad, whole grains good.” Imagine if medical students learned about paleoanthropology, read Weston A Price, and had a class about the effects of rancid linoleic acid on the mitochondrial membrane. Imagine field trips to the Hadza tribespeople.

Take a close look at corporate sponsorships—a hard look.

The American Medical Association and Harvard Medical School both receive money from Coca Cola and Pepsi.1 Fifteen years ago, between 2% and 16% of the average medical school’s budget came from donations by pharmaceutical companies, and it’s still happening today. While I’m sure it’s a huge help to receive that kind of money, it creates perverse incentives, pharma companies subject students to a constant barrage of drug advertising, and they even influence the curriculum. If you’re giving millions of dollars to a medical school, you’d better believe you’re going to expect something in return—like a curriculum centered around pharmaceuticals rather than diet, exercise, and lifestyle.

Establish the right incentives.

Pharmaceutical companies, medical equipment providers, hospitals and even a few doctors have a vested interest in keeping their patients ill. They do so not out of rancor or malice, but because of system-wide influences. You’d think that a successfully “cured” patient should represent a major victory in strict medical accounting terms—and it certainly does for the vast majority of individual healthcare professionals—yet a cured patient generates no income and no profit for a large organization.

Type 2 diabetics are a good example. Drug companies can expect a 20, 30 or 40 year income stream generating $500 to $1,000 a month per patient. The longer they live with the disease, the more additional drugs they’ll need and the more profit the company will make. In fact, the drug company has zero interest in the patient altering his or her lifestyle to beat the disease. They just need to keep them alive and filling prescriptions.

I’m envisioning a world where the doctor is the one who a complete toolbox: he or she has drugs when indicated, but if something else works too and is kinder to the body, do that. If there are interventions that reduce a patient’s reliance on drugs, the doctors would relay that information, with detailed instruction.

If you take away the influence that promotes the current model and teach a curriculum centered around prevention and lifestyle changes, doctors will be more effective and patients will be better off.

Quality and quantity.

The average doctor’s visit lasts 26 minutes, including the time spent with the assistant and waiting in the room for the doctor to come in. Actual conversations between doctor and patient last a little over ten minutes. That’s simply not enough time for a doctor and patient to build a relationship, which is exactly what patients and doctors need if the latter are to make a difference in the health and wellness of the former.

Aim for 30 minute conversations between doctors and patients, minimum (and if the situation warrants it). Aim for the establishment of actual, real relationships where it’s not just an authority figure reading bullet points but a conversation between two individuals.

I don’t expect Harvard Medical School to adopt all these measures anytime soon, if even one influential person is saying “Hmmm…” and taking down notes, I am happy that the conversation is starting somewhere.

How would you change medical school? What would you want out of your doctors that you aren’t already getting?

Let me know down below.

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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36 thoughts on “How I’d Change Medical School”

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  1. In the UK, “med school’ starts in undergrad. We should do that here. The time my daughter spent in “undergrad” is somewhat waste years in this journey.

  2. I don’t understand how a doctor can help people with diet and exercise related problems when they can’t do it themselves either. Doctors should know how to prepare a healthy meal, how to shop for food on a range of budgets, and how food is grown and prepared. I know many people have had the experience of a pudgy overworked doctor telling them how to lose weight and lower stress.

  3. Everything you say here is right on Mark. I really believe we need to train more Functional and Naturopath Doctors and a medical Doctor should be the last resort. Unfortunately most folks have the mindset that a pill is the answer. Insurance companies cover medical Doctors and money is what it is all about. In Canada we have medical coverage not alternative coverage. So I must pay for this. Why is it called alternative and not the other way around ? This is such a big mountain to climb Mark and I’m happy we have people like you who are really,y trying to change the system. Thank you for all you do.

    1. Completely agree!!! I won’t be repetitive saying the same thing. I go to a functional medicine doctor and I just don’t trust “regular” doctors anymore. They don’t dig deeply enough. My doctor knows what they others do, and then a lot more. It only makes sense to me that all doctors should be like that.

  4. Picture it, Paul Chek at a 2012 conference. Chek goes on record saying if he was given the power to implement one healthcare reform rule it would be any person practicing healthcare workers- doctors, trainers, nutritionists- would have to perform their services in a speedo or a g-string.

  5. I rarely go to doctors. Too many bad experiences. For one thing, they can be flat-out wrong a fair percentage of the time. That’s often because they don’t LISTEN. If you question their diagnosis, they get huffy. If you already know what’s wrong and just want advice on how to fix it, you might get treated like a not-very-bright 5-year-old. If you don’t want to take the rot-gut drugs they prescribe, they have nothing else up their sleeve to offer you.

    There is so much that is wrong/outdated about the American medical system in general that I prefer to have as little truck with them as possible. I’m sure I’m not the only one. The changes Mark describes would go a long way toward improvement, but I doubt they’ will happen in my lifetime, if ever. After all, this is a profession that gets paid handsomely whether they help you or not.

    1. Like all things, there are good and bad doctors. There are definitely better and worse ways to speak to doctors, and using the better ways helps them help you. The first is to be concise: explain the problem you’re having, along with symptoms, when it started, and what makes it better and worse. I’ve started writing these down and bringing them to appointments with me so I can remember. Second, explain any other existing health issues. Then, ask your doctor what their thoughts are and how they would proceed. 9/10 times, this will result in a positive interaction.

      Doctors are people too and they are working to make connections between symptoms and conditions as patients speak with them. If you’ve done research beforehand and they don’t mention a test, condition, etc., ask them about it. Most of the time, they’ll be happy to appease you and run the test you want. There’s quite a bit of overlap between conditions, so it isn’t out of the realm of possibility that sometimes they will get it wrong, but presenting the information to them in the most concise and clear cut way is a good way to help them get to the right answer.

      That being said, of course there are many things I disagree with in medicine (e.g. putting everyone with reflux on PPIs, those with cholesterol over 200 on statins, or women on OCPs). I’ve also spent quite a bit of money running my own bloodwork when I want something doctors won’t give me that I feel is important.

      I’ve observed doctors coming a long way over the last 10 years though, and I think that should be noted and appreciated. From learning more about nutrition, to the importance of sleep, stress and therapy on the body, etc. too. It won’t get there overnight, but I do feel like in some ways it’s already started improving.

      1. Yes, there are good doctors out there, I agree. The problem is that the system they are forced to work within is badly broken. The big pharmaceutical companies and insurance companies control much of what doctors can and cannot do these days. Doctors that try to buck the system are beaten down pretty quickly. As Mark said, Big Pharma has a strong incentive to keep people sick, so they keep filling their prescriptions. There is no incentive to cure someone so that they don’t require prescription meds. Functional medicine is the direction we should be heading, but it’s an uphill battle, because the drive for money and profit controls almost everything in our society, including health care.

    2. Agreed – feel the same way. I too have had negative experiences with conventional Drs. I honestly believe that if I would have listened to any or all of them, I would not be here today! Functional Med Drs. are the future – treating people holistically and getting to the root cause – not just treating symptoms and dismissing the basics like nutrition (#1 IMO), sleep, exercise, etc. Thoughtful article 🙂

  6. Hi! As a doctor myself, i almost agree with all points from you above!
    But: Basic science is needed to interpret correctly scientific studies, and i don’t agree with “diagnosis are made by computer modeling”…AI in my opinion has not come so far to replace diagnosis finding via real human interaction (anamnesis and examination)
    best regards, keep up the good work!

  7. It really all boils down to “First, do not harm…” I have seen too many friends and family experience negative health outcomes as a direct result of visiting physicians who were not good matches for them.

  8. Follow the money.
    Sounds cynical, I know, but it’s the reality.
    “Pharmaceutical companies, medical equipment providers, hospitals and even a few doctors have a vested interest in keeping their patients ill.”
    That is chilling.

  9. There’s so much credible medical information available on the internet now, but if you go to your Dr. prepared with questions and talking points, they shut you down and think you’re wacko. Skeezix is right, they don’t LISTEN. More patients have become proactive and responsible for their health matters, and a class in humility and manners would go a long way toward improving patient relations.

    1. Absolutely. I had to diagnose and cure myself a few years ago, when I had severe iron overload. I went to three different doctors first, none of whom had any idea what was wrong with me. So I did my own research and concluded that my problems might be related to too much iron in my system. I finally got a doctor to order the lab tests I needed (ferritin, transferrin saturation, total iron binding capacity), and the results confirmed iron overload. I then asked my doctor if she would order a therapeutic phlebotemy so I could start reducing the iron in my blood, and she said no. So, I had to start donating blood on my own to the blood banks…………and my symptoms all disappeared after about the third donation. But I am still angry about what I had to go through to cure myself. I still go to a doctor once yearly for blood tests, but I make sure they order the tests I need, and I interpret the results myself.

  10. During a Dr.’s appointment once I asked for nutrient deficiency testing and was told that it wasn’t standard of care. I consider that to be criminally negligent, to say the least. There’s no accountability.

  11. The same would apply for denticians. Teach them about diet and what actually cause dental decay an deformities in the jaw. Mandatory litterature would be “Diet and Physical Degeration” by Weston Price. It would save society a lot of money and save regular people from a lot of misery.
    Only problem is that if the denticians succeed to well with educating their patients they might make themselves obsolete. Maybe that would be the case with doctors too?

  12. I have been avoiding doctor’s like the plague the past few years.

    I don’t trust them anymore and they’re just little puppets of the pharmaceutical industry.

    When faced with serious health issues a few years back, my doctor thought drugs were the only answer.

    By using the knowledge found on this blog here and in Mark’s books I managed to restore my health and prove her wrong, which she’s still refusing to admit despite the evidence from my tests.

    So there’s a lot to be done to change medical school, but like Skeezix already said: not in my lifetime!

  13. I don’t envy doctors it is incredibly difficult to diagnose thousands of patients. I believe medicine is a noble career, but people flock to the medical field for $$. I think if you chose to go to medical school, and you maintain an average of 3.5 to 4.0 school should be free. You are giving up a decade of your life (for very little pay) until you graduate. If you chose to go into Plastic Surgery, than yes maybe you should pay. Ditto for Nursing School. I think if medical students did not have the long tedious and low paying journey to their goal we would get the folks that really want to practice medicine and help people.

    1. Many of us do not do it for the money. We go into knowing that we’ll be paying loans for decades. Many of my classmates graduated with nearly a million in debt. Very few make the “neurosurgeon” salary. I do pediatrics, I could easily earn that salary in other professions without massive debt.

      1. yes!!!!! agreed!!!!! the loans are unbelievable. spent my life paying them off. no vacations, no rest. it is non stop work and stress. this profession is NOT for the money.

  14. Well, docs know how to kill the microbiome but they never go about repairing it after. This needs to change. Too many reach for the antibiotics before even giving any thought to how the patient is coping, what ‘shape’ they are in, their biological age or if they really need antibiotics/drugs vs other health boosting items… like herbs, vitamins, foods or… just time.

  15. Like a previous post (from Martin), I too am a physician (primary care and functional medicine). I also agree with 90% of what your article says Mark. I think the basic sciences do serve a purpose in the medical school curriculum and I couldn’t agree more with your suggestions on carving out time to help doctors become experts in sleep, nutrition, exercise, etc. when I was in medical school from 2003/2007, I can assure you that NOTHING of the kind was taught, none whatsoever. All of my knowledge with aforementioned sleep/nutrition/exercise was done after medical school, after residency and on my own dime and with my own initiative while struggling to keep the doors of my privately owned practice open.

    It really pains me to hear and read how poor some patients’ experiences have been (as Jen mentioned). I’m not making excuses but I will tell others about my profession as a medical doctor that:
    1) we weren’t really trained in what we now know are the MOST practical subjects to learn to be able to truly help people
    2) medical school was/is dang expensive, most of us graduate around $150,000 in debt from the four yrs of med school alone; the high debt burden pushes people to high earning specialties like Ortho or neurosurgery and pulls smart people away from primary care where the need is greatest for a GOOD doctor who will listen, will help, and will be a role model for healthy living
    3) I believe most (not all of course) doctors, especially those of us coming out of education in the last 20 yrs or so, really and truly want to help and not see harm come to our patients. The current system just stinks in so many ways it’s pathetic. Again, good changes as recommended by Mark.

    To all of your frustrated patients/consumers of American Healthcare, know that there are many doctors who are equally feeling beat-down and burnt-out, but keep looking, there are those of us out there who are really trying hard to do the right thing.

    1. Thank you for caring and for being an advocate for change! Keep up the good work, your patients are way better off because you are a caring and thoughtful physician.

  16. The deteriorating health of our nation demonstrates the primary focus has been on economics and not on disease prevention. The pharmaceutical industry has long influenced the medical profession into an ideology of ‘cookbook’’ medical practice. This or that symptom necessitates a test or procedure usually resulting in a prescription ..not a lifestyle recommendation . They must keep the various diagnostic lab schedules busy. Unfortunately this will not change as MDs are chastised an even ostracized when deviating from the ‘tightly controlled’ standard of care. This has led a tunneled vision of patient care and removed most of the ‘art’ of practice known many years ago before high tech economics took over.

  17. I wish doctors would begin with nutrient deficiency testing and genetics testing.

  18. This is so spot on EXCEPT for the notion that a physician needs to be lean, strong, fast & fit to be effective. This perpetuates the notion of physician as a demi-god both among the public and physicians themselves – which can lead to some pretty unhealthy behaviors and attitudes. Also, if we truly care about the whole person, weekly psychotherapy and spiritual direction should be a key component to a training program.

  19. I live in Launceston, Australia, a local Dr here tried to change the diets of type 2 diabetes and was under investigation by the APRHA the Australian Regulation Agency for 2.5 years and cleared after 4.5 years. If you would like a little light reading about what they found about vested interests and plant based diets, have a look at his website isupportgary.com it is a real eye opener.

    1. I was just thinking about liability too!
      In some ways, practitioners hands will be tied.
      The long term solution needs to be where the code of practice, (abd other frameworks that practitioners work to) allows “alternative” practice..
      I think Mark shoukd start up his own medical school…..

  20. What a fantastic vision!
    I’d love to see the day where medical practitioners cover all this during their training. In truth, I doubt it would happen due to the influence big pharma have.
    But I could imagine schools set up and building that movement alongside. The question then comes to how these would be funded….there must be a way….

  21. Such an interesting article with so many good comments! I agree with everyone here about our broken medical system. Changes are WAY overdue. There is a little light however … as people are beginning to realize that natural approaches vs. conventional offer so many more benefits – in many cases. However natural/integrative approaches are still being condemned and considered “quackery” by many – esp. Wikipedia; who many people turn to for information …