The 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?
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.
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.
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.
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.
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.
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.
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.
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.
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