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Young Docs Not Ready to Treat Social Ills

Training blamed for no emphasis on learning to listen to patients

MONDAY, Sept. 10, 2001 (HealthDayNews) -- More than one in 10 medical residents in their last year of supervised practice apparently don't feel capable of handling common but serious social issues that doctors are likely to encounter.

That's because training today's doctors to handle behavioral and social problems they might find in places like nursing homes is not a high priority, says Dr. David Blumenthal, director of the Institute for Public Policy at Massachusetts General Hospital and chief author of a new study on the issue.

"Undoubtedly, some future physicians will avoid treating problems they feel unprepared to manage," Blumenthal says.

The study, which appears in the current issue of the Journal of the American Medical Association, looked at more than 2,600 residents in various specialties. It found that:

  • 42 percent of internal medicine residents feel unprepared to provide domestic violence counseling;
  • More than 20 percent of primary care residents feel unready to handle nursing home patients, HIV/AIDS patients or patients who abuse drugs or alcohol;
  • 32 percent of anesthesiology residents don't think they could manage a patient's chronic pain;
  • More than 10 percent of psychiatry residents think they're unprepared to treat substance abuse, diagnose and treat patients with bereavement issues or diagnose and treat eating disorders;
  • 19 percent of obstetrics and gynecology residents say they're unable to counsel patients about depression, a common problem with new mothers.

Blumenthal says these findings are especially important for people who rely on tightly staffed community hospitals and managed care organizations, where specialists may not be available to handle such problems.

The stumbling block to all this, Blumenthal says, is the complexity of today's medicine. Doctors can't learn it all and shouldn't be expected to, he says.

"We don't have clear job descriptions or objective measures," he complains. "We need to clearly establish what we expect a physician to do, teach him to do it and then measure whether those competencies are present when he leaves his training."

Dr. David C. Leach, executive director of the American Council on Graduate Medical Education, says the study points out that what suffers in the current system of physician education is training in managing relationships with patients.

"There's no time to teach physicians to listen to people," Leach says. "And physicians really need that skill."

With today's widely available resources, people don't turn to their doctors for the same kind of information they once sought, he maintains.

"You come to a doctor when the illusion that you are going to be healthy comes to a crashing halt," Leach says. "You don't just want information -- you can get that elsewhere. You want a relationship with another human who shares your vulnerabilities. And many patients aren't getting that."

Both doctors agree that training is ripe for review and revision, but neither sees changes happening overnight.

"I think this study gets at the very substance of medicine, and it goes deeper than whether you teach this or that," Leach says.

But others view the study differently. Mental health researcher David E. Pollio, who directs the Mental Health Services Research Center, a National Institute of Mental Health-funded center in St. Louis, says he's glad that residents have these concerns.

"The idea that someone in training has competence to deal with such complex issues strikes me as a silly one," Pollio says. "If they take the next step and recognize that this means that they need to consult with experts when these situations arise, and that they need to continue to learn after they graduate, then these survey results represent very good news indeed."

What To Do

Doctors are human beings, too. If you feel your physician isn't dealing well with your problem, trust your instinct and try to get a second opinion.

To learn more about the education of America's young doctors, try the Association of American Medical Colleges or the ResidencySite.

SOURCES: Interviews with David Blumenthal, M.D., director, Institute for Public Policy, Massachusetts General Hospital, Boston; David C. Leach, M.D., executive director, American Council on Graduate Medical Education, Chicago; and David E. Pollio, Ph.D., director, Mental Health Services Research Center, St. Louis; Sept. 5, 2001 Journal of the American Medical Association
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