As a part of the morning tour at my 40th medical school reunion we got to visit the anatomy lab. Probably of all the activities carefully orchestrated for the alums, all clustered by decades out of school, and whose graduation dated back as far as 50 years or more, the visit to the anatomy lab seemed the most popular. We could actually go to the eerie, white walled, uncluttered lab dedicated to human anatomy where 30 cadavers lay in body bags on steel gurneys -- not just see a dead body on a popular TV show that dramatizes doctors and the kind of bizarre lives we are purported to lead.
I was shocked, however, to learn that anatomy had been reduced to a mere eight weeks during the first year of medical school, instead of the full year that comprised my education 40 years ago. What's more, those eight weeks now also included embryology and radiology -- the logic for bundling these subjects together I could not understand nor did I ask. But eight weeks? How in the world could anyone dissect a cadaver in that time and actually learn about the human body? How could a doctor in the making have the ritualistic and for me awesome (in the best sense of the word) experience of really knowing "the body," the physical essence of us all, the structures that house how we operate -- from the muscles that move us, the organs that sustain us, the spinal and peripheral nervous systems that direct us, organs of ingestion, digestion and excretion not to mention procreation, and the wondrous brain and organs of perception -- without the deep connection to the body that literally digging into it day after day for a year produced, I wondered? The anatomy lab's director lamented that anatomy has largely disappeared from medical-school curriculum around the country and that the eight weeks was better than none.
We then were shepherded to the Clinical Skills Training area, down the hall from the anatomy lab. Here, 32 examining rooms, with video cameras, computers, electronic records and trained actors provided simulated doctor-patient encounters for the medical students throughout their full four years of medical school. From heart conditions to hernias, from domestic violence to depression, actor-patients under attentive supervisors taught medical students more about how to be with patients than about what was wrong with patients (though they did that too). Anatomy had been replaced by relationship training, by how to help a patient tell his or her story and how a doctor needs to learn how to listen, respond, assemble information and engage the person in their own care.
Now, I am a psychiatrist. So you would think I would be voicing praise for how medical-school education has changed: for how the doctor-patient encounter now has hegemony over the doctor-cadaver encounter. But I don't seem to feel that way. Dropping the body from a central role in medical education seems like a bad idea. So, I looked up the number one "Sentinel Event" in this country, a term used by The Joint Commission, which accredits all hospitals in this country, to define "...an unexpected [medical care] occurrence involving death or serious physical or psychological injury...[which] signal the need for immediate investigation and response." It is wrong sided surgery. I rest my case.
The opinions expressed herein are solely my own as a psychiatrist and public health advocate.
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