<p>the only thing i’m more dedicated to than science is this website!</p>
<p>Thanks, Texas, I had not paid enough attention to know if Kal was parent or student. I, like most other posters, have a sample size of 1 + anecdotes of DD’s friends. I still think that, just as all posters on CC speak from their experiences (check out the wedding threads and the disagreement on the groom walking the MOG down the aisle until it is discovered that is traditional at Jewish, but not Christian weddings), all doctors ought to have some advantage in areas which they have experienced.</p>
<p>I know a kid in DDs class with a 25% higher MCAT score, um, I would pick my DD all day long over this kid as my doctor. They will both be good in their specialty, but just higher numbers does not mean you are a better doctor. Kind of like admissions to HYPS, they could fill the class many times over on numbers alone, they look for more. And yes, some kids who would have been good are missed. But it also broadens the profession. I think in some URM categories, it is not that the numbers are so much lower, it is that the pool is shallower, not as many kids out there know how to play the game. The decent 30/3.6 applicant is actually able to be seen for who they are in that URM pile, they are not obscured by 34-35-36s by the thousands. Same for holistic admissions.</p>
<p>In specialty interest and interviews:
I can say that DD has seen and spoken to many people who still are not sure what they want to be (specialty); people who put XYZ rotation last because they would never do that and choose it! I can say my DD has eliminated IM & psych & ortho, and that’s it. For an interview, all her pre-med experiences could be tied to two areas, but she is liking much of what she is experiencing. She may or may not go into the specialty she thought.</p>
<p>On the other hand, another DD thought in HS she wanted to do brain stuff, talked about it in her university tour, then dropped it. Thought about MD, then dropped it. Now she is a PhD in, brain stuff.</p>
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<p>Better MCAT scores may not tell whether somebody is going to be a better doctor. Some ADCOM’s subjective assessment based on a couple of essays and a half hour interview may fare much worse, however, in that regard. </p>
<p>I love my son too, but I wouldn’t pick him as my doctor (if and when he becomes one), as emotions tend to cloud judgment.</p>
<p>A system, whether you call it “holistic review” or what not, that tries to artificially create parity of doctor demographics to population demographics, on any pretext, is not my cup of tea. There is a name for that - quotas. I would never stand for quotas.</p>
<p>Said Kal123
A system, whether you call it “holistic review” or what not, that tries to artificially create parity of doctor demographics to population demographics, on any pretext, is not my cup of tea. There is a name for that - quotas. I would never stand for quotas.</p>
<p>I agree. I practice in an area where there is a large predominance of a certain culture. These patients favor doctors of the same cultural background. However, I see many of these patients who get very shoddy care from the same physicians. Unfortunately, the patients don’t know any better and have absolute blind faith in their physicians only because the physician is of the same ethnic heritage. The patients are the ones who suffer in that their diabetes does not get managed properly, they are told that their blood pressure is doing fine, when in reality it is terrible, and many of these patients are just not managed aggressively.</p>
<p>I’m not saying that our admissions policies are perfect, but we should not put ourselves be fooled by thinking that having a physician’s ethnic background match a patient’s ethnic background is necessarily going to provide for better medical care.</p>
<p>just some food for thought:</p>
<p>Ann Behav Med. 2013 Jun;45(3):308-17. doi: 10.1007/s12160-013-9475-9.
Effects of patient-provider race concordance and smoking status on lung cancer risk perception accuracy among african-americans.
Persky S, Kaphingst KA, Allen VC Jr, Senay I.</p>
<p>Ann Behav Med. 2012 Jun;43(3):372-82. doi: 10.1007/s12160-011-9342-5.
The effect of patient-provider communication on medication adherence in hypertensive black patients: does race concordance matter?
Schoenthaler A, Allegrante JP, Chaplin W, Ogedegbe G.</p>
<p>Arch Intern Med. 2012 Nov 26;172(21):1662-7.
The effect of values affirmation on race-discordant patient-provider communication.
Havranek EP, Hanratty R, Tate C, Dickinson LM, Steiner JF, Cohen G, Blair IA.</p>
<p>J Gen Intern Med. 2007 Aug;22(8):1184-9. Epub 2007 May 8.
Patient-provider and patient-staff racial concordance and perceptions of mistreatment in the health care setting.
Blanchard J, Nayar S, Lurie N.</p>
<p>Med Care. 2011 Nov;49(11):1012-20. doi: 10.1097/MLR.0b013e31823688ee.
Patient-provider sex and race/ethnicity concordance: a national study of healthcare and outcomes.
Jerant A, Bertakis KD, Fenton JJ, Tancredi DJ, Franks P.</p>
<p>Med Care. 2011 May;49(5):496-503. doi: 10.1097/MLR.0b013e31820fbee4.
Racial/ethnic disparities in primary care: the role of physician-patient concordance.
Strumpf EC.</p>
<p>Obesity (Silver Spring). 2012 Mar;20(3):562-70. doi: 10.1038/oby.2010.330. Epub 2011 Jan 13.
Impact of patient-doctor race concordance on rates of weight-related counseling in visits by black and white obese individuals.
Bleich SN, Simon AE, Cooper LA.</p>
<p>I think that’s probably enough. There is much less consensus on the effect of race concordance than I expected. There were also several papers that showed the potential influence of race discordance could be mitigated by proper communication. I think this still shows the need for holistic admission but maybe it need not be as heavily focused on race/socioeconomic status as I would have thought.</p>
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<p>I meant theoretical, like if my DD was not my DD, she would be an excellent choice to be my doctor, because of the way her mind works. Her brilliant friend, scary choice ;)</p>
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<p>I work in the insurance industry and it is quite interesting how the physician’s standard are much different than the life insurance industry standards, sometimes we are easier, sometimes they are. I read a lot of medical records and the first thing I learned was to ‘shut up’ and not tell the doctor so much minutia of my life, amazing how much I read about people. Scary, even.</p>
<p>It is also surprising, doctor’s medicating for people with 180-200 cholesterol (and good ratios) but the insurance company allowing the very best rate class for under 220 or even under 300 if the ratio is outstanding. In other areas, the doctors seem to tell patients (according to the patient’s story) that they are doing ‘great,’ but they in fact are actually doing great for someone with their extensive health history and are uninsurable.</p>
<p>I thought a little bit more about this this morning. I feel like there is an implicit statement in many of us that without “holistic admissions” there would be major demographic shifts in the medical school classes and that feels wrong. Not that we are incorrect for thinking that but that there is a problem that that is the conclusion we all come to. There is no validity to the idea that any race/gender/socioeconomic upbringing is more equipped to be a physician so inherently doesn’t that mean that the system is flawed if it “appears” that one race/gender/SE upbringing would win out? Just as physicians strive to make our patients better, shouldn’t we be striving to make our physicians and the systems through which their trained better too? I haven’t fully thought this through because I’m not sure we should be sacrificing patient care in the short term even if it produces long term gains but does it even produce long term gains? Should we simply be trying to affect change at a different point? No particular point/conclusion to drive home. Just more food for thought.</p>
<p>somemom’s comment remind of the Dartmouth study from a year or two ago about how residency training/med school teaches young physician a “culture” of medical practice and not just medical knowledge. Some residents learn to do every possible procedure/intervention–even on terminally ill patients; other have been taught to be mindful of the ultimate futility (and costs) of going all out on someone who cannot possibly recover.</p>
<p>D1’s school trains and requires its students to do preventative interventional counseling for a number of conditions/situations. During patient exams students get graded down if they don’t offer smoking cessation referrals/pamphletes to patients who smoke, for example.</p>
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No amount of teaching can have more salutary affect on one’s ethical behavior than one’s own sense of personal integrity. If teaching of ethics in class rooms were to cure immorality and criminality, the world would have gotten ridden off those ills already. I am certainly not saying that teaching ethics is a bad idea. I am just saying that it is na</p>
<p>There are different issues in wowmom’s example vs Kal’s.</p>
<p>Wowmom’s example has to do with what the school taught in how they handle patients. I would suggest it has nothing to do with ethics but more to do with treatment philosophy. Should patient be saved at all cost if he is 80 and will live another 3 months if you do a couple of surgeries now or should they let him die peacefully. It also has to do with whether doctors should suggest lifestyle alterations as part of the treatment whether patients want to change or not. </p>
<p>Kal’s on the other hand has to do with ethics if a colleague such as his brother believes that this doctor is ripping patients off to make up income. I actually think it is a since I personally tend to do a lot more work if I am refreshed and took a few days off but if one has worked a while with someone, they do have an idea about the other person. This is no different than people scheduling an overwhelming number of c sections irrespective of the need (in a lot of cases it is facilitating a convenience factor for both docto and patient - costs be darned) or psychiatrists sending an overwhelming number of patients for 3 day observations (I heard of a practice in a rural area in Texas where everyone billed a million in one year doing this).</p>
<p>Oh, TX, don’t get me started on all those 50-60 year old kids (I seem them on documentaries) who want to throw every possible procedure at 90 year old totally demented mom, both costing a fortune- paid for by us all with Medicare- and, in my humble opinion, torturing her. I want to scream when I see some of these. I also told my DH, “Honey, I hope you don’t want to be saved at all costs, because I am NOT doing it” ;)</p>
<p>I think an ethics class true value would be in helping students to think through sample situations, to give them the chance to explore the various pros & cons, to prepare them to think about how they will act in future situations. Rather than leaving them to react to what comes without thinking, just going along with the culture of their hospital/practice.etc. Will it change an unethical person, not likely, but could it help a naive person determine some personal values, yes.</p>
<p>" “Honey, I hope you don’t want to be saved at all costs, because I am NOT doing it”"</p>
<p>Did he ask if you have a replacement lined up? :p</p>
<p>Nope, but he also knows NOT to let me linger on if I get dementia. Taking a parent through a fatal illness, taking over the care of another parent plus seeing an in law who has needed ADL assistance for nearly 30 years, we have had some serious discussions about what we want.</p>
<p>Organs being donated all around! A kidney for you, a cornea for you, heck, take the lungs, heart, etc. We have really gained clarity in what should and should not be done, which is how I ended up watching many documentaries on aging & medical treatment and assisted suicide.</p>
<p>I wonder why many people with serious fatal diseases, like my 80+ parent, still are taking their meds. If I or a family member has dementia, no meds other than comfort care. If we cannot keep the brain functioning any longer, no sense working on the rest of it! In my humble opinion ;)</p>
<p>He says if he goes like his disabled parent just to push the wheelchair off the cliff, how one does that I am not sure in reality, but at least we are clear what we do and do not want as is my remaining parent.</p>
<p>One wonders whether holistic review would have weeded out Nidal Hasan, the Ft. hood shooter or Dr. Kermit Gosnell.</p>
<p>While IQ remains fairly static over a lifetime, personality changes. The aloof genius can be taught bedside manner. No amount of teaching is going to make an average intellect into a genius.</p>
<p>kal123, wow, I could not agree with you more! As a graduate of BUSM some years back , I was part of the first few medical school classes that had a required medical ethics class. It was truly a waste of time. It was of course an introductory class, not really dealing with truly in depth complex medical ethics issues. Nonetheless, as would have been easily predicted, those who truly may have benefitted from such a class, skipped class routinely , and those of us who found the subject of value, sat there thinking " this is common sense". If a young adult starting medical school needs to be taught ( not that I think this can be done in one class) basic concepts in ethics, then that person does not belong in med school. I suppose the goal of the so called “holistic process” would be to weed out such students, but that any “holistic” process can do this, I truly doubt . I still would err on the side of what Psycho Dad has pointed out I believe, it is far more important to have competent doctors. Of course, in an ideal world one would want the competent compassionate doctor for ALL patients, but if I had to make a choice for myself or my family, I would opt for competence.
The other troubling thing to me about this holistic issue is that our society needs medical braniac innovators. Albeit a good portion of these would opt for MD/PhD programs, some of these I suspect would be weeded out via a so called holistic admissions process if applying to a regular MD program</p>
<p>OTOH, sometimes it takes time for someone from a less privleged background to catch up.</p>
<p>D has a classmate who some here would argue should have never been accepted into medical school. A member of minority culture who grew up in poverty in a culture that does not value education nor science, learning English as a 3rd language, attending some the lowest performing K-12 school in the country. Accepted into a BA/MD, then accepted into medical school despite not making the MCAT cutoff of 26. This individual is a fully particpating member of their culture group, despite the personal sacrifices it requires (lots of travel and time) and fully intends to practice medicine in an severely medically underserved area. The individual just took the STEP 1 and score well above the national mean. </p>
<p>Not accepting this person would have done a severe disservice in the long run, as s/he will provide both medical services and valuable role model for the culture. Add in the fact that this individual is active on state and national level, lobbying for improve access to medical services–and the loss becomes even larger.</p>
<p>Would I have felt good if D1 hadn’t been accepted to med school while this person was? Of course, not but adcoms are in tough positions and forced to make the choice of Solomon with every admission decision.</p>
<p>I just looked up Nidal Hasan to see his undergrad background and medical school info. It was interesting, he received his undergrad from VA Tech while enlisted for 8 years. And then applied to USUHS. So he was active duty when he applied and when he obtained his BS.</p>
<p>This profile who not be a “traditional” applicant to most SOMs. He would receive a bump since he was already active duty. Who knows what the terms of his re-enlistment contract stated.</p>
<p>I guess what I am thinking is maybe he would not have passed through any of the screening at any of the other MD schools. The threshold for GPA and MCAT might not be the same for someone else in his position.</p>
<p>I know, kind of off topic.</p>
<p>Kat</p>
<p>I do believe BA/MD is where they should do holistic process rather than start in medical school. I believe the two programs in texas geared for low income and rural populations are catching them young and trying to train them for a career.</p>
<p>Ultimately, even if 25% go back to their rural areas, they have saved a bunch of lives for just being there vs having no doctor in that area.</p>
<p>Nidal Hassan went to a military medical school. Their main requirement is joining the military.</p>
<p>wayoutwest, your daughter’s classmate sounds like a wonderful person; but nonetheless, first and foremost she must be a competent physician and I hope she will be, her underserved area deserves nothing less.
This is not to say that holistic admissions process will lead to less competent physicians, I am just fearful that it may if taken too far. Also, in my experience different personality types are suited for different medical specialties, thus med schools looking for a uniform group of individuals who pass their holistic profile ( whatever that may be), may contribute possibly to shortage in some specialties…lots to consider</p>
<p>I do agree that one can’t teach “pure” ethics in a class. If one is willing to compromise himself for money, no teaching will stop that. Cultural competency and medical ethics can be taught. </p>
<p>With regard to the idea that holistic admissions will hinder innovation. My former classmates would be so proud of me for saying this: that’s privilege talking. I could easily argue that a student who is able to achieve similar but slightly less than I have without access to the schools, tutoring, and career support services that I have had throughout my 25 years is more innovative than I am. Without holistic admissions, this student is clearly “behind me” on the list of acceptances but with holistic admissions they could potentially end up ahead of me.</p>