Unsure about science and medicine Watch

allofthat
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I am currently a second-year medical student in Belgium; as we're on a 6-year curriculum this means I'm still in my preclinical years, studying physiology/pathophysiology/...

I basically went into medicine out of scientific interest. Before I started the course I thought that a doctor is someone who knows exactly how the human body works (normally and in diseases) and applies that knowledge to diagnose and treat people. In other words - I thought that the so called basic sciences were the most important part of the knowledge needed for clinical practice.

Now in second year I've had some exposure (still very little though, just a few 'clinical lectures') to clinical knowledge and I found out that it seems to be much less scientific than I thought it was. It seems as though a big part of medicine comes down to memorizing the etiology, symptoms, diagnosis and treatment of diseases and recalling that information at the correct moment, instead of applying physiology/biochemistry/pathophysiology/... to patient cases. Is this so, or am I just deceived by these basic 'clinical lectures' and does clinical medicine actually involve science and scientific thinking? How scientific is medicine really?

Dropping out of the course is not an option because I'm really enjoying it up to now - but I'm unsure because I keep on hearing about people who hate the pre-clinical course and want to get through it just to reach clinicals; I'm afraid to be the opposite. But since I haven't had any clinical exposure yet - and will have close to none until 5th year due to the structure of our course - I would also probably regret not having given clinical medicine a chance if I dropped out now. That's why I don't really know what to do.
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Dr. Django
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if you're enjoying it, stick with it for now
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smd4std
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Finish your medical degree and see what you want to do after that


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seaholme
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(Original post by allofthat)
Now in second year I've had some exposure (still very little though, just a few 'clinical lectures') to clinical knowledge and I found out that it seems to be much less scientific than I thought it was. It seems as though a big part of medicine comes down to memorizing the etiology, symptoms, diagnosis and treatment of diseases and recalling that information at the correct moment, instead of applying physiology/biochemistry/pathophysiology/... to patient cases. Is this so, or am I just deceived by these basic 'clinical lectures' and does clinical medicine actually involve science and scientific thinking? How scientific is medicine really?
Aetiology = applied pathophysiology.
Symptoms = applied pathophysiology.
Diagnosis = applied biochemistry (investigations).
Treatment = applied pathophysiology/biochemistry.

They're not really different things?
I mean when you recognise the symptoms of something you're recognising the changes that a particular pathology has had on a person's physiology. The aetiology of how it happened requires understanding the pathological processes leading up to something and what external factors influence these. Investigating it with tests involves being able to visually identify pathology on imaging and also recognise the alterations in a person's biochemistry which can lead to including or excluding certain diagnoses. Treating it requires knowing how different drugs affect a person's physiology in order to correct for the pathology. You need a really firm grasp on all these things to be a good doctor making good diagnoses and treating correctly.

I don't really understand your dilemma, if I'm honest
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carcinoma
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(Original post by seaholme)
Aetiology = applied pathophysiology.
Symptoms = applied pathophysiology.
Diagnosis = applied biochemistry (investigations).
Treatment = applied pathophysiology/biochemistry.

They're not really different things?
I mean when you recognise the symptoms of something you're recognising the changes that a particular pathology has had on a person's physiology. The aetiology of how it happened requires understanding the pathological processes leading up to something and what external factors influence these. Investigating it with tests involves being able to visually identify pathology on imaging and also recognise the alterations in a person's biochemistry which can lead to including or excluding certain diagnoses. Treating it requires knowing how different drugs affect a person's physiology in order to correct for the pathology. You need a really firm grasp on all these things to be a good doctor making good diagnoses and treating correctly.

I don't really understand your dilemma, if I'm honest
This.

Medicine is scientific. If it just required us to be guideline and framework monkeys then medical school could be significantly shortened.


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nexttime
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Some memorisation is necessary... emergencies are a good genuine example where you should know what to do off by heart. Medicine is still heavily scientific though. If it was just about memorisation, computers would do all diagnosing and that would be that.

Additionally i'll say it depends on the speciality. All will be scientific at their core, but say you were interested in physiology: you could aim for a speciality like renal. Immunology you could do rheumatology, biochem is its own field and genetics is growing as a speciality, etc.
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Kinkerz
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(Original post by seaholme)
Aetiology = applied pathophysiology.
Symptoms = applied pathophysiology.
Diagnosis = applied biochemistry (investigations).
Treatment = applied pathophysiology/biochemistry.

They're not really different things?
I mean when you recognise the symptoms of something you're recognising the changes that a particular pathology has had on a person's physiology. The aetiology of how it happened requires understanding the pathological processes leading up to something and what external factors influence these. Investigating it with tests involves being able to visually identify pathology on imaging and also recognise the alterations in a person's biochemistry which can lead to including or excluding certain diagnoses. Treating it requires knowing how different drugs affect a person's physiology in order to correct for the pathology. You need a really firm grasp on all these things to be a good doctor making good diagnoses and treating correctly.

I don't really understand your dilemma, if I'm honest
This just isn't true though. Not on any practical level. I think it's fairly disingenuous to say actually.

You can be a doctor - a very good doctor* - with a pretty low level of understanding in the basic sciences.

Aetiology = applied pathophysiology.
Not unless adding the word applied dilutes pathophysiology into something meek and obsolete. Aetiology in clinical medicine is often reduced to a single word: autoimmune / infectious (+/- name of organism(s)) / traumatic / degenerative / etc.

Symptoms = applied pathophysiology.
In some circumstances, sure. But (1) there are loads of symptoms that cannot be explained by pathology and (2) there are lots of [good] doctors / students out there who don't understand the pathophysiology behind many of the symptoms that do have an adequate explanation.

Diagnosis = applied biochemistry [/ anatomy].
Vaguely. Most just recognise patterns in the results from blood tests. Liver function tests are a key example of this: 'Oh, this is a cholestatic picture', etc. This isn't applied biochemistry. Radiographic diagnosis is closer to applied basic science, but it's based on anatomy, which is as dry as my grandma's turkey (bless her).

Treatment = applied pathophysiology / biochemistry.
Just knowing the class and the B.N.F. data for drugs isn't really applied anything, and this is all that's really encouraged once clinical years hit. Knowing how drugs work (I mean an actual understanding of the basic science of it, not just: 'Oh, this is a calcium-channel blocker', etc.) is a pre-clinical phase priority, not a clinical phase*.

The way you're using the words pathophysiology and biochemistry in this context is not fair. You can practice medicine with an A-level biochemistry understanding and a pretty mild understanding of pathophysiology, so long as you have your illness scripts and diagnostic / treatment algorithms nailed.

This isn't always a bad thing. To thoroughly understand all the basic science underpinning medicine would be virtually impossible and doctors have to prioritise their learning to the more pragmatic end of the spectrum. This is compounded by the fact that there's so much that just isn't understood in medical science.

I'm simply saying that I understand the O.P.'s issue: I thought that an understanding of human biology was going to be more important in day-to-day practice as a doctor than it actually is. The reality has disappointed me, as I think the O.P. is worried it will for them.

*Depending on specialty to an extent.

(Original post by carcinoma)
This.

Medicine is scientific. If it just required us to be guideline and framework monkeys then medical school could be significantly shortened.
You're right. It could.
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seaholme
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(Original post by Kinkerz)
I'm simply saying that I understand the O.P.'s issue: I thought that an understanding of human biology was going to be more important in day-to-day practice as a doctor than it actually is. The reality has disappointed me, as I think the O.P. is worried it will for them.
Depends on what kind of doctor you want to be, in my opinion. If you can't figure out what's going on when something doesn't fit the learnt pattern or the list of symptoms and you can't think laterally beyond those because you lack the basic science, than you're sort-of a robot doctor who's never going to push the boundaries of medicine and never diagnose anything that's not out of the book. Which admittedly does get you quite far. If you want to do that, you can.

On the other hand, the better you understand something the better you're going to be at pulling it apart. If you know what's going on with a drug on a basic level then when an unusual side effect crops up, you might be the doctor who knows enough to rule it in or out as a secondary problem or just dismissed as a side effect. For instance. I mean I suppose I'm agreeing with you but I don't think it has to be like that. Especially if you ARE interested in science and so on, there are lots of really challenging jobs and routes you can go down and you can also get jobs with academic as well as clinical elements. I'm certainly interested in that sort of thing.

All of the best 'Dr House' type doctors of their specialty that I've ever met have been like that BECAUSE they have a grip on basic science. I agree that you can function without it, but it is by no means dismissable and if you're capable of it and find it interesting, then definitely I think it will help you become a better doctor. Assuming you're good on the whole communication skills thing as well, of course!
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Kinkerz
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(Original post by seaholme)
Depends on what kind of doctor you want to be, in my opinion. If you can't figure out what's going on when something doesn't fit the learnt pattern or the list of symptoms and you can't think laterally beyond those because you lack the basic science, than you're sort-of a robot doctor who's never going to push the boundaries of medicine and never diagnose anything that's not out of the book. Which admittedly does get you quite far. If you want to do that, you can.
But you're more likely to be able to think laterally / see things that others miss if you've gleaned a lot of experience or have a lot of medical knowledge. Being versed in the basic sciences doesn't give nearly as much of a boost at this kind of thing as people seem to think.

And 'the sort of doctor who's never going to push the boundaries' generally includes the majority of doctors. Plus, the doctors who do push the boundaries may well be leadership-management types who have just as minimal a grounding in the sciences as most other non-boundary-pushing doctors.

On the other hand, the better you understand something the better you're going to be at pulling it apart. If you know what's going on with a drug on a basic level then when an unusual side effect crops up, you might be the doctor who knows enough to rule it in or out as a secondary problem or just dismissed as a side effect. For instance. I mean I suppose I'm agreeing with you but I don't think it has to be like that. Especially if you ARE interested in science and so on, there are lots of really challenging jobs and routes you can go down and you can also get jobs with academic as well as clinical elements. I'm certainly interested in that sort of thing.
Might be the doctor who recognises an unusual side effect (although most side effects aren't easily explained even with a very solid understanding of the pharmacology). Probably more likely to do that with wrote B.N.F. memorisation really.

By all means the academic route is one way to gratify any scientific interests, but it gets pretty competitive to follow that route, especially in the jump from A.F.P. to clinical fellowship. It's not something a 'regular' doctor with a bit of an interest in science can just waltz in to.

All of the best 'Dr House' type doctors of their specialty that I've ever met have been like that BECAUSE they have a grip on basic science. I agree that you can function without it, but it is by no means dismissable and if you're capable of it and find it interesting, then definitely I think it will help you become a better doctor. Assuming you're good on the whole communication skills thing as well, of course!
Because they have a good grip on the science or is that just a by-product of someone who is very well-read in their specialty? If it's the latter, then they'd presumably be pretty much as good minus the scientific underpinning because they've consumed so much clinical information.

I accept what you're saying in a sense, I just don't think the difference it makes is all that significant. People over-estimate it. Doctoring doesn't require a great deal of science.

Overall, I think people like to push the whole 'science' gives doctors a superior ability to tackle the puzzles in medicine / push the boundaries of medicine / generally function as better doctors / etc., when in reality the enhancement it makes to your practice is minimal. A sea of clinically-pertinent facts stuffed into your head is much more pragmatic for being a doctor than good grasp of human biology. This isn't a complaint as such, just a statement for the O.P. to think about.
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Kinkerz
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Fairly interesting and telling study about basic science retention in medical students.
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