Sunday, 12 June 2011

Why I realised the importance of the psychosocial in medicine...

Women of the world
Women of the world by robynejay

Students often don't seem to understand why the social sciences are important to understanding health and the way that we organise health services. The relevance has always seemed rather obvious to me but then I have to wonder if this doesn't have something to do with my own personal circumstances. Or else wouldn't all medical students think the same? So a few facts about me, the person who entered medical school in Belfast aged 18:


  • I grew up on a small farm in Northern Ireland
  • I'm the eldest of 4 children
  • My maternal grandmother died in childbirth
  • My mother's aunt started living with us when I was 6. My mother cared for her for 25 years until she died aged 103
  • My family had a great interest in politics and my father was elected as a local councillor
  • My father died suddenly when I was 14
  • The family income fell as a result of my father's death but we were no longer entitled to free school meals
  • I took a GCSE in sociology when at school. My coursework project considered why although the school was predominantly female, we only made up 1/3 of the a-level physics class.

I don't usually write about personal things here and there is a lot more I could say about what might have shaped my identity as a doctor. I am left wondering if many students don't question the structures and practice of medicine (insights that can be gained from the social sciences) because nothing in their own personal lives has sensitised them to the way that we organise society. 

If this is so, what can we do about it? If I am wrong, then what can we do about it? Either way we need to do something to shake things up.

17 comments:

  1. Why was only 1/3 of the a-level physics class female? We need to know as I am not sure we have moved on that much.

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  2. As well as our personal experiences, might there be an impact of the medicine course requiring top grades at A-level (or equivalent), resulting in selecting for the doctors of the future that are disciplined enough to excel in a field; rather than the awkward troublemakers that question whether the field is worth doing well in - and are the ones that push for the field to get better?

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  3. @drgrumble I don't think that a sixth year school pupil can reach great conclusions. This was in the 80s... boys chose science a-levels nearly exclusively and girls everything else. I looked to EOC documents for possible explanations- could girls have been treated differently by teachers? Might boys (making up 40% of year) have felt need to choose masculine subjects?

    @kevfrost Hmmm that might be true. Yet more to think about.

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  4. I can only agree that this is a very important aspect of healthcare that must be grasped to make treatment truly effective.

    Like you I lost my father as a teen and I saw my Granny look after my great-grandparents for a few years and then my uncle look after her when she developed Alzheimer’s. I found that this means I never take a patients’ circumstances for granted and take my time to build a picture of them. Maybe this also influenced my decision to take social biology as part of my bachelors degree?

    So possible causes? Is it that medicine, although possibly having the broadest intake of students in the history of the profession, still has a core majority from a relatively narrow socio-economic group?

    Or is it that in an ear of targets and political interference there is a tendency to "treat and street", to deal with the immediate problem and not delve to deep for fear of being pulled in deeper?

    Or do the A-level science requirement for entry to medical school mean that students enter with a perception of the pre-eminence of science and that social sciences are not as important. i.e. "I must treat the pneumonia that this patient has, the poverty they live in is not my concern".

    Best wishes,

    Neil

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  5. Neil,
    Thanks a lot for your comment. You, like Kevin, have suggested that a-levels might be important. Perhaps we need a new entrance requirement- everyone should have a sociology GCSE!

    I know that will annoy lot of people on Twitter!
    AM

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  6. Vicky Grant Medical Librarian13 June 2011 00:09

    This is a really interesting debate Anne. If I had more influence I would insist that sociology was taught in all medical schools! Perhaps that's because I truanted my way through school and left without a scientific qualification to my name! My Grandpa lived in high rise flats that GPs wouldn't visit for fear of the gun crime rife in the area. Never stopped us going there...
    Keep up the good work!

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  7. Many medical students who enter medicine aged 18 have little or no life experience outside of a privileged background. I found the mature students at university a much more interesting and diverse group. I was barely 18, and although had a more realistic view than most, in retrospect feel that I was too young. I wish I had at least had a gap year or even done another degree (although I wouldn't have been able to afford it).

    I freely admit that at medical school, I found the psychosocial aspects dull and somewhat pointless, partly because they were taught poorly, but also because at 18 I didn't understand their importance. My first real taste of the social side of medicine was on elective in the Solomon Islands where I saw how important the whole social construct is in medicine. Since graduation my awareness of this has improved and continues to do so with every patient that I meet.

    How do you improve things? I would like to see a greater proportion of students in medicine from a wider range of backgrounds, perhaps with a greater proportion of graduates. For those that are 18, a better way of teaching these ideas at university would help (although not sure about how to improve that).

    @drdlittle

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  8. Thanks Vicky- I wonder if it would work? :)

    Or is as David says (and thank you for your very honest comment) if life experience isn't more important.

    All students are graduates in US, so I wonder if they fare differently.

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  9. Vicky Grant Medical Librarian13 June 2011 09:39

    I think David is right in that the best way to learn it is to live it. The problem with that is that the students who are living it are much less likely to be acquiring the straight a grade currency required to get into Medical School in the first place. I was teaching our medical students recently - we were looking at obesity drugs. Initially they were only interested in drug efficacy but when I asked them to debate aetiological factors of obesity they engaged surprisingly well. Wonder what everyone thinks about the new tuition fee regime. Will this create more or less graduate students going on to do medicine?

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  10. Further to my tweets...

    I think social sciences are seen as "soft" subjects - A level sociology and psychology are not counted as a science subject when applying to medicine/university. Perhaps there is also a snobbery around these, in my experience only large state school colleges offer these, whereas the private schools stick to "traditional" subjects. I've known friends take psychology, thinking it's a science subject, to find out they cannot get a place on their chosen university course.

    I think as well as sociology, other social sciences, particularly philosophy, could be useful in a medical school curriculum. Although as a medical student I have had lectures and workshops on medical ethics, I think students could be taught more on how to make decisions and analyse practice. My sister is studying Philosophy at LSE, and is always questioning practice which myself and my parents (both doctors) take for granted because "that's just how it is". I believe some basic philosophy teaching would really help students' critical thinking skills. We might find there was more innovation in health and better decision making.

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  11. As a 4th year medical student, I have to say 'we students' are suffering the crossfire of the "more social medicine vs more science medicine" debate concerning how medical schools should structure their curricula. And having spoken to other students in first and second year who will now have their clinical years dominated by "social determinants of medicine" instead of "clinical medicine", we all feel that this 'obsession'(albeit a positive and potentially productive one) with treating the social aspect of patients -as well, and sometimes more importantly than the actual medical issues- seems to be slowly overriding actually learning the medicine.
    There is no denying that it is important to learn about these social determinants (which in many cases are the root of the illness for which we see and treat patients) as they have the potential to drive prevention more than any 'medicalized' intervention. But there seems to be a reaction from 'governing bodies' against perceived "excessive medicalization of patients" which we hear so much about in medical school which is driving our education further away from 'the medicine'; It seems almost out of fear that as future doctors we will be incapable of understanding 'the complicated social aspects of medicine'.

    And this is where we begin to get fed up. As important as sociological concepts are to modern medicine, we are after all, medical students, not sociology students, and we would appreciate if those in charge of our education would keep this in mind.

    @RaccoonFran

    (On a side note, I already agree with drdlittle in that I feel I would've gotten more out of my degree so far had I been graduate entry and not 18)

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  12. Vicky Grant Medical Librarian13 June 2011 23:02

    Hi Rocky
    It is really good to hear a medical students opinion. My 9 year old daughter recently asked me "Mummy if doctors are so clever, why is everyone ill" How would you answer that?

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  13. Well, I think that's quite a difficult question without a straightforward answer; but the 'simple' answer I suppose would be something along the lines of "Because (as much as they/we'd like, they/we can't always help people. Either because A) there is no treatment, B) the 'treatment' requires help from other agencies other than the medical profession alone."
    Although the answer I think most healthcare professionals would like to give is "Because no one has invented a pill to treat everything yet." (which does say a lot about modern expectations of medicine)
    The long complicated reply would involve medical, social, and psychological aspects and models of illness and health and how as healthcare professionals it is unfortunately difficult to target these all at once in a successful way.

    @RaccoonFran
    http://medstudentfinalyear.wordpress.com

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  14. Very interesting discussion. I didn’t realize [note US spelling; I’m from the US] students in the UK could start medical school at age 18. It’s true that in the US most med students have completed four years of college as a pre-med major. There are just starting to be programs that allow students who majored in the humanities or social sciences to attend med school (http://buswk.co/kz9Ck8 & http://ti.me/kNnrGt).

    I can understand that there’s an overwhelming amount of information to be learned in med school, plus so much experience needs to be acquired to become a proficient doctor. But eventually doctors are in the trenches trying to help patients who suffer from diseases, many of which could be prevented if the social/environmental conditions of those patients had been more conducive to health. We leave decisions about such matters to politicians. The results are neither satisfying nor consistent over the decades. In the US, medical advocacy for addressing the underlying conditions that promote health comes from the field of Public Health. That field is not as respected or as powerful as the medical profession. I for one would love to hear more from the medical profession on these issues. I don’t hear it in the US and don’t know about the situation in the UK.

    I’m watching the TV series Doctor Finlay for the first time (I’m halfway through). That was a time when some in the medical profession supported the creation of the NHS and others were extremely wary of change. I think the medical profession is a largely untapped source of visionary thought about how to improve health, both domestically and worldwide. An education that includes the social sciences or humanities is a good foundation for thinking about the larger picture and making a very satisfying contribution to a better future for us all

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  15. I wholeheartedly agree with the idea that including social sciences may (when taught correctly and adequately focused) add substantially to a medical degree. In the UK, however, things seem to be 'swinging' too far towards the social and too far away from the medical, which myself and many of my peers are beginning to find counterproductive.

    @RaccoonFran

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  16. I can't imagine choosing to be a doctor at 17 or 18 - kudos to those who did and are happy with their decision. When I was 18, I thought I wanted to be a molecular biologist, linguist, Middle Eastern studies scholar, and film critic - all in succession within a few months. I ended up changing universities to study art and - it wasn't until I was 22 and accepted to graduate school in cinema studies - that I decided to go to medical school. I never took a social science class ever, but feel my exposure to the arts and humanities has been invaluable to my work as a physician - much more so than my organic chemistry and physics classes!

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  17. Also, I appreciate you sharing about personal events that shaped you as a physician. I wonder whether other physicians may think that this is revealing too much or would want more privacy themselves?

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