Campaign to revitalise academic medicine

Editor—Tugwell describes the campaign to revitalise academic medicine.¹ Many doctors are not able to treat the increasingly common problems seen in primary care. These include depression, anxiety (especially social anxiety), alcohol excess, other drug problems, chronic pain, and many other complex problems.

Health systems are good at managing the problems of the 1960s and the problems the current managers and teachers fear or perhaps already have, but not the problems of young, poor, and disempowered people. In some of these fields—particularly alcohol problems and addiction to benzodiazepines and prescription opiates—doctors are too often the problem.²

Figure 1.

Health systems are not good at managing problems of disempowerment

Credit: GILLES MINGASSON/GETTY IMAGES

Ten minute consultations in general practice, and stays of 2.4 days in a hospital bed, hardly serve to promote the science and art of managing complex and often chronic problems well. This approach is designed to prop up a fragmented, technology oriented, illness treatment system through which some are helped and most are disadvantaged.

Universities are preoccupied (perhaps rightly, in the current political climate) with financial matters, first and foremost. Online teaching, the apparent saviour of medical education, will only worsen the issue. Good medical practice needs to be shown, empathy needs to be taught. Engagement does not occur online, and good data, although essential, are the least important part of medical education.

Some years ago I was part of a committee that recommended that mental health never be taught in tertiary care settings. It is still usual practice as it is convenient and cheap, serving only to scare students away and ensure that they are never exposed to the mental health problems that are most common in general practice. It is rather symptomatic of the whole training problem.