A number of commenters have raised concerns that social determinants of health are important, and that poor, black and hispanic people do worse in America. I agree! And I wish to make 5 points
1. Most lectures in medical education merely restate the obvious. Poor people do worse, and minorities do worse, in so far as they are poor. At some point, this message has been conveyed. What are we going to do about it? Another 10 or 20 or 100 lectures won't help anyone.
2. There is no evidence that raising awareness has done anything to reduce disparities, just as not a single indigenous person has benefit from hundreds of people listening to land acknowledgement. This is also true for some medical disease awareness campaigns (see my JAMA paper)
3. The solutions to socioeconomic disparities largely precede medicine. These disparities begin in early life. Advocate for better elementary school education. Better nutrition for kids. Roland Frier has other good ideas (see Econ talk). But little of this has to do with medicine. (One irony is that so much of this DEI curriculum was silent about school closures during COVID-19, which did more damage to poor or minority kids than any other action in the last quarter century)
4. One of the videos I watched from UWashington discusses how doctors should advocate for (a higher) minimum wage, and stronger tenant laws. But It is entirely unclear if those policies will help poor and minority patients. Minimum wage increases have spillover effects-- some low wage jobs get replaced with robot kiosks-- and strong tenant laws often lead to fraud, as apartments are passed along in families or to friends, or kept empty. Moreover, these topics are better covered by economists rather than doctors
5. Finally, there is only so much time in medicine. Graduating students are often unable to calculate post test probabilities of basic diagnostic tests. Few can tell you what a p value means. Nearly none can dissect a NEJM paper. Not all know how to care for DKA, or COPD or HF. Medicine must prioritize these things.
I agree with your points. A few more points to those commenters:
-until people (students/ faculty & admin at medical schools) are ready to go into the deep and work with the people they are talking about, don’t pontificate from on high about how to solve these problems.
-if you feel moved to solve these problems, good on you! But it is not a good use of doctors’ brain power or time to focus precious curriculum hours on advocacy issues. Train to be the brightest most competent doctor you can be, and then go do something powerful with your skills!
-there are better “on the ground” ways already in existence to help underserved populations. We should expand them. In my Community Hospital based Residency Program in Family Medicine (we were trained to practice in a rural setting -full spectrum care including Obstetrics and Hospital medicine), we did a “Community Medicine Month” in our city with high Hispanic, homeless, poor & dual diagnosis populations as part of our curriculum. We spent time getting to know the different resources in our area. One of these was the Community Health Center (a non-profit, non-governmental entity) which had a medical clinic, a migrant clinic, a homeless clinic, a dental clinic & a pharmacy. They had social workers & RNs on staff who worked on outreach programs in high need in our area. Some of the Residents were assigned to these clinics for their continuity clinic, and all the Residents cared for the Medical & OB patients from their clinic that came into our hospital for care. I went on to work for that Community Health Center & also got NHSC loan repayment funds to do so.
-having two college age daughters, I have been on many college tours in the last 3 years. The land acknowledgements are ubiquitous. They may come from a good place, but come off as disingenuous/ performative. I heard one person give the analogy, “it’s like you go up & swipe a sandwich out of someone’s hand right before they are going to eat it & say, ‘I’m sorry I took your sandwich, but I’m going to eat it anyway’…” It would be much better if they followed their statements with…”our school offers scholarships to all Native Americans who apply, and has developed a relationship with the local tribes…” otherwise don’t do it.
There's plenty of time wasted in medical education. I am pretty sure I had a question about pheochromocytoma on almost every exam, but I have yet to see one. I had almost no education in critical appraisal, addiction, immunology, or many things I deal with every day. However, I don't think that is what Idaho lawmakers are worried about. Rather, they don't want students exposed to ideas those lawmakers find offensive. If they were smarter, they would be worried that kids exposed to diverse urban environments will not choose to return to Idaho.
Virtue-signaling is annoying, for sure, and in many ways does more harm than good when it makes people think they are actually doing something. You can see why people are trying to teach about SDH, though, even if they aren't doing it in a practical way. One thing that would actually be useful in medical education is a lecture series in the exigencies of poverty. Learning about how poor people live, why they can't afford the newest medications, how the copay for an MRI may make someone homeless - these would also seem like "woke" ideas to many, but they would be more medically relevant than knowing which chromosome abnormality causes a Wilms' tumor (sadly, I still remember).
You are conflating DEI & virtue signaling with "urban" ideas... Perhaps you don't understand what "urbanites" really think? Or, maybe you don't know what many of them think because many on the more conservative end are keeping their mouths shut, because they don't want their cars, or homes, or children messed with by the true vandals of our time - Leftists.
If you don't understand how so many people are poor, re-read Vinay's comment. Then maybe take a couple of non-woke courses in Psychology. "Poor" and "poverty" starts in the mind - how one thinks of ones self. It is inherently tied to how children are taught to think of themselves by their parents, their siblings, their friends, their "teachers". And, what they're taught to think about stuff. "Poor" has NOTHING to do with how much stuff you do or don't have.
Billy Boy Gates was asked on camera how much money and stuff and power is enough, when he's one of the richest men in the world, yet he still actively looks and creates new ways to make yet more money and get more power. He was silent, utterly silent.
Jesus' apostles and disciples would probably fall under "the poverty line", yet they had rich lives filled with hope, and friends, and love.
We need to stop equating "rich" and "poor" with stuff and money.
Absolutely! Removing objectivity in the name of gender equality may have enabled a non-smoking friend's restrictive lung disease (onset after the C shots) to be ignored because her Hgb of 16.9 was "normal." Not that there is an effective treatment, but she made some life decisions that she otherwise would not have made. Race differences are likewise erased.
I agree completely, but it is disconcerting how many commenters decline to understand what you are writing. Perhaps were need to start with reading comprehension for all.
They are in a cult. Understanding what he had written as it is written would involve a cataclysmic shift in their worldview. It’s not that they can’t understand, they won’t understand.
Please look at SilentMajorityFoundation.org under the tab "freedom of speech" for further information about Washington State medical schools. Our future doctors have lost the ability to speak freely and engage in open discussion and debate. The medical education system is even coming after professors of medicine who dare to speak openly as private citizens. We cannot allow this tyranny to continue or our future doctors and all people will start to believe that this madness is normal!
I know of at least 12 large families who have moved from western Washington to Idaho in the past 10 years, all for political and religious reasons. They don’t want their children to grow up in this [liberal] environment in western Washington. I attended graduate school at UW in 1978-79, taking many courses in the medical school. I earned an M.S. and subsequently worked in healthcare here for 40 years at the same community medical center. I attribute much of my success to my tenure at UW. I contributed financially to the UW Medical School for several years as my finances would allow. However, around 2010, I noticed that the UW was becoming overtly more liberal (like most colleges) so I halted my charitable giving. Through COVID and since, it’s only worsened. I encourage Idahoans to start their own medical school, or perhaps partner with Wyoming and/or Utah.
Dr. Prasad - your editorial about the proposal to withdraw Idaho from the WWAMI program reflects an unfortunate knowledge deficit about Idaho , and the WWAMI program in particular. Just for background , I actually live in rural Idaho and have an Idaho medical license, and spent many years teaching and training WWAMI students in my community . The proposal to withdraw Idaho from WWAMI has nothing to do with " woke" shenanigans at UW in Seattle , and everything to do with the politics of religious fundamentalism in Idaho. Quite frankly , a number of legislators in Idaho will do just about anything to advance their deeply held religious agenda against reproductive choice, and they hate the fact that their neighboring state of WA has not enacted anti-abortion laws , and is in fact a place of refuge for Idaho women who need such care. They do not like the fact that UW offers elective abortion training ( no Idaho tax dollars are allocated for this, just to be clear ) . The problem with withdrawing from WWAMI however, is that it is the proverbial act of cutting of your nose to spite your face. Idaho is a very rural state. It's schools are poorly funded, and Idaho student achievement ranks in the bottom tier of states nationally. Idaho kids are smart, and strong and every bit as capable as their more urban and well off peers, but they have none of the advantages that wealthy West Coast kids from Washington have - Running Start, AP, IB, summer research opportunities etc. Idaho parents for the most part are not hiring SAT tutors and college entrance coaches. Idaho lags far behind WA in educational attainment , standardized test scores , family income and post secondary opportunities . WWAMI allows Idaho to avoid having to run it's own medical school ( a hugely more expensive venture , and not something that the tax averse ID legislature has ever wanted to do ) , and guarantees 40 slots for ID residents in it's top tier med school at in state rates. Idaho ranks 50th in the nation for number of doctors per capita. Yes, dead last. Pun intended. Physicians are not signing up in droves to come practice in Idaho - unless you would like to move here? The plan to ally with University of Utah is just that - a plan. Utah has " maybe promised " 10 slots for ID students , and is legally bound to maintain 85% of it's med school slots for Utah residents. It would require years of work and planning, and an act of the Utah legislature to expand the med school there to accommodate 40 Idaho students, not to mention WY , AK and MT ( no med schools there either) . Trying to arrange appropriate clinical teaching for 40 ( or 50 or 70 ) new students in Salt Lake is not something that occurs overnight . WWAMI allows ID students who have community ties and are most likely to want to practice here to get a world class education - and quite frankly many of them would not be competitive with WA peers if state of origin was blinded in the admissions process . WA students will eagerly snap up the 40 slots if ID gives them up - all to the detriment of Idaho, not WA . But sure, " we owned those libs!" The sad fact is that the bulk of WWAMI med school training is actually done IN IDAHO - not in Seattle . The U of I partners for didactic training , and rural track WWAMI students spend 6 months at a time in a rural community seeing everyone for everything during their clinical years. It is a fabulous program . Idaho students are smart enough to sort the wheat from the chaff when it comes to med school politics - and they are beating down the doors to get in. Locking those doors hurts no one but the citizens of my state.
If a medical school or postgraduate training program really wants its trainees to learn something about poverty or social disadvantage, why not encourage trainees to make house calls as part of mandatory rotations? Nothing like witnessing the conditions in which less privileged people live.
A good start would be to read A. J. Cronin: The Citadel. Or comparable novels. Another invaluable experience is to visit worksites. Some medical students or doctor will have experience at working in stressful, poorly paid jobs - but not many. How many readers of Sensible Medicine have worked as, or taught a student who had worked as an agricultural labourer, for example?
This was a really disappointing take. Have you ever asked indigenous people how they feel after a land acknowledgment is read? I have — and I'd say that it definitely does something good.
Ugh. I enjoy a lot of the thoughtful commentary on medical studies and your perspective on a lot of what is going on in medicine, but I'm losing some respect after this article. You are losing your mind of a land acknowledgment that might take 20 seconds to read before starting a presentation. Anyone buying into this DEI is creating an incompetent workforce is truly buying into a conservative toxic narrative. Vinay, do you really think that the young doctors you work with now are worse because of a couple videos and a land acknowledgment?? Do you really think there's no place for discussing issues of race or representation in medicine?? Can you deny that the lack of fair representation of people of color and women in medical studies has led to standards of care that are tailored for white men? Can you deny that people of color and women often have worse outcomes based on gender and skin color? Can you deny that social status does play a part in the overall health of people? And, finally, do you think that doctors who notice these patterns should potentially look for ways to correct these issues when they can?
I also think you are making some very bold statements based on your "investigation" of looking at their website?? A student who is actually in the program commented and said that this is not true of what they are finding at all in school. Maybe actually do a more thorough study of this before such a sweeping and angry rebuke.
There is no medical school in Idaho and this partnership has been a great one for Idaho in terms of producing doctors for the state. The stated reasons for the Idaho bill are that UDub is not able to offer expanded seats for Idaho doctors and an issue regarding no state funds going toward abortion care training which could not be guaranteed. I'm not even sure where Vinay is getting his facts about this. Overall, it seems like losing this partnership would be a bad thing for state as it is complex and difficult to replicate elsewhere and the UDub program is well respected and trains great doctors.
during the pandemic, i started listening to TWIV (i stopped when they obviously started propagandizing on behalf of the government). in one episode, a listener wrote in asking them to please discount the disgusting racist assertion that black people did poorly with covid because their vitamin D levels were generally low.
the TWIV team were happy to oblige. of course, black people were poor and medicine was infected through and through with systemic racism and the only way to correct the disparity was to preferentially ration medical care.
i was stunned! would anyone make a claim that systemic racism was responsible for black people having more sickle cell anemia? malaria in africa?
I have attended a number of occupational medicine seminars put on by the U of Washington, and we are treated to the indigenous peoples statement every time. I would not blame Idaho for withdrawing - they do now also have a DO medical school in the state, so probably do not need to outsource many students.
Medical education should focus on educating students about MEDICINE. And about the art and science therein. Students should be taught compassion and empathy for all along with their scientific education, but not at the expense of time spent on learning physiology and pharmacology. They should have had plenty of exposure to the DEI curriculum during their undergraduate experience. For the price they are paying for their medical education, they ought to get their money's worth.
Thank you for sharing this, Vinay - I am regularly frustrated with what I see coming out of my alma mater/school where I am an adjunct professor.
May I suggest that this part of the med students curriculum be dropped and replaced with how to baby-size Big Pharma. At least make the course of studies closer to what impacts doctors and patients.
Dr. Prasad's article demonstrates ignorance of of the Nex Perce and the Nimipu people in Idaho as well as other regional native American tribes of Washington and Oregon. Most of central Idaho belongs to the Nez Perce nation. Tens of thousands of Idahoans are members of the Nimipu tribe. Their healthcare needs are unique, complex and interwoven with their cultural beliefs and practices. The same is true for large areas of Washington and Oregon. Dr. Prasad's narrow minded view is reflective of his experiences which are unfortunately limited to large urban medical centers in Chicago, Portland and San Franciso. I would urge he spend some time in places such as Lapwai, Idaho caring for the Nimipu. Perhaps he will have the good fortune (as I have) of being invited into the sweat lodge by tribal elders as they chant and communicate with the Great Spirit. Perhaps then his perspective would broaden and his dissmissive attitude toward native Americans might become more enlightened. Every physician who trains in Idaho and the surrounding areas should be educated to respect those upon whose land we tread. As Chief Joseph said "A man who would not love his father's grave is worse than a wild animal." As an Idaho licensed MD, I never lose sight of whose father's grave I tread upon.
As a native american physician and graduate of UW school of medicine your article is highly offensive. You are speaking about something you clearly know nothing about. In the end if Idaho breaks from UW it's those future physicians who will lose out on unique training opportunities throughout the WWAMI region. Many of which are not available at any other medical school in the country. It's short sighted and would be a disservice to Idaho
My past home state of Minnesota and current residence in Indiana have adopted "no grades" in medical school coinciding with adopting DEI criteria for accepting medical school candidates. As we've seen with DEI hired air traffic controllers, federal government slackers, military personnel and federal deep state personnel; if you beckon the worst society has to offer, the American public will suffer the consequences. When medical and law school candidate selections are governed by DEI criteria and coupled with student candidates encouraged to occupy political picket lines rather than the classroom, one can rightly surmise the eventual disastrous outcomes for society with such deleterious decisions. Immediately, our country is best served by cutting off the "head of snake" by the following:
First, stop all federal funding of leftist ideologues and their institutions.
Second, fire and publicize the non-complying heads (college presidents , et cetera).
Third, if met with slow-walking and/or non-compliance, revocation of their 501C3 status should be simultaneously coupled with taxation of their sacrosanct 501C3 monetary caches. The latter action will nicely add to he monies saved by DOGE.
Nothing like adding to the turmoil with more noise. You can be sure those legislators will not be among those without doctors in the future. And your suggestions to all the issues you raised are????
A number of commenters have raised concerns that social determinants of health are important, and that poor, black and hispanic people do worse in America. I agree! And I wish to make 5 points
1. Most lectures in medical education merely restate the obvious. Poor people do worse, and minorities do worse, in so far as they are poor. At some point, this message has been conveyed. What are we going to do about it? Another 10 or 20 or 100 lectures won't help anyone.
2. There is no evidence that raising awareness has done anything to reduce disparities, just as not a single indigenous person has benefit from hundreds of people listening to land acknowledgement. This is also true for some medical disease awareness campaigns (see my JAMA paper)
3. The solutions to socioeconomic disparities largely precede medicine. These disparities begin in early life. Advocate for better elementary school education. Better nutrition for kids. Roland Frier has other good ideas (see Econ talk). But little of this has to do with medicine. (One irony is that so much of this DEI curriculum was silent about school closures during COVID-19, which did more damage to poor or minority kids than any other action in the last quarter century)
4. One of the videos I watched from UWashington discusses how doctors should advocate for (a higher) minimum wage, and stronger tenant laws. But It is entirely unclear if those policies will help poor and minority patients. Minimum wage increases have spillover effects-- some low wage jobs get replaced with robot kiosks-- and strong tenant laws often lead to fraud, as apartments are passed along in families or to friends, or kept empty. Moreover, these topics are better covered by economists rather than doctors
5. Finally, there is only so much time in medicine. Graduating students are often unable to calculate post test probabilities of basic diagnostic tests. Few can tell you what a p value means. Nearly none can dissect a NEJM paper. Not all know how to care for DKA, or COPD or HF. Medicine must prioritize these things.
I agree with your points. A few more points to those commenters:
-until people (students/ faculty & admin at medical schools) are ready to go into the deep and work with the people they are talking about, don’t pontificate from on high about how to solve these problems.
-if you feel moved to solve these problems, good on you! But it is not a good use of doctors’ brain power or time to focus precious curriculum hours on advocacy issues. Train to be the brightest most competent doctor you can be, and then go do something powerful with your skills!
-there are better “on the ground” ways already in existence to help underserved populations. We should expand them. In my Community Hospital based Residency Program in Family Medicine (we were trained to practice in a rural setting -full spectrum care including Obstetrics and Hospital medicine), we did a “Community Medicine Month” in our city with high Hispanic, homeless, poor & dual diagnosis populations as part of our curriculum. We spent time getting to know the different resources in our area. One of these was the Community Health Center (a non-profit, non-governmental entity) which had a medical clinic, a migrant clinic, a homeless clinic, a dental clinic & a pharmacy. They had social workers & RNs on staff who worked on outreach programs in high need in our area. Some of the Residents were assigned to these clinics for their continuity clinic, and all the Residents cared for the Medical & OB patients from their clinic that came into our hospital for care. I went on to work for that Community Health Center & also got NHSC loan repayment funds to do so.
-having two college age daughters, I have been on many college tours in the last 3 years. The land acknowledgements are ubiquitous. They may come from a good place, but come off as disingenuous/ performative. I heard one person give the analogy, “it’s like you go up & swipe a sandwich out of someone’s hand right before they are going to eat it & say, ‘I’m sorry I took your sandwich, but I’m going to eat it anyway’…” It would be much better if they followed their statements with…”our school offers scholarships to all Native Americans who apply, and has developed a relationship with the local tribes…” otherwise don’t do it.
There's plenty of time wasted in medical education. I am pretty sure I had a question about pheochromocytoma on almost every exam, but I have yet to see one. I had almost no education in critical appraisal, addiction, immunology, or many things I deal with every day. However, I don't think that is what Idaho lawmakers are worried about. Rather, they don't want students exposed to ideas those lawmakers find offensive. If they were smarter, they would be worried that kids exposed to diverse urban environments will not choose to return to Idaho.
Virtue-signaling is annoying, for sure, and in many ways does more harm than good when it makes people think they are actually doing something. You can see why people are trying to teach about SDH, though, even if they aren't doing it in a practical way. One thing that would actually be useful in medical education is a lecture series in the exigencies of poverty. Learning about how poor people live, why they can't afford the newest medications, how the copay for an MRI may make someone homeless - these would also seem like "woke" ideas to many, but they would be more medically relevant than knowing which chromosome abnormality causes a Wilms' tumor (sadly, I still remember).
You are conflating DEI & virtue signaling with "urban" ideas... Perhaps you don't understand what "urbanites" really think? Or, maybe you don't know what many of them think because many on the more conservative end are keeping their mouths shut, because they don't want their cars, or homes, or children messed with by the true vandals of our time - Leftists.
If you don't understand how so many people are poor, re-read Vinay's comment. Then maybe take a couple of non-woke courses in Psychology. "Poor" and "poverty" starts in the mind - how one thinks of ones self. It is inherently tied to how children are taught to think of themselves by their parents, their siblings, their friends, their "teachers". And, what they're taught to think about stuff. "Poor" has NOTHING to do with how much stuff you do or don't have.
Billy Boy Gates was asked on camera how much money and stuff and power is enough, when he's one of the richest men in the world, yet he still actively looks and creates new ways to make yet more money and get more power. He was silent, utterly silent.
Jesus' apostles and disciples would probably fall under "the poverty line", yet they had rich lives filled with hope, and friends, and love.
We need to stop equating "rich" and "poor" with stuff and money.
Absolutely! Removing objectivity in the name of gender equality may have enabled a non-smoking friend's restrictive lung disease (onset after the C shots) to be ignored because her Hgb of 16.9 was "normal." Not that there is an effective treatment, but she made some life decisions that she otherwise would not have made. Race differences are likewise erased.
I agree completely, but it is disconcerting how many commenters decline to understand what you are writing. Perhaps were need to start with reading comprehension for all.
They are in a cult. Understanding what he had written as it is written would involve a cataclysmic shift in their worldview. It’s not that they can’t understand, they won’t understand.
Please look at SilentMajorityFoundation.org under the tab "freedom of speech" for further information about Washington State medical schools. Our future doctors have lost the ability to speak freely and engage in open discussion and debate. The medical education system is even coming after professors of medicine who dare to speak openly as private citizens. We cannot allow this tyranny to continue or our future doctors and all people will start to believe that this madness is normal!
I know of at least 12 large families who have moved from western Washington to Idaho in the past 10 years, all for political and religious reasons. They don’t want their children to grow up in this [liberal] environment in western Washington. I attended graduate school at UW in 1978-79, taking many courses in the medical school. I earned an M.S. and subsequently worked in healthcare here for 40 years at the same community medical center. I attribute much of my success to my tenure at UW. I contributed financially to the UW Medical School for several years as my finances would allow. However, around 2010, I noticed that the UW was becoming overtly more liberal (like most colleges) so I halted my charitable giving. Through COVID and since, it’s only worsened. I encourage Idahoans to start their own medical school, or perhaps partner with Wyoming and/or Utah.
Dr. Prasad - your editorial about the proposal to withdraw Idaho from the WWAMI program reflects an unfortunate knowledge deficit about Idaho , and the WWAMI program in particular. Just for background , I actually live in rural Idaho and have an Idaho medical license, and spent many years teaching and training WWAMI students in my community . The proposal to withdraw Idaho from WWAMI has nothing to do with " woke" shenanigans at UW in Seattle , and everything to do with the politics of religious fundamentalism in Idaho. Quite frankly , a number of legislators in Idaho will do just about anything to advance their deeply held religious agenda against reproductive choice, and they hate the fact that their neighboring state of WA has not enacted anti-abortion laws , and is in fact a place of refuge for Idaho women who need such care. They do not like the fact that UW offers elective abortion training ( no Idaho tax dollars are allocated for this, just to be clear ) . The problem with withdrawing from WWAMI however, is that it is the proverbial act of cutting of your nose to spite your face. Idaho is a very rural state. It's schools are poorly funded, and Idaho student achievement ranks in the bottom tier of states nationally. Idaho kids are smart, and strong and every bit as capable as their more urban and well off peers, but they have none of the advantages that wealthy West Coast kids from Washington have - Running Start, AP, IB, summer research opportunities etc. Idaho parents for the most part are not hiring SAT tutors and college entrance coaches. Idaho lags far behind WA in educational attainment , standardized test scores , family income and post secondary opportunities . WWAMI allows Idaho to avoid having to run it's own medical school ( a hugely more expensive venture , and not something that the tax averse ID legislature has ever wanted to do ) , and guarantees 40 slots for ID residents in it's top tier med school at in state rates. Idaho ranks 50th in the nation for number of doctors per capita. Yes, dead last. Pun intended. Physicians are not signing up in droves to come practice in Idaho - unless you would like to move here? The plan to ally with University of Utah is just that - a plan. Utah has " maybe promised " 10 slots for ID students , and is legally bound to maintain 85% of it's med school slots for Utah residents. It would require years of work and planning, and an act of the Utah legislature to expand the med school there to accommodate 40 Idaho students, not to mention WY , AK and MT ( no med schools there either) . Trying to arrange appropriate clinical teaching for 40 ( or 50 or 70 ) new students in Salt Lake is not something that occurs overnight . WWAMI allows ID students who have community ties and are most likely to want to practice here to get a world class education - and quite frankly many of them would not be competitive with WA peers if state of origin was blinded in the admissions process . WA students will eagerly snap up the 40 slots if ID gives them up - all to the detriment of Idaho, not WA . But sure, " we owned those libs!" The sad fact is that the bulk of WWAMI med school training is actually done IN IDAHO - not in Seattle . The U of I partners for didactic training , and rural track WWAMI students spend 6 months at a time in a rural community seeing everyone for everything during their clinical years. It is a fabulous program . Idaho students are smart enough to sort the wheat from the chaff when it comes to med school politics - and they are beating down the doors to get in. Locking those doors hurts no one but the citizens of my state.
If a medical school or postgraduate training program really wants its trainees to learn something about poverty or social disadvantage, why not encourage trainees to make house calls as part of mandatory rotations? Nothing like witnessing the conditions in which less privileged people live.
A good start would be to read A. J. Cronin: The Citadel. Or comparable novels. Another invaluable experience is to visit worksites. Some medical students or doctor will have experience at working in stressful, poorly paid jobs - but not many. How many readers of Sensible Medicine have worked as, or taught a student who had worked as an agricultural labourer, for example?
This was a really disappointing take. Have you ever asked indigenous people how they feel after a land acknowledgment is read? I have — and I'd say that it definitely does something good.
Siliness. They should lose their federal funding
Ugh. I enjoy a lot of the thoughtful commentary on medical studies and your perspective on a lot of what is going on in medicine, but I'm losing some respect after this article. You are losing your mind of a land acknowledgment that might take 20 seconds to read before starting a presentation. Anyone buying into this DEI is creating an incompetent workforce is truly buying into a conservative toxic narrative. Vinay, do you really think that the young doctors you work with now are worse because of a couple videos and a land acknowledgment?? Do you really think there's no place for discussing issues of race or representation in medicine?? Can you deny that the lack of fair representation of people of color and women in medical studies has led to standards of care that are tailored for white men? Can you deny that people of color and women often have worse outcomes based on gender and skin color? Can you deny that social status does play a part in the overall health of people? And, finally, do you think that doctors who notice these patterns should potentially look for ways to correct these issues when they can?
I also think you are making some very bold statements based on your "investigation" of looking at their website?? A student who is actually in the program commented and said that this is not true of what they are finding at all in school. Maybe actually do a more thorough study of this before such a sweeping and angry rebuke.
There is no medical school in Idaho and this partnership has been a great one for Idaho in terms of producing doctors for the state. The stated reasons for the Idaho bill are that UDub is not able to offer expanded seats for Idaho doctors and an issue regarding no state funds going toward abortion care training which could not be guaranteed. I'm not even sure where Vinay is getting his facts about this. Overall, it seems like losing this partnership would be a bad thing for state as it is complex and difficult to replicate elsewhere and the UDub program is well respected and trains great doctors.
Nice straw man argument in that first paragraph!
during the pandemic, i started listening to TWIV (i stopped when they obviously started propagandizing on behalf of the government). in one episode, a listener wrote in asking them to please discount the disgusting racist assertion that black people did poorly with covid because their vitamin D levels were generally low.
the TWIV team were happy to oblige. of course, black people were poor and medicine was infected through and through with systemic racism and the only way to correct the disparity was to preferentially ration medical care.
i was stunned! would anyone make a claim that systemic racism was responsible for black people having more sickle cell anemia? malaria in africa?
i didn't last long after that.
I have attended a number of occupational medicine seminars put on by the U of Washington, and we are treated to the indigenous peoples statement every time. I would not blame Idaho for withdrawing - they do now also have a DO medical school in the state, so probably do not need to outsource many students.
Medical education should focus on educating students about MEDICINE. And about the art and science therein. Students should be taught compassion and empathy for all along with their scientific education, but not at the expense of time spent on learning physiology and pharmacology. They should have had plenty of exposure to the DEI curriculum during their undergraduate experience. For the price they are paying for their medical education, they ought to get their money's worth.
Thank you for sharing this, Vinay - I am regularly frustrated with what I see coming out of my alma mater/school where I am an adjunct professor.
GREAT IDEA! Go your own way, no need for the performative politics at U Dub.
May I suggest that this part of the med students curriculum be dropped and replaced with how to baby-size Big Pharma. At least make the course of studies closer to what impacts doctors and patients.
Dr. Prasad's article demonstrates ignorance of of the Nex Perce and the Nimipu people in Idaho as well as other regional native American tribes of Washington and Oregon. Most of central Idaho belongs to the Nez Perce nation. Tens of thousands of Idahoans are members of the Nimipu tribe. Their healthcare needs are unique, complex and interwoven with their cultural beliefs and practices. The same is true for large areas of Washington and Oregon. Dr. Prasad's narrow minded view is reflective of his experiences which are unfortunately limited to large urban medical centers in Chicago, Portland and San Franciso. I would urge he spend some time in places such as Lapwai, Idaho caring for the Nimipu. Perhaps he will have the good fortune (as I have) of being invited into the sweat lodge by tribal elders as they chant and communicate with the Great Spirit. Perhaps then his perspective would broaden and his dissmissive attitude toward native Americans might become more enlightened. Every physician who trains in Idaho and the surrounding areas should be educated to respect those upon whose land we tread. As Chief Joseph said "A man who would not love his father's grave is worse than a wild animal." As an Idaho licensed MD, I never lose sight of whose father's grave I tread upon.
As a native american physician and graduate of UW school of medicine your article is highly offensive. You are speaking about something you clearly know nothing about. In the end if Idaho breaks from UW it's those future physicians who will lose out on unique training opportunities throughout the WWAMI region. Many of which are not available at any other medical school in the country. It's short sighted and would be a disservice to Idaho
My past home state of Minnesota and current residence in Indiana have adopted "no grades" in medical school coinciding with adopting DEI criteria for accepting medical school candidates. As we've seen with DEI hired air traffic controllers, federal government slackers, military personnel and federal deep state personnel; if you beckon the worst society has to offer, the American public will suffer the consequences. When medical and law school candidate selections are governed by DEI criteria and coupled with student candidates encouraged to occupy political picket lines rather than the classroom, one can rightly surmise the eventual disastrous outcomes for society with such deleterious decisions. Immediately, our country is best served by cutting off the "head of snake" by the following:
First, stop all federal funding of leftist ideologues and their institutions.
Second, fire and publicize the non-complying heads (college presidents , et cetera).
Third, if met with slow-walking and/or non-compliance, revocation of their 501C3 status should be simultaneously coupled with taxation of their sacrosanct 501C3 monetary caches. The latter action will nicely add to he monies saved by DOGE.
Nothing like adding to the turmoil with more noise. You can be sure those legislators will not be among those without doctors in the future. And your suggestions to all the issues you raised are????