It seems the text of the post does not support the title, or it’s thesis. The argument is for reference letters to be less cookie-cutter, more unique, with more useful information; the argument might be to do away with reference letters that are form scripts, but that doesn’t mean we should rid the process of reference letters altogether.
And yes, every letter provides subjective and “biased” info, but it’s also likely about things with no objective metrics. How do you measure “work ethic”, or “team player”; or “bedside manner”? You can’t, and you don’t. You rely on the people who have observed and worked with the applicant ie the writer of those reference letters, to give you their opinion. I see no other way to gather that info, but that is info I would absolutely like to have, flawed and all.
Medicine is being rigged as far as I can see. The DEI principles, lack of accountability ( don’t see that your medicine is hurting a patient so gaslighting is best-taught option), belief that Pharma is all knowing and teaching new doctors to unquestionably follow preset protocols are intentionally designed to corrupt good medicine. The system is designed to create people who follow orders without questions. You are awarded financially to comply.
I can't tell you how comforting it is to know that the surgeon fixing my ACL or putting in a new hip was DEI certified but never really tested or evaluated. It is quite droll to propose that views of this development relies on politics . . . how about a good outcome of treatment, or even survival? Oops, the never-evaluated doctor left a sponge in my G. I. tract? Well, he was just doing his best. And he's a warm person, fun to lunch with.
But then again, maybe doctors don't really need to know any medicine these days since 50% of clinical practice (that would be gross revenue) is simply following Pharma's instructions and cashing the checks. It's so troublesome to do actual patient assessment and, you know, medical practice. Much better to have a day which is 80% reading charts and tests and suggesting altering levels of prescriptions. "Mr. Phillips, let's just dial it back a little bit with your BP medicine, see if that solves your syncope problems. Have we talked about statins? I see you probably need the latest Covid booster."
We used to think the medicine caused deaths (iatrogenics) in third place was a disaster, but clearly it 1) is an undercount and 2) ignores all the iatrogenic deaths caused outside the hospital, particularly among the elderly with multiple, cross-damaging chemical prescriptions and little knowledge of geriatric care, as well as all the vaccine-induced damage and deaths across the young and vibrant.
Medicine doesn't need more thoughtful essays (although I enjoy them). It needs a complete reformation from the bottom up (because top down never works).
I'm going with iatrogenic deaths, across the board, standing at the gold medal spot on the platform.
This is why I love MDs writing about medicine - empathy combined with honesty. Thank you. Humanity is facing a fundamental challenge which Wil Van Cleve, MD MPH alludes to, but resists explicitly unveiling. "Meritocracy" and "Free Will" don't exist in the way we PREFER to think about ourselves and our physicians. We're egos, looking for justification that we're special piles of goo. I AM UNIQUE! That is true. SPECIAL? No. Stanford’s Dr. Robert Sapolsky has long documented how our executions of punishment, reward, meritiocracy, and free will are, "intellectual gibberish." If Sapolsky is correct, then we could randomly choose MDs from a population, and come out with the results we have presently. I would guess that’s correct. All these exercises of tests, recommendation letters (from POWERFUL/WEALTHY ALLIES, if candidates are CONNECTED to them), interviews, panels, and grades are futile attempts to correlate what intellectually, WE SHOULD KNOW BY NOW, has no predictable correlation for any given human being. What's the issue? M O N E Y!
Money. Money, money, money, money. Rich people want their kids to become MDs and go into the sciences and Medical Industrial Complex professions. The Empire today warring around the world, controls a CARTEL of RICH PRIVILEGED MDs and RICH PRIVILEGED UNIVERSITY LEADERS - all of whom are destroying the world with self-defined EXCEPTIONALISM, and self-defined ADMISSIONS TO THE CLUB. Why does all this madness continue? Empire addiction and wealth immunity, under the Medical Industrial Complex. Three terms I created to describe what we face today, as we lie to ourselves and humanity. This lie will kill us, as sure as the sun will rise - "WE ARE SPECIAL!" No. We are human - all connected and dependent upon each other for survival of our species. Everything we were sold in this corrupt system, is nakedly shown as a lie today. Medicine has become a cartel of wealthy money managers - rather than an art of medicine guided by human consciousness and the connectedness of all things. Only money drives speech, power, and action in the empire's Medical Industrial Complex. Only a new honesty about the nature of our human experience will save us from being driven permanently into the ditch. We must awaken to these undeniable truths in this moment of unprecedented existential threat to our species.
A lot of the residency application has been nullified, not just LORs, but Step scores, grades, even publications. So what can we base selection upon? Even the interview itself can be watered down by virtual venues. Points are well taken, but why not let the Program and deciding faculty make their own judgements, and weigh factors, including LORs, accordingly ... rather than getting rid of them wholesale?
Thanks for writing this. Very thought provoking. I'm a recently retired physician. During my career I encountered a number of medical staff colleagues with serious personality disorders. Serious enough to need action by the MEC and hospital board and/or the state medical board. I have to assume every one of these folks had three glowing letters of recommendation to enter med school and then again for residency.
Thank you for this article! Some of the best people in my life are hard to get along with. How lucky you were to get that recommendation!
It seems the text of the post does not support the title, or it’s thesis. The argument is for reference letters to be less cookie-cutter, more unique, with more useful information; the argument might be to do away with reference letters that are form scripts, but that doesn’t mean we should rid the process of reference letters altogether.
And yes, every letter provides subjective and “biased” info, but it’s also likely about things with no objective metrics. How do you measure “work ethic”, or “team player”; or “bedside manner”? You can’t, and you don’t. You rely on the people who have observed and worked with the applicant ie the writer of those reference letters, to give you their opinion. I see no other way to gather that info, but that is info I would absolutely like to have, flawed and all.
Medicine is being rigged as far as I can see. The DEI principles, lack of accountability ( don’t see that your medicine is hurting a patient so gaslighting is best-taught option), belief that Pharma is all knowing and teaching new doctors to unquestionably follow preset protocols are intentionally designed to corrupt good medicine. The system is designed to create people who follow orders without questions. You are awarded financially to comply.
Inquiring minds need not apply!!!
I can't tell you how comforting it is to know that the surgeon fixing my ACL or putting in a new hip was DEI certified but never really tested or evaluated. It is quite droll to propose that views of this development relies on politics . . . how about a good outcome of treatment, or even survival? Oops, the never-evaluated doctor left a sponge in my G. I. tract? Well, he was just doing his best. And he's a warm person, fun to lunch with.
But then again, maybe doctors don't really need to know any medicine these days since 50% of clinical practice (that would be gross revenue) is simply following Pharma's instructions and cashing the checks. It's so troublesome to do actual patient assessment and, you know, medical practice. Much better to have a day which is 80% reading charts and tests and suggesting altering levels of prescriptions. "Mr. Phillips, let's just dial it back a little bit with your BP medicine, see if that solves your syncope problems. Have we talked about statins? I see you probably need the latest Covid booster."
We used to think the medicine caused deaths (iatrogenics) in third place was a disaster, but clearly it 1) is an undercount and 2) ignores all the iatrogenic deaths caused outside the hospital, particularly among the elderly with multiple, cross-damaging chemical prescriptions and little knowledge of geriatric care, as well as all the vaccine-induced damage and deaths across the young and vibrant.
Medicine doesn't need more thoughtful essays (although I enjoy them). It needs a complete reformation from the bottom up (because top down never works).
I'm going with iatrogenic deaths, across the board, standing at the gold medal spot on the platform.
This is why I love MDs writing about medicine - empathy combined with honesty. Thank you. Humanity is facing a fundamental challenge which Wil Van Cleve, MD MPH alludes to, but resists explicitly unveiling. "Meritocracy" and "Free Will" don't exist in the way we PREFER to think about ourselves and our physicians. We're egos, looking for justification that we're special piles of goo. I AM UNIQUE! That is true. SPECIAL? No. Stanford’s Dr. Robert Sapolsky has long documented how our executions of punishment, reward, meritiocracy, and free will are, "intellectual gibberish." If Sapolsky is correct, then we could randomly choose MDs from a population, and come out with the results we have presently. I would guess that’s correct. All these exercises of tests, recommendation letters (from POWERFUL/WEALTHY ALLIES, if candidates are CONNECTED to them), interviews, panels, and grades are futile attempts to correlate what intellectually, WE SHOULD KNOW BY NOW, has no predictable correlation for any given human being. What's the issue? M O N E Y!
Money. Money, money, money, money. Rich people want their kids to become MDs and go into the sciences and Medical Industrial Complex professions. The Empire today warring around the world, controls a CARTEL of RICH PRIVILEGED MDs and RICH PRIVILEGED UNIVERSITY LEADERS - all of whom are destroying the world with self-defined EXCEPTIONALISM, and self-defined ADMISSIONS TO THE CLUB. Why does all this madness continue? Empire addiction and wealth immunity, under the Medical Industrial Complex. Three terms I created to describe what we face today, as we lie to ourselves and humanity. This lie will kill us, as sure as the sun will rise - "WE ARE SPECIAL!" No. We are human - all connected and dependent upon each other for survival of our species. Everything we were sold in this corrupt system, is nakedly shown as a lie today. Medicine has become a cartel of wealthy money managers - rather than an art of medicine guided by human consciousness and the connectedness of all things. Only money drives speech, power, and action in the empire's Medical Industrial Complex. Only a new honesty about the nature of our human experience will save us from being driven permanently into the ditch. We must awaken to these undeniable truths in this moment of unprecedented existential threat to our species.
A lot of the residency application has been nullified, not just LORs, but Step scores, grades, even publications. So what can we base selection upon? Even the interview itself can be watered down by virtual venues. Points are well taken, but why not let the Program and deciding faculty make their own judgements, and weigh factors, including LORs, accordingly ... rather than getting rid of them wholesale?
Thanks for writing this. Very thought provoking. I'm a recently retired physician. During my career I encountered a number of medical staff colleagues with serious personality disorders. Serious enough to need action by the MEC and hospital board and/or the state medical board. I have to assume every one of these folks had three glowing letters of recommendation to enter med school and then again for residency.