Sunday, July 4, 2010

Med School

Recently I fell sick, and since it was the first time I had to take care of myself, I quickly realized that I didn't know what to do. Should I take fever-reducing medicine or not? Do I just have a cold or something worse? How can I tell? Will it just pass with time or will it just get worse?

Conventional wisdom says that when in doubt just go and see a doctor, but that can't be practical, and plus it's very expensive. We may leave the real medicine for doctors, but we shouldn't be so helpless that we have to rely on them for everything. It strikes me as strange that we have a system of societal organization where the knowledge most essential to our own well-being is also the most outsourced and divorced from our control. I feel the complete asymmetry of information in the doctor-patient relationship is dangerous, because a clueless patient has no way of defending herself against an insincere, mistaken, or scheming doctor.

That's why I think it would make a lot of sense to teach medicine in K-12 schools. Why not? After all, it's the most practical thing to learn. Teachers spend all of elementary school trying to convince us that math is useful, but the benefit of learning medicine is self-apparent. If there's any guarantee in life it's that every man, woman, and child is going to fall sick.

We already offer general health courses here and there that educate mostly about nutrition and STDs. This can just be another component. There's no need to pass the MCATs to be able to understand that a viral infections go away with time whereas bacterial ones don't; or that a nice hot, ginger tea works well for clearing out mucus and wet coughs.


  1. Hi Kunal,

    When you want to add something to K-12 curriculum, you must make time for it by increasing the length of the school day or by removing something else from the curriculum. Either way the monopolistic unions will dig in their heels. They don’t want to work more hours. If you want to remove something, say PE, then you have to fight all the PE teachers who are defending their jobs, while I doubt you’ve got teachers of medicine rallying to your cause. That’s not to say medicine shouldn’t be taught in school, only that unions would probably try to prevent it.

    We might reasonably expect teachers of medicine to cost more than PE teachers. Thus, the curriculum change means more taxes or more debt as well.

    There’s a ton of information in the world; so much so that we can’t know as much as we’d like to know if time were less scarce (I hope that’s the reason and not something else). Thus we outsource a lot of information to other people. We outsource the burden of understanding to lawyers, plumbers, and electricians. Sure, we could learn all this stuff, but at what cost? The argument for teaching medicine in school is perhaps one of the last one’s I wouldn’t think everybody should know themselves. Much folk medicine goes against the rapidly changing body of medical knowledge. I wonder if a teaching medicine in schools would have a D.A.R.E. effect where more people end up sick/dying than helping themselves.

    The costs of getting medical knowledge wrong, is enormous. That’s the kind of thing I’ll gladly leave to a specialist. This fact is enough to persuade many libertarians to favor occupational licensure in the medical field, where they are against it virtually everywhere else. Friedman, in Capitalism and Freedom, comes close to this conclusion but ultimately rejects occupational licensure for doctors.

    There’s no question that we could teach a better curriculum in school. The question is how to do so when unions oppose you at every step? Can the school nurse teach it? Can this stuff be added to existing health and nutrition classes at little additional cost? The most outstanding question is, what specifically do we add?

    On the other side of the coin, is not a lot of folk medicine already taught in school? By eighth grade I’m sure that my class knew the function of fevers, white blood cells, and sunburns. To me, this begs a question about the efficacy of K-12 education. I gather you learned much of the material that was taught during those years, but many don’t. We teach math at all levels, yet many students’ math abilities are hopeless inept. Extrapolate that to medicine and you’re preaching to deaf masses; most of these people will end up needing a medical professional nonetheless!

    The best thing about medicine is the thing you shouldn’t know, but you probably already know about it: The placebo effect. Understand I’m pulling these numbers from thin air, but something like 25% percent of most patients with a run-of-the-mill illness get better if a doctor does nothing. The human body’s ability to heal is great. If the doctor give a placebo, around 40% get better. The power of healing is believing, especially in minor medical cases. At times, pretending to treat something can be a more effective treatment than a real physiological treatment.

    Finally, have you been reading Foucault or feminist philosophy or medical malpractice suits or something similar? What’s with the worry of the doctor-patient power inequity? I’m partial to the worry and often make similar arguments in my philosophy of psychiatry work, but most people take comfort in having an expert doctor to counsel them.


  2. I feel like I learned a lot of that stuff at home just from being sick. I mean for the most part, it works to throw over-the-counter medicine at yourself for up to 2 weeks, and only go to the doctor if it doesn't get better.

  3. Although I didn't realize it while I was writing the post--which is why I didn't frame it this way--I was more interested in historical inquiry than policy recommendation. How is it that our society ended up prioritizing other knowledge rather than medical knowledge in schools in the first place?

    Part of the answer may be that they assume you learn the basics at home, as Mugdha suggests. I for one learned quite a bit after having to take care of myself, so maybe schooling would just be redundant or unnecessary. On the other hand, schools nowadays don't take any kind of knowledge for granted--like, for example, sex, or discipline--so why treat medicine differently?

    The answer may lie in Nolan's point that the cost of messing up is "enormous." He's right, but that's only when you get into serious medicine I think. I suggested only general basic care, and I have the sense that many people in this area are still clueless.

    My Foucault-ish paragraph comes from personal frustration. I don't like not being able to judge what the doctor is telling me, especially when they insist I need to take four different medications on a general basis, even though I'm only a teenager, a time of supposed health and vitality.

    That's part of why I don't trust doctors. I don't gladly go to a specialist; I go because I have to and I keep my wits up. They've messed up with me, and they've messed up with a lot of people I know, and plus they're way too eager to prescribe things. (The cough I came down with recently would have surely earned me some Mucenex, but it cleared up with a regular regimen of ginger tea.) For me, personally, a doctor's visit would be more fruitful as a dialogue rather than a lecture. I'm aware that a little bit of knowledge is often more dangerous than no knowledge at all, but I pride self-reliance and it chafes me to be so dependent for something so vital.