The fundamental and most pervasive problem with the practice of medicine in Australia originates in the education system, which selects the wrong people to study medicine.
The system will be similar in other states and in other countries, but in Australia, in NSW, to get into medicine at university, you need to finish the Higher School Certificate (HSC) with a very high University Admissions Index (UAI), now the Australian Tertiary Admission Rank (ATAR), and particularly in science subjects. This approach selects students who are very good at remembering and recalling facts, but excludes students with any problem-solving ability or any ability to think creatively. By creative thinking, I’m not referring to artistic talent, I’m referring to the ability to change the way you think about a problem if the usual way of thinking doesn’t give you the answer. Arts students are taught to think. Engineering students are taught to think. Medical students are taught to remember and recall facts. To achieve a high UAI in your HSC, you need to remember and recall facts. To succeed in university medical training, you need to remember and recall facts. To succeed in the hospital system training, you need to remember and recall facts. No part of medical training requires you to solve problems. Doctors will tell you that their diagnosis of human disease is the pinnacle of problem-solving, but it’s not, it’s just recalling the facts (symptoms, tests and treatments) associated with a particular disease label.
The skills of a doctor are in passing exams by remembering and recalling facts. They spend the rest of their careers recalling facts associated with their particular disease or test or treatment. They have no ability to think about anything that they didn’t learn. I’ve formed these ideas over the last 30 years of dealing with my mother’s doctors, my own doctors and my daughter’s doctors. Not one of those many doctors has given me any reason to think differently. Not one.
Largely because of the selection process, but also because of attitudes taught during their medical training, we end up with doctors, in fact a whole profession, who are good at recalling facts that they’ve learned but are short of problem-solving skills and also on inter-personal skills.
“the spread of secondary and latterly of tertiary education has created a large population of people, often with well-developed literary and scholarly tastes, who have been educated far beyond their capacity to undertake analytical thought.” Peter Medawar
“You know how they become specialists? They obsess about the material over and over until it becomes lodged in their brain.” Dr John Dorian, Scrubs