Learning in Medicine


Learning in Medicine
Honesty, kindness, awareness and
concern for others are essential
for the effective practice of medicine
Lt. Gen. Mahmud Ahmad Akhtar

Medicine begins in philosophy; philosophy ends in medicine, is an aphorism attributed to Aristotle. The philosophy in which medicine begins is a devotion to learning- devotion built on the faith and hope that we can do something about the problems that limit our lives. Patients come to the doctors with problems. Medical practice is a kind of problem solving. Problem solving is thus another name for learning. Each medical encounter is a unique experience in a personal, social and biological sense. Each patient is a product of genome that has neither existed before nor will exist again. Different patients suffering from the same disease will show different reactions and same patient having the same disease at different times will also show different reactions. Doctors treat patients on the whole and not the diseases alone.

The importance of learning medicine lies from its vast breadth and depth. In fact no branch of knowledge falls out of its scope. It spans the natural sciences the social sciences, humanites other professions like law, engineering and business. Medicine is also very deep; to explore its depth is the basis of higher learning. Finally medicine is dynamic and not static. It needs continued education .To attain a certain standard and to achieve a qualification is easy but to maintain it is difficult.

Lt. Gen. (R) Mahmud Ahmad Akhtar

Every patient has three aspects, the patient as a living organism, the patient as a member of the society and patient as a person. The first dimension expresses the roots of medicine in the natural sciences, the second is the social sciences and third in the humanites.

The patient is not only a living organism and a member of society but also an individual person alone in a universe vast complexity. Each person is born alone and dies alone and much of medicines speak to that condition. Part of the doctor’s role has always been to serve as a private and personal counselor who has patients to contend with the hard questions that disease and dying raise about the meaning of living.

The making of decisions is most important aspect of problem solving. First the doctor must decide which of the facts available are important in the patient’s situation. He must then decide what additional information is needed and how to gather it. He must choose the most promising path of management, taking into account the biologic, social and personal dimensions of the problems. Decision trees must be climbed on both the diagnostic and therapeutic sides of each clinical episode. Often decision must be made on the basis of inadequate information. As Claude Bernard said “Medicine is a science forced to practice before it is ready”. The doctor must have the emotional and intellectual toughness to tolerate such uncertainly and be alert to the consequences of his decision. Doctors of all kinds must receive, store, file, sort, recall and use vast amount of information which is essential of help in decision making.

Finally the most important thing is that the doctor must have the desire and will to learn. They must not only learn but express that desire in hard and continuing work. Hard work and other essentially moral virtues- honesty, kindness, awareness and concern for others -are all clearly essential for the effective practice of medicine. A design for medical education must include the nature of what used to be called character. For efficient learning, there should be close contact between members of the medical faculty and the students. Members of medical faculties, particularly the seniors must reach out to the students and tell how they try to solve problems. To learn in medicine, it must be acknowledged that the most important, indeed the only, thing teachers have to offer students is themselves. Indeed the love of learning is the philosophy on which medicine is based. Learning means not only absorbing facts but also acquiring understanding. In Pakistan sadly rote learning and enforced memorizing is encouraged, not using critical thinking and analytical skills killing creativity. Students should be taught to use analytical skills and critical thinking and have creative mind and be research oriented individuals.

Many teachers keep archaic old notes- dictates notes to the students and expect regurgitation of notes in the words given during exams. The students should be made to understand, conceptualize the knowledge, know its application to practical situations and be able give practice examples. Medicine is an art and science- in fact the art based on science- the art is old and most enduring.

In clinical practice, history taking is the most important, is an art based on humanites, social and biological sciences knowledge. The famous Cardiologist Dudley Heart remarked that “I would trust my senior registrar for doing physical examination of my patient but not for history -taking which I would do myself. In clinical discipline history taking has importance of 80% ,physical exam 15% , investigation only 5% .A good history taken makes diagnosis .In many patient’s problems are reduced to a very few conditions and doing good physical examination further reduces possibilities to a very few conditions and narrows need for investigations which may be very costly. It is cost effective particularly for the countries with poor resources and population with poor means. Unfortunately many of our clinicians spend a few minutes- do not take proper history – do not do detailed physical examination and rush to costly unaffordable investigations and then to costly unaffordable treatments increasing financial burden of patients and add to their miseries.

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