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Doctors must run fast to stay in the same place

Posted October 6th, 2018, 10:25 AM IST

Doctors must run fast to stay in the same place

Today's Truths in medicine may be tomorrow's half truths. 50% of what you are taught today is wrong …or inaccurate 5yrs hence!

In our constantly evolving discipline, the training and education of doctors is a complex process. Medical training has been criticized for not adapting to the more holisticneeds of contemporary society.The scientific literature hashighlighted deficiencies in both the procedural and humanistic clinical skills.





Medical practitioners are a product of their education and trainingthat, for most, is a lifelong experience. In a sense, there is no finishedproduct, but a continually developing professional who is expected toadapt to advances in medical knowledge.

The medical field is as intriguing as it is respected. Who wouldn't want to save lives for a living?A doctor's education only begins after medical school, residency training, and specialty fellowships have been completed. There is a phrase in medical education which often gets aired at the welcoming lecture to medical school:"50% of what we teach you today will be wrong or inaccurateover the next five years!Medical progress is so unrelenting that all of what went before was wrong or inaccurate!

While welcoming students to a physically and mentally demanding degree course why anyone would openly admit that 50% of what is on the syllabus is likely to be wrong reflects the idea of a lifelong learner. Keep yourself updated or perish down the line. You have no choice.

It will not be long before personalized therapies for different diseases will be based not on crude groupings like age, sex, or smoking habits, but will be guided by genomic studies of target organs - the age of truly personalized medicine is very nearly upon us.

In respiratory medicine, the two giants of obstructive airways disease - Asthma and Chronic ObstructivePulmonary Disease- COPD, are becoming ever more blurred - are often determined by the inflammatory cells which inhabit the airways.A paper in Thorax recently suggested scrapping the terms Asthma and COPD - a sign perhaps of things to come in the post-genomic era of modern medicine, partly because the treatments we are developing are more and more exact.



Lung cancer is another field that is changing at a blistering pace. A recently published article in the PMJ questioned the need for even asking if patients have smoked when considering their treatment for lung cancer. The thesis is that smoking doesn't correlate well with the driver mutations found in lung cancer genotypes, and therefore can't predict suitability for, or response to treatment. This isn't to say that smoking isn't an important factor in the development of lung cancer - but it demonstrates how our understanding of a disease process has been revolutionized by technology which a few years ago was far out of reach, and is now a routine practice. William Halsted, a surgeon working on breast cancer thought he had a solution. Cancer is like a crab?-?sending microscopic pincers out into the adjoining tissue which are not visible, leading to inevitable relapse. Well, why not simply cut all possible tissue affected even if there was no evidence of involvement. This was called 'radical' surgery.

With the Curies discovery of radium, more powerful and precise x-rays could be developed. This brought up the tantalizing possibility of blasting cancer with X-rays and the new field of radiation oncology was born.

The search was on for systemic agents that could kill cancer. What was needed was something that could be delivered to the whole body-birth of chemotherapy. Cancer is a disease of uncontrolled cellular growth.If the problem is too much growth, then the answer is to kill it. This gave us surgery, radiation and chemotherapy, still the basis of much of our cancer treatments today-Cancer Paradigm 1.0

It did not answer the question of what was causing this uncontrolled cell growth. It did not identify the root cause.The treatments could only treat the proximal causes and therefore were less useful. Local diseases could be treated with local treatment, but not asystemic disease.

We know that there are certain causes of cancer?-?smoking, viruses- HPV, and chemicals -soot, asbestos etc.Doctors treated the excessive growth with relatively indiscriminate killing of cells that are growing quickly. And it worked for some cancers, but failed for the majority. Nevertheless, it was a step.

More innovations can be predicted and the changes are likely to accelerate over the next 5?yr. What seems to be almost science fiction today may then be daily routine!

As my understanding of medicine has grown, so has my skepticism. And there have been several points in the curriculum that I've come to view as clearly in the 50% of misinformation that we're memorizing. The medical world doesn't stay still, but that the relentless pursuit of new knowledge allows us to bring greater understanding to the illnesses that afflict the patients we see day to day.

The doctor of tomorrow will have a yet undefined role. By appreciating that we can only be taught what is known when we are in medical school, the 50% rule is actually a reassuring acceptance of reality, and I think, a call to lifelong learning.Believe it or not, all the blood, sweat, and tears shed in medical schools don't produce doctors. Rather, doctors emerge from their cocoons in residency and practice.

In 2017, there 've reports on everything from a cancer "kill switch" and Artificial intelligence -assisted cancer detection, to the cancer vaccine and the creation of a portable skin cancer detector. These stories were just the tip of the iceberg in terms of exciting developments in cancer research this year.For The Doctors of Tomorrow, it's a Long, hard, narrow road with gratifying results.

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