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Medical schools do not prepare students to care for autistic or disabled people

174 点作者 wjb3超过 1 年前

24 条评论

hereme888超过 1 年前
Medical school is not supposed to prepare anyone for specialized care. It&#x27;s only to help students gain enough knowledge and experience for residency.<p>Here&#x27;s the breakdown (this is meant as an exaggeration and a joke, to illustrate the point):<p>- First 2 years of med school: mostly academic teaching so you don&#x27;t kill anyone when you show up in an actual hospital.<p>- Third year of med school: (jokingly) you can look and touch, but even the nurses are keeping an eye on you. You just contaminated your hands by touching your beard, get out of the room!<p>- 4th year of med school: did you talk with the new patient? What do you think? Student: &quot;He was a little odd, otherwise he&#x27;s here for a checkup.&quot; Doctor: &quot;He&#x27;s autistic...&quot; Student: &quot;Oh...I had a feeling he was.&quot;<p>Residency: how to actually do something for patients in general.<p>Fellowship: how to actually do something for complex medical conditions.<p>Residency is what&#x27;s supposed to prepare people to operate in their respective fields. And then comes fellowship for specialized care.<p>For anyone who wants to complain about what doctors should or should not learn during medical school: first go learn what the curriculum does teach, then ask yourself if you&#x27;re even mildly qualified to make those judgements based on your understanding of healthcare, and then maybe you could comment on what would have to be left out of education to accommodate for X, because the curriculum is already super bloated and a firehose of information.
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slibhb超过 1 年前
&gt; Oliver McGowan was 18 years old when he was hospitalized in England with recurrent seizures and pneumonia. He was autistic, and he and his parents had one specific request for the medical team: no antipsychotic medications. When he had taken them in the past, they made his seizures worse and had devastating effects on his mood. Despite the family’s vehement protests, doctors gave him an antipsychotic. A few days later, Oliver suffered a lethal neurological side effect. A week later, he was taken off life support. An inquest into his death found that the drug had led to the rapid deterioration.<p>I don&#x27;t see what this has to do with autism.<p>Also, I understand that receiving medical care can be alienating but I&#x27;m not sure there&#x27;s a way to fix that. It&#x27;s real hard (impossible?) to train people to be kind, patient, and empathetic. Being honest and not making medical errors are probably more important training targets for doctors, nurses, and other medical professionals (and more achievable).
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markx2超过 1 年前
I qualified as a nurse - Registered Nurse Mental Handicap - RNMH - here in the UK in 1989.<p>Many of those I cared for needed regular blood tests. Esp those prescribed lithium and other anti-convulsants so that the drug regime was within therapeutic limits.<p>There is, for example, a patient called John. He needs a blood test. He comes into a room with a person he has never met, to be subjected to something he is unfamilar with and, unsurprisngly, get agitated and refuses.<p>This happened again and again and again.<p>We, as a group of nurses say &quot;Hey, let us do the blood sampling, we know the person, we can time it right, we know this person&quot;<p>This idea was opposed 100% because DOCTORS KNOW BEST.
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Podgajski超过 1 年前
I’ve told doctors countless times the medication’s they used to treat my Asperger’s and my bipolar disorder schizoaffective type, make me ill weak and caused me pain. But they never listen to me. So this is not even about people with serious mental handicaps. They don’t listen to patients in general. But that’s true for people with mental illness They think every pain or issue we have is solely our heads.<p>But I also recently had a friend mother who went to the doctor because her ankles were swelling and she had some other issues. They took a blood test and didn’t tell her. Her kidney function was with stage 3B kidney failure. It was two weeks until my friend showed me the labs and I told her to go back and force him to take more test.<p>I don’t know what’s going on in medicine if this is something new or is this something old but medical school shouldn’t cost as much as it does if they’re putting out doctors like these.
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Trasmatta超过 1 年前
They also don&#x27;t teach them how to care for people with Type 1 diabetes. There are so many horror stories about how awful hospitalization is for T1Ds. So many doctors and nurses don&#x27;t understand the complexity of treating the disease, or respect the patient&#x27;s ability to treat it themselves while in the hospital. Not to mention how common misdiagnoses are: I was diagnosed as T2, when I was clearly T1. They didn&#x27;t even do an antibody test, all because I was an adult. So many people (including doctors) still have the dangerous idea that T1D only manifests in kids.<p>I&#x27;m terrified of being hospitalized for that reason. I&#x27;ll sign whatever paperwork needed in order to self treat with my CGM and pump. I&#x27;ve been doing this for 12 years, no doctor is going to be about to do it better.<p>This also scares me in terms of inpatient mental health facilities. They often don&#x27;t even give you access to your own insulin and testing supplies. Which is a recipe for feeling much worse after leaving then entering.
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ThinkBeat超过 1 年前
To play the devils advocate.<p>What should the medical schools remove from the curriculum to accommodate this? It is not like they have part of a semester that that is just waiting to be filled. It is already stuffed to the gills.<p>There are 100s probably 1000s of things that should be added in order for doctors to be better prepared for one scenario or another.<p>Being autistic I would like to see this added, but at the same time I have no idea what they could remove. They could keep adding semesters until they got it all covered by that is probably not going to work either.<p>They have a set schedule. You want to push something in, you gotta take something out.
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bloopernova超过 1 年前
My wife is autistic, and has hyper mobile Ehlers-Danlos syndrome. She&#x27;s had nurses accuse her of pill seeking while one or more joints have been dislocated.<p>It seems as if a large part of the world&#x27;s (professional) empathy was drained during the COVID-19 pandemic and I&#x27;m not sure it&#x27;s ever coming back.
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dimal超过 1 年前
I get the feeling that doctors aren’t really trained for more than half of the stuff they need to know. Trauma informed care is a joke, yet a huge proportion of people have a history of multiple adverse childhood experiences, and these have very real effects on health. And any chronic illness that doesn’t have an easy biomarker is a complete unknown to most doctors. They just throw up their hands and say the bloodwork is normal, you must be fine.<p>I don’t know how doctors can be trained for twelve years and have so little understanding of health. And yet they have such confidence in their abilities.
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duffpkg超过 1 年前
I don&#x27;t dispute the headline but this article is a total mess. First referring to the US health system but then citing anecdotes from the english health system. It then mingles US healthcare and dentistry. The US health system is as different from the UK health system as different can be and in the US dentistry is a fundamentally separate industry and education tract that has absolutely no connection to healthcare whatsoever.<p>In the US I can speak first hand as a former hospital executive that a lot more can be done to improve treatment paths for people with a wide variety of mental health diseases. Medical school can play a role but residency programs are a much more important element, at least in terms of how US doctors are trained. From history the best way to do this is to create a specific health system focused on treating those patients and to lead by example. I am not aware of such an effort but there may be one.
thomastjeffery超过 1 年前
Autism and ADHD are, by far, the most thoroughly studied mental disorders. They are also the most thoroughly <i>undiagnosed</i>, <i>untreated</i>, and <i>ignored</i>.<p>Sprinkle the hyper-politicization of stimulant medication on top, and you get what we have today: hell.<p>Imagine if the wheelchair store was at the top of a staircase. Imagine if the glasses flashed bright lights into your eyes every time you tried a frame on. Imagine you broke your leg, and your physician told you with a straight face, &quot;I think it might be a sprain. I&#x27;m going to prescribe you a mild painkiller, and see if that helps.&quot; There&#x27;s a shortage of crutches, and we don&#x27;t want to risk getting you dependent on those anyway.<p>Think I&#x27;m being heavy-handed here? Just read any collection of first-hand ADHD diagnosis. If anything, it&#x27;s <i>worse</i>.
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at_a_remove超过 1 年前
Medical schools do not prepare students <i>for a lot of shit.</i><p>I have a rather rare metabolic disorder, a subtle one with a lot of complications. I had to fight to get the correct tests done, I had to fight people who got constellations of symptoms wrong, older people with MDs who didn&#x27;t want to listen to some <i>kid</i>. The tests came back: they were wrong. (This was all prior to all of this information being available on the Intarwebz; I had to learn everything from books)<p>I still have to check the meds I am prescribed. I have to deal with doctors whose pupils visibly twitch when scanning my chart -- they mysteriously excuse themselves for a bit and return, &quot;I see it says here you have ...&quot; Others simply pass the buck on treatment. I had a hematologist client-dump me on the answering machine.<p>It&#x27;s hard enough to treat the bulk of the boring patients. If you&#x27;re on the edge, well, they simply don&#x27;t have experience. Most doctors won&#x27;t ever see someone like me. If doctors were some other species who lived to be a few hundred years old, they would have the experience. I&#x27;m reminded of that recent Slate Star Codex parable about the alchemists and the dying prince. It&#x27;s just too much to ask from mere mortals.<p>The flip side of this is me recognizing doctors <i>as</i> mere mortals and not just going with everything like a lamb.
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calamari4065超过 1 年前
Honestly this has less to do with training and more about the catastrophically understaffed and overworked healthcare system.<p>There are not enough nurses on shift at any given time, and patients like this are difficult and require a lot of one-on-one care. Hospitals won&#x27;t or can&#x27;t bring on additional staff to care for these cases. It&#x27;s already nearly impossible for a nurse to round on all their patients, so sometimes they use sedatives so that they can care for everyone else.<p>Which is clearly a very bad thing to do, but when your options are sit with one patient who only needs social&#x2F;psychological support or caring for a dozen or three other people, it&#x27;s a much more difficult call.<p>The problem is staffing and pay, not training. Nurses <i>are</i> trained to deal with difficult situations. Maybe not this specifically, but part of the job is recognizing an unusual situation and dealing with it rationally. But after being burnt out for so long, rationality gets lost.<p>And not to excuse these doctors, when family tells you not to use a particular drug, you DO NOT DO THAT. And this is why: you kill people.
brcmthrowaway超过 1 年前
Most people go into medicine because of the money and status
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growingkittens超过 1 年前
It all needs to be reimagined.<p>There needs to be more than one level of doctor. No decision should be left solely to one doctor: human health is too complex for our current level of technology.<p>At the patient level, there is the doctor that interacts directly with the patient.<p>There should be a doctor whose sole purpose is to observe and support; to consult on patient cases, contact specialists, research cases, etc.<p>There should be a doctor who manages a patient&#x27;s overall health - but like a teacher with students, there should be a limit to the number of patients they can manage at a time.<p>Then there should be a doctor who reviews this process.<p>Specialists should focus not on direct patient interactions, but on supporting general care doctors in the technicalities of their specialty and guiding them through cases.<p>These different types of doctors would have training based on the role they want to fill in patient care. Doctors who interact directly with patients could have focused training in collecting information and other subjects related to the article at hand.
siva7超过 1 年前
Many important topics are competing for the limited teaching time available in med school. Special care isn&#x27;t the professional duty of a medical doctor and therefore doesn&#x27;t belong in the core curriculum.
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egberts1超过 1 年前
Unless these medical students have some immersion exposure into the physically-challenged (including Deaf) or mentally-challenged communities, this trend of ignorance shall continue.
deadbabe超过 1 年前
I wonder if there’s some opportunity for AI to help with guiding care for special needs individuals.
Perenti超过 1 年前
I&#x27;ve had quite a lot of medical treatments, due to terrible luck and universal health care.<p>In my experience (3 continents, 6 countries) medical training does not prepare students for people.<p>For people with communication issues, sensory issues or disability it has to be even worse.
aristofun超过 1 年前
Let&#x27;s face it - modern medical schools do not prepare students to care for anybody.<p>They prepare them to do the paperwork and follow bureaucracy. Sometimes, if you&#x27;re lucky, you find a doctor who is capable of caring despite that.
ghufran_syed超过 1 年前
How is this different from giving a patient a drug that they say they are allergic to? Doesn’t seem to have anything to do with the patient being autistic
cratermoon超过 1 年前
Or women&#x27;s unique health issues either, really.
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ChrisMarshallNY超过 1 年前
Also, substance abuse (including alcohol). I think they get about two hours&#x27; training, in twelve years of school.
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charred_patina超过 1 年前
No offense, but what <i>do</i> medical schools prepare you for? I know very few people who have ever said &quot;yeah I have a really great doctor&quot;, and then it&#x27;s only because they spent time searching and learning to navigate the system.<p>When I go to the mechanic (honest ones) will tell me everything wrong with my car. When I go to the doctor, unless I do outside research and proffer solutions, they just send me home.<p>On a related note, I think a big part of the anti-vax phenomenon is how many people end up seeking care outside of the medical system because it&#x27;s so broken. People find holistic solutions like diet and exercise and end up falling down a conspiracy pipeline.
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micromacrofoot超过 1 年前
sometimes it feels like medical school doesn’t even prepare students to talk to people
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