Tuesday, September 13, 2022

When you are sick, do you want Dr Woke or Dr Smart? By Brian C. Joondeph, M.D.

Medical school and postgraduate training is a long and arduous journey, often taking 8-10 years beyond college. There is much to learn, process and assimilate. Clinical judgement stems not only from experience but also from intelligence.

Medicine is a high stakes game. Sickness and health lie in the balance, as does life and death (or vision and blindness in my professional world of retina surgery). Medical errors can be due to accidents, incorrect judgement calls, or lack of knowledge.

When your health or life is on the line, you want the smartest physician caring for you, making critical decisions, or performing challenging surgery. I would want the best and the brightest caring for me. I am not as much concerned with my doctors’ bedside manner, wokeness, or social skills but rather that they be smart, capable, and competent.

Are woke doctors necessarily the smartest? If they are thinking more about proper pronouns and social justice, are they thinking less about blood tests and MRI findings?

YouTube screen grab CC BY 3.0 license

Dr Stanley Goldfarb is a physician-writer, like yours truly. He is “A board-certified kidney specialist, a former Professor and Associate Dean for Curriculum at the University of Pennsylvania School of Medicine. He has been widely published in medical journals, as well as The Wall Street Journal.”

Dr Goldfarb would be considered a “Dr Smart”. He founded an organization called “Do No Harm” with a mission to, “Protect healthcare from a radical, divisive, and discriminatory ideology. We believe in making healthcare better for all – not undermining it in pursuit of a political agenda.”

He recently wrote an op-ed in the New York Post, calling out top medical schools for shifting from a hundred years of educating and training “Dr Smart” in favor of their new preferred student “Dr Woke”. His opening line, “Elite medical schools are deliberately recruiting woke activists, jeopardizing their mission of training physicians.”

His organization reviewed the application process for America’s 50 top medical schools as ranked by US News and World Report. His conclusion was that for these top schools,

Nearly three-quarters of these institutions — and 80% of the top 10 — ask applicants about their views on diversity, equity, inclusion, anti-racism and other politicized concepts. The clear goal is to find the students who will best advance divisive ideology, not provide the best care to patients.

Several examples from the article cites elite medical school applications.

Harvard asks applicants to share, “Significant challenges in access to education, unusual socioeconomic factors, identification with a minority culture, religion, race, ethnicity, sexual orientation or gender identity.”

Columbia, states its commitment to “diversity,” then asks applicants to prove how their “background and experiences” will “contribute to this important focus of our institution.”

The University of Pittsburgh tells applicants: “We are interested in combating all forms of systemic barriers and would like to hear your thoughts on opposing specifically: systemic racism, anti-LGBTQ+ discrimination, and misogyny.” It then doubles down with the ask: “How will you contribute?”

The University of Miami asks, “What have you done to help identify, address and correct an issue of systemic discrimination?” The answer can come from any facet of life, not just medicine.

The top medical schools are changing admission and educational standards away from academic rigor and intelligence instead toward the social justice trio of diversity, equity, and inclusion. It’s not that woke students cannot also be smart and handle the rigors of medical school and beyond, but that they are thinking more about proper pronouns than proper surgical technique, or systemic racism rather than systemic metastases.

Spending more time studying critical race theory and gender equity means less time studying depression or diabetes. When you are sick, what do you want your doctor to know more about, wokeness or medicine?

Dr House is a fictional television doctor, an unwoke, brash and often rude physician, but one who is brilliant, seeing the subtleties his colleagues missed, making the tough diagnosis. Dr House was singularly focused on the patient and their malady, not gender pronouns or safe spaces.

Social determinants of health are important and always have been; many diseases are more prevalent in specific ethnic or socioeconomic groups, either due to genetics or environment. But the new woke thinking goes beyond these concepts into artificial constructs that have not been validated as medically relevant in assisting in medical diagnosis and treatment.

Beyond admission to medical school, what about the curriculum? The Association of American Medical Colleges,

Recently released a report describing the new “diversity, equity and inclusion competencies” that medical students and residents will be expected to master. Practicing physicians who work at teaching hospitals may also soon be required to undergo this form of, well, political re-education.

Personally, I want my doctor to understand cardiology rather than intersectionality and systemic lupus rather than systemic oppression. Leave social justice to humanities departments, not medical school.

Academia has already been corrupted by wokeness. The military and medicine are well underway down a woke mentality path. In these latter two endeavors, the consequences can be lethal when woke replaces smart and well trained.

The slippery slope of this thinking may lead to healthcare rationing based on race and gender. As Betsy McCaughey recently wrote,

Prominent medical organizations and the Biden administration are pressing for rules that will move “disadvantaged” populations to the front of the line for scarce medical resources — think vaccines, ventilators, monoclonal antibody treatments. That means everyone else waits longer, in some cases too long.

Or as a New York Times columnist wrote, “Can I withhold medical care from a bigot?” Rude or abusive patient behavior should be challenged, and boundaries set, but it is dangerous to use value judgements to determine who receives medical care. Many physicians, myself included, care for the occasional prisoner, some who have committed crimes against children or murder. As distasteful as these patients may be, as a physician we should be doing our best for each patient.

When wearing social justice glasses, physicians may fall short of delivering the best medical care to their patients. What happens when we disagree with our patients over politics, such as Trump, climate change, or mask mandates? Will the new crop of woke physicians be able to make this distinction and remain neutral, treating the patient rather than their politics or wokeness?

Lastly, judgmental “equity” may cause prejudice where presumed beneficiaries of lower admission and graduation standards are viewed, rightly or wrongly, as inferior doctors who got a pass based on social constructs. How is that fair to those who worked hard and fully deserve their professional status?

The medical profession has taken a big hit over COVID, following the politics instead of the science. Going woke won’t help matters. Leave social justice and gender pronouns to college sociology departments. Let doctors return to being our top guns, the best of the best.

Brian C Joondeph, MD, is a physician and writer.

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