Thu, May 29, 2003 - Page 8 News List

Improved medical education required

By Huang Kun-yen 黃崑巖

The SARS outbreak has exposed numerous problems in medical circles, including crisis management, infection control, the resident system and whether medical and nursing education in this country attaches any value to medical ethics, thinking, judgement, logic and discipline.

In fact, these problems were mentioned in my accreditation reports on local medical colleges over the past two years. As the chairman of the Ministry of Education's Committee on Medical Education, I regret that these problems were not resolved earlier, thereby causing both the public and medical workers to pay a considerable price.

The field of medicine is not about broken generators or crashed computers waiting to be repaired. It is about flesh-and-blood patients who think and feel and come from different social backgrounds and positions. That's why I have always stressed that the first thing a doctor has to learn is how to be a decent person. Otherwise he or she can never become a good doctor. That's why medicine is viewed as both an art and a science.

College education in this country is too career-oriented, as is medical education. Meanwhile, because of the National Health Insurance reimbursement system, hospitals have become profit-oriented and have ignored the importance of infection-control personnel. It is not without reason that hospitals in Taiwan have been seriously hit by the SARS outbreak.

An additional problem is that about half of the medical students enter the profession because their parents want them to do so, while the number of nursing students who have no idea whatsoever what the job actually entails is unbelievably high. Unless these students can strengthen themselves by taking some thought-provoking psychological-development courses, their faith in their professions may be shaken when confronted by a crisis such as the SARS epidemic.

Although many in medical circles are dutifully continuing to treat patients, a number of doctors and nurses have already quit. The number of students transferring from medicine-related departments to other departments has also reached a new high.

We must not forget that medical students in this country enter medical school straight from high school -- as opposed to those in the US, who must be college graduates. Hence, I have suggested that our medical education not provide professional courses in the first two years, but instead only offer courses related to human life -- about birth, aging, illness and death. But this proposal fell on deaf ears.

Not every medical worker is an angel. It's perhaps too late to realize this fact now, in the face of the SARS outbreak.

Medical workers account for a large number of the deaths from SARS here. The ratio is twice as high as that of Hong Kong. This is clearly the result of lax training. Why is it that almost all the doctors who have died of SARS were inexperienced, first-year residents? Residents are only doctors-in-training, who need to be supervised by senior doctors. Where were those senior doctors? Why did they not step in when some junior doctors were struggling to intubate their SARS patients for over an hour and failing?

The commercialization of medical services has to be stopped. Today, most hospital superintendents only care about profits and a doctor's salary is determined by the number of patients he or she examines in a month. This is the major cause of the deteriorating quality of medical treatment. It's also an open secret that much hospital evaluation data is fabricated. This is not only an issue of medical ethics. It will also affect our ability to contain any new disease.

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