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Writer's pictureIslon Woolf MD

Concierge Medicine and lifelong learning

Updated: 1 day ago


Learning is never done. This is particularly true in the field of medicine. Medical school is only the beginning. Doctors must commit themselves to a lifelong of learning.



Reasons why lifelong learning is important


1. Lifelong learning completes medical training. Medical schools emphasize the pharmaceutical and surgical management of acute medical problems. Unless a doctor practices exclusively in the hospital setting, this leaves considerble knowledge gaps with respect to chronic disease and wellness. Lifelong learning fills in these gaps, and can provide patients with a comprehensive approach.


​2. Lifelong learning updates obsolete knowledge. Medical knowledge grows at an exponential rate. In 1950, the knowledge doubling time was about 50 years. Presently, the knowledge doubling time is 73 days. There are one million biomedical scientific papers published per year. Medical knowledge is estimated to become obsolete after 5 years. This makes lifelong learning essential.


3. Lifelong learning leads to intellectual humility. Doctors that continue learning after medical school will nvariably witness some of their most cherished ideas become obsolete. Some ideas are even found to be dangerous. This is humbling. However, it is the nature of scientific discovery. Ideas are generated. Over time they are tested with progressively more rigorous tests. What initially looked promising is eventually disconfirmed. Learning to let go of wrong ideas - unlearning - is as important as learning new ones.


4. Lifelong learning leads to good medical decisions. A medical decision is only as good as the knowledge that infomed it. The above traits (comprehensive knowledge, updated knowledge, and the ability to discard obsolete knowledge) ensures accurate knowledge.



The seeds of lifelong learning are planted in medical school


Medical education is not only about memorizing facts, it’s about being inspired to learn, and learning how to think. As the Roman philosopher Plutarch wrote,

"The mind is not a vessel to be filled, but a fire to be kindled."

The principles of how to think are:

  • Question authority - Inquiry is a good thing. Scientific progress is achieved when anomalies are identified and paradigms are challenged.

  • Critical thinking - The mind is prone to error; such as: cognitive bias and logical fallacy. Be aware and try to correct these errors in yourself and others.

  • Scientific integrity - The truth is more important than being right.

  • Learn from your past - The history of medicine, our past successes and failures, is important to help predict the future.

  • Intellectual humility and flexibility - Science is an imperfect process. It can never to be “right”, it can only be “less wrong”.


These general principles equip a doctor with the tools to address any medical problem they encounter. I was fortunate enough to train at excellent medical institutions with mentors that shared these princples (click here for my biography).


(If you want to learn about your doctor's training, it is available here. Including: license status, board certification status, malpractice claims, etc.)



Lifelong learning continues with case-based learning


The most natural way for doctors to learn is through the cases they see. This is known as Case-based learning. It is so powerful that some medical schools, such as McMaster University in Canada, use it exclusively for medical training. There are several advantages to case-based learning, including:

  • Improved understanding of knowledge

  • Improved retention of knowledge

  • Stimulation of interest

  • Promotion of responsibility and accountability

  • Teaching problem solving skills and critical thinking

  • Promotion of self-learning behavior

  • Enhanced resourcefulness - where and how to access information



Deliberate practice


However, simply practicing your “10,000 hours” is not enough to become an expert. HOW one practices is crucial. This is a difference between "practice", and "deliberate practice". A good musician doesn’t practice the entire piece, they practice the part they’re bad at, over and over again. Likewise, it's insufficient for a doctor who is a lifelong learner to see a high volume of cases, they must follow up on cases, and see where they went wrong. That's how they get better.



Obstacles to lifelong learning


There are several obstacles to lifelong learning. The greatest of which is excessive work loads; where the shear volume of cases make it impossible to follow up and learn from them. This is compounded by the problem of physician burnout. Over 50% of doctors are so disenchanted with the practice of medicine they simply lack interest in learning.


Other obstacles to lifelong learning include:

  • Poor initial training - Educated at schools interested only in students passing board exams.

  • Overconfidence - Lacking awareness of one’s own ignorance and limitations. A cognitive error common in doctors.

  • Conflict of interest - A doctor’s ability to learn may be clouded if it conflicts with their ability to earn. As American author Upton Sinclair famously said,

"It is difficult to get a man to understand something when his salary depends upon his not understanding it."


Is your doctor a lifelong learner?


It may be difficult to determine whether your doctor is engaged in lifelong learning. A good sign is if they reference information DURING your visit. For example, "I don't know what the latest research shows, let me look that up", or "Let me see what the current recommendations are". Ironically, in the past, looking up something in front of a patient was viewed as a sign of ignorance. Now, it’s a sign of intellectual humility, and a deep understanding of how modern science works - knowledge becomes obsolete very quickly.


A sign of a lifelong learner is a doctor that references information during and after your visit.

Another sign of a lifelong learner is seeking follow up on your case. Misdiagnosis and failed treatments are commonplace in medicine. Instead of being defensive or evasive, a lifelong learners views them as opportunities for improvement.



Concierge Medicine and lifelong learning


Concierge Medicine is ideal for incorporating lifelong learning. I incoproate it directly into my practice. With a low patient volume, I devote approximately one third of my day to learning. Each case I see launches an investigation to update my knowledge on that topic. Over the decades my knowledge gaps have been filled, and I can provide a comprehensive approach. Without conflicts of interests, it’s easy to adopt what is new, and discard what is obsolete. To consolidate my learning, I share what I've learning with my patients in educational emails and lectures.


With every case, I get to learn, and my patients are guaranteed of getting the best care. Case-based learning is a win-win situation from everyone.





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