Islon Woolf MD
Concierge Medicine and lifelong learning
Updated: Jul 6, 2020
Learning is never finished. This is particularly true in the field of medicine. Doctors must commit themselves to a lifelong of learning. For doctors, medical school is only the beginning.
Why lifelong learning is important for doctors
There are four main reasons why lifelong learning is important for doctors: it completes medical training, it updates obsolete knowledge, it teaches intellectual humility, and ultimately, it leads to better medical decisions for their patients.
1. Lifelong learning completes medical training. Medical training is incomplete. Medical schools emphasize the pharmaceutical and surgical management of acute medical problems. As a consequence, your doctor starts practice with considerable knowledge gaps - especially in the management of chronic disease and wellness. Lifelong learning after medical school fills in these gaps. The lifelong learner can provide you with a comprehensive approach - so that you know all of your options for any given medical medial problem.
2. Lifelong learning updates obsolete knowledge. Medical knowledge grows at an exponential rate. The doubling time for medical knowledge was estimated at 50 years in 1950, it accelerated to 7 years in 1980, 3.5 years in 2010, and is 73 days in 2020. At present there are millions of biomedical scientific papers published each year. As knowledge grows exponentially, ideas become obsolete exponentially. Lifelong learning is essential to continually update obsolete knowledge and keep up-to-date.
3. Lifelong learning leads to intellectual humility. Doctors that continue learning after medical school witness some of their most cherished ideas become obsolete - some of these ideas are even found to be dangerous. This is humbling. It is the nature of scientific discovery. First, ideas are generated. Then, over time, they are tested by replication and more rigorous experiments. Most ideas are eventually disconfirmed. The lifelong learner learns that knowledge is dynamic and fleeting. Current knowledge represents only a slice in time in the evolution of knowledge. Most ideas are wrong or will be replaced by better ones. Learning to let go of wrong ideas - unlearning - is essential to let new ones in.
4. Ultimately, lifelong learning leads to good medical decisions. The lifelong learner can present their patient with good information. They have a comprehensive knowledge base, an updated knowledge base, and can discard outdated ideas. Good information leads to good medical decisions. (If you are interested in how good medical decisions are made in medicine, read here.)
Lifelong learning begins with a solid foundation in education
A solid foundation in eduction is very important. Medical education is not only about memorizing facts, it is about being inspired, 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."
I was fortunate enough to train in some of the finest medical institutions in the world (click here for my biography). Yes, they insisted I memorize facts to pass standardized exams, but, they also encouraged me to question the facts. They taught me how to think, not what to think. Some of these scientific principles of thinking are as follows:
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 - Learning the history of medicine, our past successes and failures, is important to help predict the future.
Intellectual humility and flexibility - Science is imperfect and does not know the truth. Science instead, strives to get as close to the truth as possible.
These principles gave me a solid foundation to start my path of lifelong learning. A general toolkit to approach any medical problem that I may encounter. I am grateful to the institutions that trained me.
(If you want to learn about your doctors training, it is available online at Florida Department of Health practitioner profiling. You can also view license status, board certifications status, and other details.)
Lifelong learning continues with case-based learning
After medical school and residency, the most natural way for doctors to continue learning is through the cases they see. This is known as case-based learning; learning concepts and principles from real-world cases relevant to a doctor. This is in contrast to conventional medical learning, where facts and concepts are presented directly without context. Case-based learning is so successful that some medical schools, such as McMaster University in Canada, exclusively use case-based learning. Theer are several advantages of case-based learning over conventional methods, they include:
Improves understanding of knowledge
Improves retention of knowledge
Promotes responsibility and accountability
Teaches problem solving skills and critical thinking
Promotes self-learning behavior
Enhances resourcefulness - where and how to access information
In caring for patients from day to day, doctors in practice have an unlimited source of cases. After formal medical training ends they can tap into arguably the most powerful form of learning - case-based learning. And not just "any" cases, cases of their patients - cases they are highly motivated to solve. Practice, therefore, presents doctors with the both ultimate opportunity, and the ultimate motivation, for lifelong learning.
Practice presents doctors with both the ultimate opportunity, and the ultimate motivation, for lifelong learning.
Obstacles to lifelong learning
There are several obstacles to lifelong learning. However, the greatest obstacle is lack of time. The typical doctor, with excessive workloads, leaves little time for much else but work. They never get to learn what medical school didn't teach them; what they did learn becomes obsolete soon after. 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 - Attending schools interested only in making sure its students pass board exams.
Over-confidence - A common cognitive error in doctors. Some doctors lack awareness of their ignorance.
Conflict of interest - A doctors ability to learn may be clouded if it conflicts with his 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 your doctor references information during and after your visit. If she says, "I don't know what the latest research shows, let me look that up", or "Let me me see what the current recommendations are". Ironically, looking up something in front of a patient was once viewed as a sign of ignorance, now it is sign of intellectual humility, and a sign of a deep understanding of how modern science works - knowledge becomes obsolete very quickly.
A good sign is if your doctor references information during and after your visit.
Concierge Medicine and lifelong learning
The Concierge Medicine model is ideal for incorporating lifelong learning. A low volume of patients affords me plenty of time to spend with patients; but, it also affords me plenty of time to learn, before and after I see patients. In fact, I spend approximately one third of my day engaged in learning. Learning generated by the cases I see - case-based learning.
I methodically research the different approaches for every case I see. Over several decades this has filled in the knowledge gaps left by by my initial medical training. I am now able to provide my patients with all of their options - a comprehensive approach. Furthermore, I understand medical knowledge becomes obsolete at an exponential rate. I use each case to learn what is new, and unlearn what is now obsolete. I can provide each patient with the most updated information available.
To consolidate my learning, I share it with my patients in educational emails and lectures. To uncloud my learning from any source of bias, I have designed my practice to avoid financial conflicts of interest and specialty bias.
Case-based learning is a win-win situation from me and my patients. It is both, an opportunity to learn, and an opportunity to provide the best care. With every case, I get to learn, and my patient is guaranteed of getting the most comprehensive and updated approach to their medical problems.