How to Fix the Premed Curriculum - Another Try

How to Fix the Premed Curriculum - Another Try

by Richard Ratzan 

Rich Ratzan is a retired ER physician from Hartford, Connecticut who was a classics major as an undergraduate.  He has taken Lewis Thomas' modest proposal to reform the premedical curriculum to heart and recently published an essay on this in the JAMA.  He writes:

"Forty-one years ago, physician-essayist Lewis Thomas proposed that applicants to medical school who were traditional premed science majors be considered last, if at all, for admission.  Instead, he wrote, preference should be given to students who concentrated on “some central, core discipline, universal within the curricula of all the colleges, which could be used for evaluating the free range of a student’s mind, his [sic] tenacity and resolve, his innate capacity for the understanding of human beings and his affection for the human condition."

Richard Ratzan's fine essay in the August 27, 2019 JAMA updates Thomas' classic NEJM article.
Download Jama_ratzan_2019_JAMA

Also see: Lewis Thomas, How to Fix the Medical Curriculum (NEJM 1978) It begins with this prescient paragraph:



Both of these essays are worth close reading.  Dr. Ratzan's JAMA piece has beautiful images depicting Achilles and Priam.

The Brygos Painter, Hector’s Ransom Skyphos,circa 490 BCE, clay pottery (h, 250 cm),

Knowing More Can Sometimes Serve a Patient Less

Don’t  Tell Me When I am Going to Die

By B.J. Miller and Shoshana Berger

NY Times Op-Ed Piece, Sunday, June 23, 2019

When faced with serious [life-threatening] illness, being able to make decisions about the flow of information is one of the most life-affirming things you can do.

 Steve Scheier has created a tool to help you let your physicians and other caregivers know your wished regarding how much information you want to hear.  It’s a form called the Prognosis Declaration, and it allows patients to choose among a four options:

1)   Tell me everything.

2)   I’ve not decided what I want to know about my prognosis, so ask me over the course of my treatment.

3)   I want to participate in my treatment, but I don’t want to receive any information on my prognosis.

4)   I don’t wish to know any information about my prognosis but I authorize you to speak with [blank] about my case and for you to answer any questions that this person may have about my likely prognosis and treatment.

The Prognosis Declaration form is not a vote for denial; it’s simply an acknowledgment that knowing more sometimes serves us less. Because, no matter what we choose, we never really get to know everything.

B.J. Miller, the co-author of this Op-Ed piece, has had an interesting trajectory from student to doctor.  Spend three minutes with his “Brief But Spectacular” take on Living and Dying.