Medicine: Patients, Not Textbooks

Patients, Not TextbooksStudents used to spend two years in medical school before they ever saw a patient. They learned about bones from a skeleton and from charts, and often had a hard time when it came to setting a fracture. U.S. medical schools have been gradually shifting the emphasis from textbooks to patients. At the nation’s newest medical school, at the University of California at Los Angeles, which opened its doors this week, first-year men will begin learning from patients in their first week.

Each student will be assigned (under the eye of a graduate pediatrician) to watch the growth of a young baby. He will get to know his “patient” in sickness & in health. In emergencies he must get up at 3 a.m., if necessary, to be on the spot as soon as the pediatrician.

The “Whole” Subject. U.C.L.A.’s medical school consists, so far, of 28 students, 25 teachers and temporary quarters in remodeled buildings. Eventually there will be 400 students and 58 teachers in a $20 million plant housing the school and its hospital. The man behind the plans for a modern medical school at U.C.L.A. is 55-year-old Dean Stafford Leak Warren, who went to U.C.L.A. in 1947 from the University of Rochester, after serving as medical director of the Manhattan Project and consultant to the AEC.

Warren had definite ideas about the proper way to lay out medical buildings, and he drew the first rough sketches for U.C.L.A.’s. Example: operating rooms used to be on the top floor, to catch all possible daylight; since modern lighting now makes this unnecessary, Warren placed his operating rooms on the ground floor, easy to reach from an ambulance. But his fundamental idea is to teach medicine as a “whole” subject, not just a series of loosely connected courses in anatomy, pharmacology and biochemistry.

The Smell of Acetone. Dean Warren does not claim that his philosophy of medical education is original, only that he has a grand chance to build it into the foundations of a new school. “In the first year,” he says, “our anatomy student is also taught physical diagnosis. A patient is brought in, say an orthopedic case—a, dislocation of the shoulder. The anatomy professor is taking up the shoulder girdle. The radiologist brings the films down, showing normal shoulder girdles, abnormal ones, displacements and fractures.

“The student learns a little about the interpretation of X-ray films. He visualizes the anatomy much more clearly. The orthopedist describes the case, how the accident developed, what the symptoms are. He shows the patient, actually reduces the dislocation if possible. As he puts on the bandages or plaster, he has the help of the first-year students.

“The same thing ought to happen all the way through what are called the preclinical sciences. During biochemistry, for instance, the diabetic case ought to be brought down to the laboratory as the students are studying the blood-sugar problem. The students ought to smell the acetone on his breath. They ought to see him as a patient, and relate him to the urine they are examining.”

In short, as Dean Warren never tires of saying:”The doctor exists for the patient.”