In
By the Bedside of the Patient, Nortin Hadler places
current efforts to reform medical education--from the undergraduate
level through residency programs and on to continuing medical
education--in historical context. In doing so, he traces the
evolution of medical school curricula, residency and fellowship
programs, and the clinical practices they promoted. Hadler examines
crucial junctures in history to locate the seeds for reform.
Some believe that medical education and training should highlight
literature, ethics, and culture, while others emphasize science and
efficiency to abbreviate the time from entry to licensure. Neither
of these approaches, Hadler argues, maintains or improves patient
care, which should be at the core of medical education and
practice. Hadler contends that most reform attempted thus far
constitutes, at best, little more than a reshuffling of the basic
curriculum and, at worst, an augmenting of medicine's predilection
to measure, grade, and record. Examining generational changes in
medical education, Hadler mines sixty years of training and
practice to identify mistaken approaches and best practices.
Ultimately, in the contemporary era of managed care, Hadler argues
for a clinical practice that draws on the best available scientific
knowledge, transmits the wisdom of experienced clinicians, reforges
an empathetic relationship between physician and patient, and
treats each patient as an individual--all centered on restoring the
mandate to care.