PROGRESS NOTES

An exploration of “how physicians can see patients better.”

Nussbaum, chief education officer at Denver Health and author of The Finest Traditions of My Calling, agrees that the 19th-century introduction of science into medical education was an admirable revolution that converted medicine to a profession based on human physiology rather than folk beliefs. The result has been miraculous advances in curing diseases and repairing broken bodies, but people still get sick and die. Indeed, they often stay sick longer, take longer to die, and have limited access to appropriate cures. Nussbaum maintains that medical education, now based on the “textbook of the body,” should expand to include the “textbook of the community.” He makes his case by describing a pilot program at the University of Colorado, where he is a professor of psychiatry, and similar programs are being instituted at a few other schools. Medical students traditionally spend their third year in a hospital rotating through the specialties (surgery, obstetrics, psychiatry, etc.). The author describes seven students who do not follow doctors but patients, accompanying them to clinics, emergency rooms, and surgical procedures, as well as to their homes and communities. This approach, as Nussbaum demonstrates, has proven transformative, especially because research shows that “social determinants have more effect on a patient’s health than a physician’s clinical care.” The author also describes how, in the past few decades, medical schools have started paying greater attention to communication skills, and classes now include far more women and people of color. Nussbaum lays out his concepts with refreshing clarity, though he notes that his vision of medical education remains a work in progress. Given the success of the pilot programs so far, readers will hope that the work continues to improve and spread to more medical schools and hospitals.

An ingenious new approach to educating doctors.