Langone Examines Medical Education

BOOK

Harvard Med

by John Langone

Crown Publishers, Inc.

400 pp., $25.00

For pre-med students in Cabot Science Library burning the midnight oil, the white marble buildings of Harvard Medical School (HMS) represent something of a holy shrine--and institution to be fantasized about over problem sets and lab reports.

The typical dream? To have achieved, what John Langone, Kennedy fellow in medical ethics, calls "Preparation H"--graduating from Harvard College and Harvard Medical School, and then securing a residency in a Harvard hospital.

In his latest book, Harvard Med, Langone illustrates how the nation's top medical school has hand-picked and educated the country's premier doctors since the American Revolution, using anecdotes, case studies and first-hand experiences.

The author of many works, including Bombed, Buzzed, Smashed or...Sober: A Book about Alcohol and Like, Love, Lust: A view of Sex & Sexuality, Langone has exposed the human drama behind the gleaming facade of the "marble white palace" of Harvard's Longwood campus. In doing so, he is perhaps the first writer to enliven the medical profession in such a potent, entertaining and realistic manner.

Of interest to undergraduates, Langone talks about HMS admission requirements and standards and describes some of the students who are accepted.

More importantly though, he focuses on the widening gap between patients and care-givers in medicine today, using colorful interviews and descriptions to demonstrate how students and faculty at HMS are both contributing to this gap and trying to narrow it.

He does not set this issue up as a thesis and then argue each side to reach a conclusion. Instead, he uses a rather unconventional structure--interweaving the school's history with a loosely chronological narrative following the progress of a class of medical students from orientation to graduation.

While the structure may be a little disorienting at times, it does add some unpredictability that medical historical texts often lack. And Langone effectively ties together past and present, discussing the consistent lower status of women in the profession while romanticizing the "coarse" general-care, small-town practitioner who knew how to be kind, understanding and available.

Throughout the narrative, Langone drives home the message that patient care should ideally be both scientifically sound and socially conscious.

According to Langone, the Medical School is a research-oriented institution, not the place to study geriatrics of primary care, nor the place where one goes "to train to work with Indians in Fargo or set up a dermatology practice in Biloxi." Instead, HMS produces mostly specialist and surgeons making six-figure salaries.

The book traces the Medical School's 200-year history, but the irony is that nothing has changed, really, in terms of the medical types that this institution puts out. Langone makes a rather severe, but convincing generalization, that "It is, and is likely to remain, mostly a haven for `3-M's'--male medical magistri, gowned gurus who are far more scholar, researcher, and specialist than empathetic, readily-available healers."

He attributes this phenomenon to time constraints, pressure to keep up with the explosion in new scientific technology and huge tuition debts that can be paid off more easily by larger salaries specialists and surgeons earn. He alsoportrays medical school applicants in a negativelight, calling them "biokids," "brainoids" and"organodweebs." According to Langone, they are allafflicted with the competitive, noncooperativeillness called "premed syndrome."

In the context of a multitude of issues--HMO'sand managed care, the New Pathway curriculum atHMS, specialization versus primary care--Langonerepeatedly argues that many of the students becomedehumanized, over-specialized and one-dimensionalas a result of the fierce pre-med race. As aresult, they end up knowing little about realdoctoring and interacting properly with patients.

Langone, however, does mention the fewexemplary medical school faculty who do understandthe social aspects of being a patient and attemptto impress these "humanistic" values upon theirstudents.

Langone contrasts stories of residents treatingtheir patients roughly with those of the few idealpractitioners--the ones who hug their patients andspend time talking to them. One Dr. O'Connell evenplants antibiotics outside for a poor alcoholicpatient who refuses to remain in the hospital,These are the "good" doctors, the ones who haveachieved some sort of balance between beingmedically knowledgeable and socially apt.

Langone's work is wonderfully provocative, notonly because it's filled with anecdotes dug fromthe bowels of Harvard's Countway Library ofMedicine but also because his sources arepredominantly primary. Langone observed a grossanatomy class firsthand and shadowed medicalstudents and doctors to detail their experiences.

Other medical school histories are often dryand uninteresting--their style is factual ratherthan reflective, and information is frequentlyjust culled from newspaper articles and hospitalannual reports.

Hands-on participation allows Langone toreflect somewhat philosophically abbot medicineand life in general. His gross anatomy experience,for example, prompts a reflection about death,privacy, sex and love. "The heart is out," hewrites, "and holding it in my hand. I feel that itis cold, and I think of hard-hearted Hannah, thevamp of Savannah, and hear of my heart andValentine cards and love, courage, and thestrength of kids and lions."

Langon's conclusions, though harsh, are largelytrue; the technological revolution, from germtheory in the late 19th century to the diagnosticcomputers used today, has greatly depersonalizedmedicine. Patients have come to be thought of asbiochemical systems rather than human beings.

But Langone becomes overly critical of theMedical School's scientific bent when he downplaysthe school's research efforts. He especiallycriticizes the school's Health Sciences-Technologyprogram (HST), a research-intensive curriculumdesigned for students seeking "careers at theinterface of science and engineering withmedicine."

Langone depicts HST participants as Nobel-boundnerds armed with "auto-mechanic" mindsets; out ofall the students at HMS, they need sensitivitytraining the most.

But Langone is inconsistent in his portrayal ofmedical students. He argues that many of them arelopsided science-types, but many of his storiesportray the students as the caring types, thosewho are often chastised by their superiors forgetting emotionally involved with patients. Thusit is unclear whether today's students areentering medical schools as "organodweebs" or associal-minded idealists.

These inconsistencies are minor, however, anddo not detract from the educational value orengaging charm of the work. The book remainsthought-provoking and highly readable.

Langone's work focuses exclusively on Harvard,but his points about the doctor-patientrelationship applies to all cultures andcommunities--from the doctors in inner-cityhospitals treating gunshot wounds withsophisticated machinery to the Native American,medicine man treating the flu with herbalmedicine.

Hopefully Langone's work will serve toentertain, educate and most importantly, help thepre-med "biokids" of today become the socially andscientifically capable practitioners of tomorrow

In the context of a multitude of issues--HMO'sand managed care, the New Pathway curriculum atHMS, specialization versus primary care--Langonerepeatedly argues that many of the students becomedehumanized, over-specialized and one-dimensionalas a result of the fierce pre-med race. As aresult, they end up knowing little about realdoctoring and interacting properly with patients.

Langone, however, does mention the fewexemplary medical school faculty who do understandthe social aspects of being a patient and attemptto impress these "humanistic" values upon theirstudents.

Langone contrasts stories of residents treatingtheir patients roughly with those of the few idealpractitioners--the ones who hug their patients andspend time talking to them. One Dr. O'Connell evenplants antibiotics outside for a poor alcoholicpatient who refuses to remain in the hospital,These are the "good" doctors, the ones who haveachieved some sort of balance between beingmedically knowledgeable and socially apt.

Langone's work is wonderfully provocative, notonly because it's filled with anecdotes dug fromthe bowels of Harvard's Countway Library ofMedicine but also because his sources arepredominantly primary. Langone observed a grossanatomy class firsthand and shadowed medicalstudents and doctors to detail their experiences.

Other medical school histories are often dryand uninteresting--their style is factual ratherthan reflective, and information is frequentlyjust culled from newspaper articles and hospitalannual reports.

Hands-on participation allows Langone toreflect somewhat philosophically abbot medicineand life in general. His gross anatomy experience,for example, prompts a reflection about death,privacy, sex and love. "The heart is out," hewrites, "and holding it in my hand. I feel that itis cold, and I think of hard-hearted Hannah, thevamp of Savannah, and hear of my heart andValentine cards and love, courage, and thestrength of kids and lions."

Langon's conclusions, though harsh, are largelytrue; the technological revolution, from germtheory in the late 19th century to the diagnosticcomputers used today, has greatly depersonalizedmedicine. Patients have come to be thought of asbiochemical systems rather than human beings.

But Langone becomes overly critical of theMedical School's scientific bent when he downplaysthe school's research efforts. He especiallycriticizes the school's Health Sciences-Technologyprogram (HST), a research-intensive curriculumdesigned for students seeking "careers at theinterface of science and engineering withmedicine."

Langone depicts HST participants as Nobel-boundnerds armed with "auto-mechanic" mindsets; out ofall the students at HMS, they need sensitivitytraining the most.

But Langone is inconsistent in his portrayal ofmedical students. He argues that many of them arelopsided science-types, but many of his storiesportray the students as the caring types, thosewho are often chastised by their superiors forgetting emotionally involved with patients. Thusit is unclear whether today's students areentering medical schools as "organodweebs" or associal-minded idealists.

These inconsistencies are minor, however, anddo not detract from the educational value orengaging charm of the work. The book remainsthought-provoking and highly readable.

Langone's work focuses exclusively on Harvard,but his points about the doctor-patientrelationship applies to all cultures andcommunities--from the doctors in inner-cityhospitals treating gunshot wounds withsophisticated machinery to the Native American,medicine man treating the flu with herbalmedicine.

Hopefully Langone's work will serve toentertain, educate and most importantly, help thepre-med "biokids" of today become the socially andscientifically capable practitioners of tomorrow