Educating the Next Generation of global doctors

Every fortnight we will publish a blog post by an expert in the field of global health. Professor Tony Freemont, Head of Undergraduate Medical Education at the University of Manchester has kindly agreed to write our first blog

Tony Freemont copy


Global Health means different things to different people. To some it means practicing medicine in “3rd world” countries or war zones or dashing round the world bringing emergency medicine to those stricken as a consequence of war or natural disaster. Of course Global Health incorporates  both of those, but together they are only a tiny part of the whole.

People argue, sometimes vehemently, about the definition of global health, but the arguments are usually around the periphery of an accepted broad definition which is something like – “medicine that is practiced and researched with a view to achieving equity in access to and delivery of healthcare for all people worldwide”.

Now, that goal is easily met. All you have to do is to find the cheapest and “worst” healthcare system in the world and bring everyone down to that level. You have then achieved equal access to healthcare of the same type globally. It would also sort out the largest single problem facing the world today, too may humans using too much of the world’s natural resources for life to be sustainable long term on our planet. If the above strategy were implemented, a natural equilibrium would develop and Homo Sapiens Sapiens would take on its natural role in the food chain: hunter; scavenger; subsistence farmer; and food source for large beasts and tiny micro-organisms.

Of course, that is not what people mean by Global Health.  As soon as you extend the definition to encompass compassion and relief of suffering, the whole concept and ethos changes. But they bring new problems. Is modern medicine, as practiced in the USA for instance focused on caring, compassion, and the relief of suffering.  You can come to your own judgments about that, but for what it’s worth I consider the answer is very clearly no.

I am not even sure the primary objective of Global Health should be the delivery of medical care or that doctors are the best people to deliver “Health”. The overwhelming majority of doctors are concerned with disease, not health. There are many countries across the globe where health is best improved by a supply of clean water, removal of sewage, ensuring an adequate diet and inoculations to provide resistance to infection, all very much focused on maintaining health, not treating disease. Of course, if you then superimpose basic outpatient disease management: treating infections; dressing wounds, managing pain; improving mobility, etc within the context of traditional “medicine” and “care pathways” you are more than 95% of the way towards establishing the level of “health” that we “enjoy” in the “west” (Sorry about all the quotation marks but these are all very loaded words).

So how does all this fit into training global doctors. Well buried in the deliberately challenging remarks above are some real truths. Global Health is:

  • About, ensuring “health” rather than treating disease
  • Concerned with doctors needing to understand their role, and in particular recognising that they are parts of teams many members of which are more important to delivering healthcare objectives than they are.
  • About working with patients in their own culture and understanding their needs, desires and aspirations, not imposing your views.
  • About 10% of the medicine we teach in medical schools being enough to manage 90+% of disease.
  • recognising that communicating and understanding are more important than pontificating.
  • realising that 120% of what we teach (and 250% of what most other medical schools teach) around care, compassion, empathy with patients, and reflective learning and practice, is more important than knowing the Kreb’s cycle or the 201 branches of the femoral nerve.
  • (And one that is only obvious if you think about it) global medicine includes what we do for patients in the NHS.

I hope you recognise how Manchester Medical School prepares you to become the next generation of global doctors even in being a global doctor means practicing in Abbey Hey, Gorton where I live (where there is arguably the largest ethnic diversity of patients in the world!!).

Some clues – total immersion in the NHS, learning from patients, lots of travelling around to appreciate the needs of patients (and the doctors who manage their disease), focus on the basics of healthcare and patient management, emphasis on communication, expecting you to become an independent and reflective learner (yes we are talking portfolio here), etc, etc.

To corrupt an old saying, we can only provide the horse trough, you have to be prepared to drink.

Over to you!

Tony

 

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