A tweet thread.
There are a few noteworthy drawbacks in India's education system: One is the emphasis on fact rather than method/process in science education explained in this article: newslaundry.com/2020/07/06/ind…)
There are a few noteworthy drawbacks in India's education system: One is the emphasis on fact rather than method/process in science education explained in this article: newslaundry.com/2020/07/06/ind…)
Another is the artificial separation of the arts and the sciences. So we end up with engineers and scientists (who anyway lack the rigour and scepticism of science) without an understanding of the social sciences of behavioural psychology, economics, philosophy or literature
Equally we have arts graduates with limited understanding of science or biology, and even less about scientific method and scepticism. Of course those who never get to school or do not progress beyond primary school are left behind altogether.
But the one that is particularly damaging is the artificial separation of the physical and biological sciences. So Most young medical college entrants In India would have studied biology and chemistry (again rote learning rather than understanding) but no maths.
Much of medicine is based on research that is statistically driven, terms like Type 1 / type 2 error apply to medicine as to quality control. Concepts like -ve and +ve predictive value of a test drives diagnostic uncertainty. NNT(number needed to treat) informs prognosis
Once in medical college, instead of studying and understanding anything about the interaction between health, illness and society they spend 12-18 months studying anatomy, physiology and biochemistry. The key topics about medicine and society are left for the few liberal nerds
They focus on clinical medicine as a set of rules to memorise and implement. If symptom X do test Y and if Disease Z then prescribe Pill P. No nuance. No why? No q abt where is the evidence of benefit. No Q about entertaining any questions from the patient.
The patient or her family is never involved in decisions about their care. Communication skills is another that is never taught or tested in Medical colleges in India. Its all one-way comms: "Do as I tell you" ("Pay my bill", if Pvt sector, or "dont waste my time" if Govt sect)
One result of this is an understandable loss of trust between patient and doctor. It also leads to #Overdaignosis and '#Overtreatment. Overdiagnosis because it is easier (and it pays more) to do an expensive imaging procedure than talk to the patient.
Prescribing a pill is an easy route because it is seen as an exercise of specialist knowledge. Saying 'this does not need treatment, give it time' is an admission of failure. Looking up the evidence is seen as inexperience and lack of confidence.
Could this be the reason why the senior doctors in @BiocolMimited's #Itoluzimab trial were using their seniority and status and anecdotal experience to clobber the science journos asking uncomfortable Qs. After all if #Coronavirus is such a new disease that we need new drugs
Then the same #coronavirus infection is also something no one however senior has any experience with. "Experience is not that happens to you, it's what you do with what happens to you". The utter confidence with which senior doctors at the #Biocon Press conference and TV debate
were asserting their belief that they had found a magic drug was something to behold. No sign of reflection, no hint of scientific caution or self critical analysis, or scepticism. It wasn't just an effective treatment, it was a 'breakthrough'; to Q it was to challenge their auth
The #Coronavirus epidemic showed up the lack of humility among India's medical stars. From Cardologists to cardiothoracic surgeons the big names pontificated in TV studios. None said why dont you ask an epidemiologist or a Public health professor. #Celebrity culture prevailed
And yet Indian doctors have pioneered some amazing developments, esp in applying the principles of industrial-quality mass production to routine procedures (hbr.org/2013/11/delive…
If things are to change, it has to start at the bottom, in an education system that focuses on learning, questioning, discovery; that is iconoclastic, values the contrarian, encourages challenge, fosters humility, and engenders respect for knowledge rather than seniority
