Tuesday, December 8, 2015

On the shoulders of giants

The following was sent to me by a professor who sits on the admissions committee of a medical school in the United States. Here’s what he asks prospective students during interviews.

Sir Isaac Newton said, “If I have seen further, it is by standing on the shoulders of giants.”

If you want to become an astronaut, I’ll bet you know who Neil Armstrong is. If you want to become a rock-star, you likely know who the Beatles were or who the Rolling Stones are. If you want to become President of the United States, you know who Barack Obama is. But you want to become a doctor, right? That’s why you’re here.

So, who are those giants of medicine? What famous scientists or doctors who have advanced the science of medicine can you name?

The following would not be acceptable:

Mehmet Oz, MD
Sanjay Gupta, MD (Medical reporter)
Phillip McGraw (“Dr. Phil”)

Here are some names that would count: Drs. Watson, Crick, and Franklin

You wouldn't believe the answers I get. For example:

Me (after an applicant couldn’t think of any names): "What do we do to milk to make it safe to drink?"

Applicant: "Put antibiotics in it."

Me: "What was your major in college?"

Applicant: "Microbiology."

Me: "OK, what is the PROCESS we use to make milk safe called?"

Applicant: Crickets...Crickets...

Me: "I'll give you a hint. It is named after a French scientist."

Applicant: Crickets… “I wasn't a history major.”

Me: “No, worse—you were a microbiology major. Let me give you another hint: His first name was ‘Luis’ (Loo-ee, pronouncing it best I can).”

Applicant: Crickets...

Me: “Okay, what is the process of heating milk at a high temperature, under pressure, to kill bacteria called?”

Applicant: “WAIT!!!! Pasteurization!!!!”

Me: “Great. So what is the guy's name?”

Applicant: “Dr. Pasteurization!!!! Dr. Franco (after I'd already told him the first name was Luis) Pasteurization.”

Me: Crickets...

Here are a few choice responses from other applicants: Patch Adams, David Perlmutter, anesthesia, the one who created penicillin, Bill Nye, Ben Carson, and [my favorite]—Jonah Salt (sic).

39 comments:

RobertL39 said...

But did he get admitted?? Maybe he had other extenuating circumstances...

Libby said...

Good gravy, it does blow my mind when I meet people who don't really know much about the area they are either in or interested in. For me it would be a basic thing to do when investigating an area I'm interested in. Hmm guess that's why I know about Banting & Best, Madame Curie, William Osler, Christiaan Bernard....& some dude who calls himself "Skeptical Scalpel"

Paula said...

Thanks for the laugh!

Les said...

*OUCH* These students are probably good at "new math" and John Dewey's 'sight' reading method.

Joe Middle said...

Would Theodor Seuss Geisel be an acceptable answer?

Anonymous said...

Skep is one. I'd give myself away for a couple others but they're in general IM, heme/onc, GI, & RE (reproductive endocrinology). Otis Brawley, Marty Makary, LD Britt. Howard and Georgianna Jones.

Egerton Yorrick said...

I'm usually not a supporter of left-of-field interview questions but this is a pretty good idea for selecting out candidates with a) good general world knowledge and/or b) those with a genuine passion for the study and practice of medicine. Obviously it's not any use the second year running because all candidates will have become experts on the life and times of Sir William Osler...

artiger said...

Has anyone said Dr. Dre? Dr. Scholl?

Anonymous said...

I am now in my fourth year of medical school and probably could not come up with a very good answer to this question. History is just not one of my interests even though it may be important to some self-important academicians. Enjoy filling your incoming medical school class with liberal arts majors who struggle with basic physiology.

Skeptical Scalpel said...

Thanks for all the comments.

To anonymous who posted at 11:54 PM last night, I'm sorry that you don't find the history of medicine interesting. You are missing out on some things that could enrich your understanding of how we got to where we are today. Reading about some of the pioneers of medicine can also be fun.

I don't know what you plan to specialize in, but if it is surgery, aren't you curious to know who Whipple was? What about Halsted or Cushing?

Too bad.

connmannic said...

There is a weekly podcast about the history of patent medicine/bad medicine called Sawbones. Highly recommended.

In my interview for one of my schools, the interviewer asked me about if I had recently read any books about medicine. I was in the middle of reading "Destiny of the Republic", a book about the life of President James Garfield, which is a really incredible story. What a man. Probably one of the greatest presidents we ever had. Contrary to popular belief, he wasn't assassinated. He was shot, and likely would have lived, but his physician didn't believe in sterile technique, and probed for the bullet day after day, week after week. He died two months after he was shot. Alexander Graham Bell even invented a device to find the bullet, but the pigheadedness and pride of the physician wouldn't let it be used for more than a few seconds. I will read about good physicians for inspiration, but I will read about bad physicians, and mistakes in medicine to stay grounded.

About the start medical school, and I can't help but wonder if finding the healthiest amount of skepticism isn't one of the most difficult things to cultivate. How does one do it?

I am a biomedical engineer and have always loved technology. Hopefully my degree will help me better weed out the promotional BS to find the real innovation.

Unknown said...

Wow, just wow...As soon as you asked about the process to make milk safe to drink without ANY clues, I thought of Pasteurization and Louis Pasteur and I thought I was dumb...

Anonymous said...

Watson, Crick, and Franklin were not physicians. I think this is a pretty silly way to evaluate a candidate for medical school since many who go into medicine were inspired by physicians that they know, rather than read about.

And I think it's pretty sanctimonious of you to list Ben Carson among the joke answers. Whether you agree with his politics or not, he overcame some serious obstacles and ascended to a top academic post (and he's actually a physician).

Skeptical Scalpel said...

Anon, if you had read the post carefully, you might have noticed that the fourth paragraph contains this sentence, "What famous scientists or doctors who have advanced the science of medicine can you name?"

Unfortunately, Ben Carson has gone way off the rails. I would hardly consider him a giant of medicine right now. Too bad.

Skeptical Scalpel said...

Connmannic, I don't know how one cultivates skepticism. Maybe it's like common sense. I've found that is hard to teach too. I think one of the greatest qualities a budding MD can have is to ask "why" instead of simply accepting dogma as truth.

Anonymous said...

Reading this has opened my eyes. I can study and know all the book material, but what good it to if you can not be well rounded. What are some recommendations to be well rounded?

Skeptical Scalpel said...

If you have time, you should read some non-medical books or medical history just for fun. Spend some time on current affairs too.

Chris said...

I have often lamented... medicine is simply not a field that venerates its history. I think in part this is because the state of medical practice changes so rapidly. What was the state of the art 10, 20, or 30 years ago is in many fields barely remembered now. Students, both pre-medical and medical, want to know what they should do now, but don’t care much about how we got here. Students and residents want to become cardiologists because they like the ability to modify diseases, the excitement of procedures, and yes, the prestige and riches it provides. Many of them are not especially interested in finding out who was first to use HCTZ. This is understandable to some extent—medicine is increasingly technology-oriented and future-looking.

But it is also important in my opinion to recognize what is lost when trainees don’t care about their forebears. The simplest summation would the famous Santayana quote: “those who cannot remember the past are condemned to repeat it.” When I was a medical student some of my friends and I actually started a medical history club where we would invite faculty members to give presentations on historical developments in their fields. We had talks about Semmelweiss, the history of immunosuppression in transplantation, John Hunter, William Halstead, and Elizabeth Blackwell, among others. I don’t know if the club is still in operation, but I doubt it. It was always a chore to get any significant number of students or residents to attend, even though several prominent members of the faculty were willing, even eager to give these presentations. Ever since then, I continue to find that older physicians are often more interested in history than their younger colleagues. To some extent this may just represent the disinterest of most young people in history. I think as most people get older, they recognize more clearly their position in a long parade of history stretching out behind and before them, and get more interested in what came before.

To me, the history of medicine has always been of personal interest and edification. I think the lack of interest in medical history is symptomatic of the larger decline of humanism and interest in humanities among younger generations of physicians. This starts in undergraduate education, where most “pre-med students” are just that—passing through university grudgingly as a necessary station of the cross on the way to physicianhood. I have known far too many pre-med students who loaded themselves with chemistry, organic chemistry, biochemistry, and biology coursework (all things that they will learn again in medical school, one notes) and treat their liberal arts coursework with a sense of obligation, if not disdain. Is it surprising then that they have no interest or facility in the study of history? The medical school application conveyor belt has bred it out of them. Which is a shame, because burnout among physicians continues to rise to ever higher levels, and I think that engaging with the life and professional stories of physicians of previous generations can be of great benefit in combating burnout. It is hard to read about the lives and work of people like Osler, Cushing, Welch, or Hunter (both of them!) and not feel inspired to return to work with a renewed since of purpose.

Sentenza said...

Would Semmelweis be an acceptable answer?

How about Joseph Lister? Jonathan Letterman? Richard Gatling? Michael Crichton?

Anonymous said...

Chris: What a great post! And a great idea--a medical history club. Never thought of role it could play in burnout, too.

Skeptical Scalpel said...

Chris, it's interesting that at a time when some med schools (eg Mount Sinai) are accepting more students with backgrounds in humanities, some think it is the other way around. And you get pushback from students like the anonymous commenter above who think history is BS. Good point about possible link to burnout.

Sentenza, Semmelweis and Lister yes. Not buying Gatling and Crichton as giants of medicine. Letterman? Not sure.

Sean MSII said...

I'd like to mention Robert Liston and Galen. Robert Liston a surgeon in the 1800s who worked before anesthesia. He taught his students to respect the patients and try to understand their fear. In addition, he only operated as a last resort. Because of his incredible speed (leg amputations in as little as 30 seconds) and his insistence on clean bandaging, his survival rate was 1 in 6 at a time when 25-35% of people died from the operation.
Galen is the ancient Greek physician who basically defined anatomy and medicine for the next 1300 years with his idea of the four humors. He should be applauded for his interest and dedication into figuring out the process of human disease, despite how wrong he was. In addition, I find it illustrative as to how we can make mistakes about pathophysiology because "it makes sense". Sometimes things make sense that are incorrect, and we have to always be seeking the best evidence for our treatments.

As a side question, did anyone watch The Knick on cinemax? Plays fast and loose with medical history, but still a fun historical show about medicine.

Skeptical Scalpel said...

Sean, thanks for the comments. About "his survival rate was 1 in 6 at a time when 25-35% of people died from the operation" -- did you mean to say his *mortality* rate was 1 in 6?

I haven't watched "The Knick." I hear is good.

Sean MSII said...

I did mean his mortality rate! Thanks for catching that!

Chris said...

Michael Crichton never actually got a medical license or practiced medicine after his training (according to Wikipedia anyway)

Some reading I would suggest to people interested in the history of Medicine:
Lewis Thomas - The Youngest Science: Notes of a Medicine-Watcher
Wendy Moore - The Knife Man (biography of John Hunter)
Michael Bliss - Harvey Cushing: A Life in Surgery
Michael Bliss - William Osler: A Life in Medicine
Kenneth Ludmerer - Learning to Heal
Paul Starr - The Social Transformation of American Medicine
Roy Porter - The Greatest Benefit to Mankind
Sherwin Nuland - Doctors: The Biography of Medicine

Sentenza said...

Jonathan Letterman was the medical director of the Army of the Potomac, and he heavily influenced battlefield medicine. If you've studied the battlefield treatment of casualties, you can see echoes of it down through the present day. He also started the very first ambulance corps, Letterman is fairly obscure, but he did make an important contribution to military medicine and the treatment of battlefield casualties.

I should also add Walter Reed to my list. We also shouldn't forget Alexander Fleming. I had to do a little more obscure research, but, you shouldn't ignore the contribution of a non-medical person who made an important contribution to the field of medicine, such as Margaret Hutchinson Rousseau.

Anonymous said...

Thanks for sharing this story.

I disagree that any knowledge of medical history and who is and isn't a giant should be necessary to get admission into medical school.

Perhaps I want to be a psychiatrist and I know the history of social movements in psychiatry, which inspired me to do medicine. Perhaps it was a personal connection with a doctor. Why should my admission hinge on the scope of knowledge, interests and personal biases of an interviewer? This sounds too subjective to be a fair interview.

I don't want to diminish the value of history. I have read many medical history texts cover to cover. And maybe I will be a better doctor for it, but I everyone has their own path and a love of medical history is but one possibility.

Anonymous said...

To "Anonymous" (posting at 2:03 pm on 12/11): Please understand the reason this question is being asked--and there is A LOT of lattitude allowed in the answers (pretty much any/all of the names here would likely be accepted). The purpose is explained in the first paragraph: it simply defies common sense that you'd want to be an Astronaut if you don't know who Neil Armstrong was. Likewise, if you're running for President. It is NOT asking too much, I believe, and I'm sure the interviewer believes this too, to ask any potential physician or surgeon if they know any of these famous scientists. We're given an example of a microbiology major who couldn't even remember Pasteur! Names like Hooke, Pasteur, Halstead, Osler, Walter Reed, Fleming, Linus Pauling, and literally HUNDREDS of others, could be named--and some of these students can't name any. Do you think NASA would let you be an astronaut if you didn't know who Buzz was? I doubt it. Seems like a completely fair interview question to me--one that others will probably use in the future. And, if you want to be a psychiatrist, and you don't know who Freud, Pavlov, or Skinner were, I have my doubts about how serious you are. But I'm just one person.

William Reichert said...

Please forgive me for submitting a very impertinent question: What is the evidence that a knowledge of the history of medicine predicts whether a candidiate for admission to medical school will "succeed".Is there any evidence?
Thank you.


Old Fool said...

We have a television commercial here in Pittsburgh featuring a group of cardiovascular surgeons who claim they are the giants and others are standing on their shoulders.

I would like to nominate 2 giants: Dr. Walter Dandy, the true founder of neurosurgery and of course Dr. Skeptical.

Anonymous said...

Dr Peter Huttenlocher a pediatric neurologist, who did extensive research on the importance of synapses, which led to future developments in this field.

Skeptical Scalpel said...

William, of course there is no evidence. We are allowed to have an opinion though.

Old, thanks for the vote of confidence. I would hardly qualify.

Anon, I will take your word about Dr. Huttenlocher.

Chris said...

Perhaps William Reichert doesn't think Medicine or its practitioners have anything to learn from history.

Personally, I feel that Medicine would do well not to forget some history: Walter Freeman, dioxin, the South African "aversion" project, medical complicity with CIA torture throughout the 2000's, Tuskeegee, Josef Mengel...

I'll cite Santayana once again: "those who cannot remember the past are condemned to repeat it"

Anonymous said...

Chris brings up a great point: those who have contributed to medicine by being INFAMOUS. I'd garner the interviewer would probably love to hear some of those names, too!

Skeptical Scalpel said...

Yes, we can learn from the bad guys too.

Anonymous said...

Sentenza -

My first thought was Semmelweis as well. Lister would be a good one. Personally, I'm pretty partial to Vesalius, so that would have probably been my answer (now at the end of med school). I'm not exactly sure who my answer would have been during interviews, but since I was studying micro at the time, I bet I would have said someone along the lines of Fleming, Pasteur, Koch, or the like.

Skeptical Scalpel said...

Anon, all good choices. Thanks for commenting.

Anonymous said...

I'm NOT a doctor, nor do I even play one on TV. I DO believe that you received all the responses that you listed in your blog post, Dr. Skeptical. At least here in the USA we as a group of people are losing IQ points with each new generation. If you haven't heard of the movie "Idiocracy", watch it. It is a hilarious comedy - but I fear that through hyperbole it foretells our future (500 years from now). The overall premise is that a guy of only average intelligence becomes the smartest man in the world via being forgotten in suspended animation for 500 years or so. You will really enjoy the hospital scenes.

Part of my fear comes from working in IT for 25 years. The youngsters nowadays are growing up used to Googling for information as they need it, rather than trying to actually REMEMBER anything. I'm sort of an in-betweener, born in 1960. I learned multiplication tables and such by rote repetition. I learned to figure sales tax in my head while running a cash register. I can actually still perform simple math with a paper and pencil. (Don't ask me to do a square root though!) I can add/subtract/multiply/divide fractions AND decimals! I do also love my smartphone, but I consider it and my always-on internet connection a luxury. Having unlimited information on any subject available within a few seconds is an addictive drug to me, who grew up learning the Dewey Decimal System and digging though card catalogs.

What happens if our brains gradually become lumps of cold oatmeal that only know one thing - internet searching - and 313 years from now society collapses? Or, 57 years from now, your power goes out for a couple weeks post tornado or hurricane? Will we all go outside and mill around, not knowing what to do next?

Skeptical Scalpel said...

Thanks for the comments. I saw the movie and while ago. You and the movie may be right about what the future holds.

The last time we had a power failure, we sacrificed light for cell phone charging because our portable generator could only handle one or the other.

The one flaw in googling for information is that it's difficult to tell sometimes what is valid or not. You must be able to discern the difference which sometimes is not so easy.

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