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I am so tired of seeing statements like these:

• Nutrition is not taught in medical school.
• Pain management is not taught in medical school.
• Practice management is not taught in medical school.

All three of those statements, and the vast majority of others bemoaning the shortcomings of medical education just because “XYZ isn’t taught in medical school” are right, but oh so wrong.

“Nutrition” is not taught in medical school. What we learn is biochemistry, metabolism, gastrointestinal and endocrine anatomy and physiology. We may not learn “nutrition” per se, but we learn what we need to know to understand nutrition in a more fundamental and comprehensive way than can be gleaned from any course in “nutrition”. This also means we understand nutrition differently — and more completely — than anyone without that same level of medical education can, however much they’ve read about nutrition.

“Pain management” is not taught in medical school. What we learn is neuroanatomy, pharmacology, behavioral psychology, and neurophysiology, so that we have the basic knowledge to understand pain management. Narcotics dosing, epidural steroid injection techniques, rehab protocols and so on are learned in residency. I agree that pain is often not well managed, but not because “it’s not taught in medical school.”

Practice management is not taught in medical school. Why should it? Not every doctor is going to have to manage a practice. Many of them are going to become employees. Should everyone leave medical school knowing how to read an employment contract? Well, yes, but is medical school really the right place to learn that? How about the basics of money management and investing? You should have learned that around the kitchen table from your parents before you started high school. That’s not what medical school is for.

Medical school is where you learn the basics about the human body, its structure and function in health and disease, and the disease processes that afflict it. You learn about the microorganisms that make people ill and the drugs that make them well. And that’s just the first two years. The second two years is when you put those basics to work at the bedside, discovering what all those things you learned the first two years look like in real life. Hopefully by the time you’ve gone through those four years, you’ve decided what kind of physician you want to be, so you can move on to postgraduate (residency) training, where you learn how to do what you need to do. Almost all of the knowledge and skills physicians use in day-to-day practice are learned in residency, not medical school. That’s where a surgeon learns to surge, where OBGs learn to deliver, and where family docs learn everything. Even after training is completed, there’s Continuing Medical Education to help us keep up to date. (There’a also UpToDate.)

Family doctors, internists, pediatricians and all other primary care doctors need training in nutrition. Surgeons, hospitalists, oncologists, and all doctors who take care of sick people need training in pain management. Everyone needs to understand the basics of running a business, including the underlying principle of receiving payment for providing professional services. But medical school is not where these things need to be taught.

Doctors also need to know how to respect others, how to manage their time, even how to wash their hands. Ideally they should know these things long before medical school. If not, they shouldn’t be accepted in the first place.

Most of the hue and cry about alleged med school deficiencies is really a set of straw man arguments made by non-physicians trying to demean medical education because “doctors aren’t taught about this,” whatever it is they’re selling. Don’t but it. By the time you see a doctor, he knows what he needs to know  in order to figure out what’s wrong with you and what to do about it. If not, any deficiencies are not because of things “not taught in medical school”.

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