Re: International Electives

[marshan]

This whole forum seems to be hating on people who do international volunteering premed. What about international electives in developing countries?

 

I think it's a great experience to go abroad, learn about a new culture and their challenges, and all the while you get to see clinical stuff too.

 

So I guess my question is, do people hate on med students who go overseas? And if they don't, then why the double standard for the premeds?

[Firsttimer]

This is an excellent topic of debate and one that I hope to work with more throughout my career. As you put it, yes, it is great to learn about a new culture and their challenges. However, it is not that simple. Read any of the literature regarding learning about a culture as an outsider and you will quickly realize that it is difficult, indeed impossible; to really learn about another culture without a lengthy engagement in said culture. Generally it is thought that you can only start to see the tip of the cultural iceberg if you have been living in (and actively trying to understand) another culture for six months. The issue does not lie in going abroad; the issue lies in a variety of other facets and is a complex topic (like any topic, you can bury yourself for life trying to understand everything). If you’d like to talk more about these ideas in contexts other than medical education, I would be more than happy to but, for now, let’s focus on the medical side. Also, I am not speaking of going abroad to places like New Zealand, I am speaking in the context of “developing” countries.

 

As I said in a previous post in another context medical school electives represent a neo-colonialism where instead of robbing a country of its natural resources, you rob the country of its knowledge–you take experience, give nothing back and then use your experience to your own ends. I recognize that medical students and medical professionals will argue that they do give back by treating patients. Electives are by their very nature educational experiences for the medical student. They are learning from others, notably doctors who would be better spending their time focusing on their patients and focusing on teaching students from their own country.

 

I think there a number of issues stemming from medical student electives abroad. Most notably, there is no reciprocity involved; only single sided taking from Canadian medical students. Second, the medical sides of too many global health issues are symptoms of much larger issues (i.e. the social determinants of health) and medical students (and doctors) so often miss the boat here. Third, medical school electives are not socially accountable. Fourth, too many medical students do their electives in a country that speaks a language other than a language spoken by that student. Communication is so vital in human interaction. Again, I know some will say that individuals can communicate with each other in other ways than language alone–I am not talking about superficial body language. You cannot get the same level of interaction with someone through facial expressions and gesturing that you can actually speaking with someone. So, unless a student is willing to take the time to learn the language (and I mean really learn, not just bring a Lonely Planet guide to_____) they should ensure they go to a country where they can actually engage in the community. Fifth, there is a great need for improvements in global health pedagogy as well as curricula both before going abroad, while abroad, and after–again, a huge topic.

 

Like I said, I would love to talk about this more as it is one of my life’s passions and this short post hasn’t even scratched the surface.

[Jochi1543]

I've attended a fair number of global health-related presentations and it seems that as a physician, you are, for most part, better off working here for 20 grand a month and sending that month's earnings to UNICEF or something to buy medical supplies instead of going there and realizing you can't do anything because you've got jack **** for meds and instruments.

 

As far as med student electives in the developing world because they "want to help people," I'm pretty skeptical of anyone who spends $2000 to fly to Africa and waste other people's time there. If you want to go there because Tanzania or whatever is cool and awesome and you've always wanted to travel there, that's a different story, but then do your host clinic a favor and bring some supplies or something with you.

[Firsttimer]

Yep, totally agree.

 

That said, there are distinct and valuable (for both ex-pat and national) international experiences that doctors can do. For instance, MSF fills a certain niche in international health where EXPERIENCED physicians work as relief workers in a disaster or war zone. Generally, engagement with this type of international elective is shorter and a one-off type of thing. This type of work can be contrasted with "development" work, which generally implies a much longer period of time in a context and, in my opinion, those wanting to work in that type of area should expect to be involved in the community that they work (in one way or another) for a period of years to a lifetime. Most medical students and doctors are not really interested in, nor really understand the latter though.

[marshan]

...They are learning from others, notably doctors who...

 

...Most notably, there is no reciprocity involved; only single sided taking from Canadian medical students...

 

...Second, the medical sides of too many global health issues are symptoms of much larger issues (i.e. the social determinants of health) and medical students (and doctors) so often miss the boat here.

 

...Fifth, there is a great need for improvements in global health pedagogy as well as curricula both before going abroad, while abroad, and after–again, a huge topic.

 

Great answers! Sorry, I don't know how to quote in blocks, but I took out the points of yours that I found interesting! My school really encourages international electives and we're quite proud of the experiences our students have gained, but it is indeed a topic of debate!

 

As for addressing the earlier points:

 

- I would argue we learn a great deal from the patients as well. In fact, when encountering clinical practice that is hindered by cultural differences, the patient-doctor interaction is much more revealing than what another physician instructs you to do.

 

- Can't reciprocity be returned in more ways than just treating patients? Perhaps a better understanding of a certain way of life can be translated into practice with new immigrant populations, or even as motivation for a physician to be involved in global health initiatives in the future (e.g. returning Canada-trained foreign residents to their country of origin).

 

- Finally on the last quoted point, isn't one of the best ways to engage a student's education and awareness is by providing first hand experience? Perhaps a good elective abroad will demonstrate the need for better global health education, during med school and throughout one's career.

 

 

P.S: Most students who go abroad bring many textbooks, scrubs, instruments, you name it to donate to their host hospital! Several students in the year above me even fundraised to bring a huge shipment of bed nets when they went to Tanzania last summer.

[blaaaax]

This is an excellent topic of debate and one that I hope to work with more throughout my career. As you put it, yes, it is great to learn about a new culture and their challenges. However, it is not that simple. Read any of the literature regarding learning about a culture as an outsider and you will quickly realize that it is difficult, indeed impossible; to really learn about another culture without a lengthy engagement in said culture. Generally it is thought that you can only start to see the tip of the cultural iceberg if you have been living in (and actively trying to understand) another culture for six months. The issue does not lie in going abroad; the issue lies in a variety of other facets and is a complex topic (like any topic, you can bury yourself for life trying to understand everything). If you’d like to talk more about these ideas in contexts other than medical education, I would be more than happy to but, for now, let’s focus on the medical side. Also, I am not speaking of going abroad to places like New Zealand, I am speaking in the context of “developing” countries.

 

As I said in a previous post in another context medical school electives represent a neo-colonialism where instead of robbing a country of its natural resources, you rob the country of its knowledge–you take experience, give nothing back and then use your experience to your own ends. I recognize that medical students and medical professionals will argue that they do give back by treating patients. Electives are by their very nature educational experiences for the medical student. They are learning from others, notably doctors who would be better spending their time focusing on their patients and focusing on teaching students from their own country.

 

I think there a number of issues stemming from medical student electives abroad. Most notably, there is no reciprocity involved; only single sided taking from Canadian medical students. Second, the medical sides of too many global health issues are symptoms of much larger issues (i.e. the social determinants of health) and medical students (and doctors) so often miss the boat here. Third, medical school electives are not socially accountable. Fourth, too many medical students do their electives in a country that speaks a language other than a language spoken by that student. Communication is so vital in human interaction. Again, I know some will say that individuals can communicate with each other in other ways than language alone–I am not talking about superficial body language. You cannot get the same level of interaction with someone through facial expressions and gesturing that you can actually speaking with someone. So, unless a student is willing to take the time to learn the language (and I mean really learn, not just bring a Lonely Planet guide to_____) they should ensure they go to a country where they can actually engage in the community. Fifth, there is a great need for improvements in global health pedagogy as well as curricula both before going abroad, while abroad, and after–again, a huge topic.

 

Like I said, I would love to talk about this more as it is one of my life’s passions and this short post hasn’t even scratched the surface.

 

Firsttimer, I respect the opinions you are putting forth here, but I personally feel you are being a tad cynical. I don't think international electives are a waste, in fact I think they are an important part of our education, as long as they are recognized for what they are. Obviously we are not contributing a significant amount by going overseas for one month, but that should never be the goal. As you and others have alluded to, it is about learning, expanding your horizons, and hopefully galvanizing a few to continue to try and make meaningful contributions to global health as their careers unfold (which I believe practicing physicians are capable of doing, in one way or another).

 

As for your criticisms, I grant that you will not even begin to understand another culture after spending one month living there - but at least you might come to respect the differences and realize how sheltered we are in the West. Secondly, relating medical electives to neo-colonialism and the idea of "robbing them of their knowledge" seems a little extreme. I think that a well-prepared student who is willing to take some initiative can limit their burden on an elective and possibly even make some kind of positive contribution (although undoubtedly less that their $2500 would). Nonetheless, they would not be accepting these students if there wasn't some kind of incentive on their side, monetary or otherwise.

 

I think that electives aren't something to engage in spuriously without some reflection on why it is that you are doing this and what you hope to take away, but I believe that the annoyance of having a med student tagging along for a few weeks is not much more than just that, while the experience of working in such a different environment can have profound effects on the trajectory of some people's medical careers.

 

Incidentally, I am intrigued by the idea of international electives going in the opposite direction....

[osmosis]

I've attended a fair number of global health-related presentations and it seems that as a physician, you are, for most part, better off working here for 20 grand a month and sending that month's earnings to UNICEF or something to buy medical supplies instead of going there and realizing you can't do anything because you've got jack **** for meds and instruments.

 

As far as med student electives in the developing world because they "want to help people," I'm pretty skeptical of anyone who spends $2000 to fly to Africa and waste other people's time there. If you want to go there because Tanzania or whatever is cool and awesome and you've always wanted to travel there, that's a different story, but then do your host clinic a favor and bring some supplies or something with you.

 

I LOVE THIS ANSWER!

[Firsttimer]

Blaaaax, I think we’re getting off on the wrong foot. I recognize that sometimes critiques can be a little hard to swallow, but I am giving them here to open up dialogue on ways to improve the system. What comes across as cynical (and perhaps it is at the level of the system ) is not a critique of medical students or really their professors, but a critique of the system that is the medical elective. The medical profession is still deeply entrenched in modernity and medical training therefore continues to teach and function from that perspective. But, the fact that we can even open up dialogue on this matter demonstrates medicine is inching its way out, albeit slowly.

 

I don’t think the international electives are a waste for the medical student. Given the right person, they can be an amazing experience–but the amazing experience is for the medical student. I can understand how you would think that labeling the elective as a type of neo-colonialism is extreme, however, I stand by my criticism. It is true that there are benefits to the countries in question, but there were also benefits for First Nations when whites colonized Canada (pots, pans, blankets, guns, etc). Doesn’t make the colonial experience any different.

 

What do you mean by international electives going in the opposite direction? As in, creating longer electives for students? If so, I agree. As I said in my first post, medical issues are only one small aspect of global health issues. What could that look like? What about expanding the role of physician to a role that includes primary health care?

[Firsttimer]

Blaaaax, I fear we’re getting off on the wrong foot (as can happen so often on forums ). I recognize that sometimes critiques can be a little hard to swallow, but I am giving them here to open up dialogue on ways to improve the system. What comes across as cynical (and perhaps it is at the level of the system ) is not a critique of medical students or really their professors, but a critique of the system that is the medical elective. The medical profession is still deeply entrenched in modernity and medical training therefore continues to teach and function from that perspective. But, the fact that we can even open up dialogue on this matter demonstrates medicine is inching its way out, albeit slowly.

 

In response to your post, I don’t think the international electives are a waste for the medical student. Given the right person, they can be an amazing experience–but the amazing experience is for the medical student. I can understand how you would think that labeling the elective as a type of neo-colonialism is extreme, however, I stand by my criticism. It is true that there are benefits to the countries in question, but there were also benefits for First Nations when whites colonized Canada (pots, pans, blankets, guns, etc). Doesn’t make the colonial experience any different.

 

What do you mean by international electives going in the opposite direction? As in, creating longer electives for students? If so, I agree. As I said in my first post, medical issues are only one small aspect of global health issues. What could that look like? What about expanding the role of physician to a role that includes primary health care? What about the relationships that we begin and then, generally, terminate so quickly? How can we maintain those relationships?

[A-Stark]

As I said in a previous post in another context medical school electives represent a neo-colonialism where instead of robbing a country of its natural resources, you rob the country of its knowledge–you take experience, give nothing back and then use your experience to your own ends. I recognize that medical students and medical professionals will argue that they do give back by treating patients. Electives are by their very nature educational experiences for the medical student. They are learning from others, notably doctors who would be better spending their time focusing on their patients and focusing on teaching students from their own country.

 

I think this is generally ridiculous and patronizing for people in the host country. Robbing the country of "knowledge"? If you take pictures of the locals, does that amount to robbing them of their souls too? It's fair to say that many doctors would be "better off" spending time focusing on their patients rather than teaching, but I don't see what the difference is. If they're interested in teaching foreign students, then it is not "neo-colonial" for them to choose to do so. You are arguing as if Canadian students are travelling abroad to exploit the unsuspecting natives.

 

I think there a number of issues stemming from medical student electives abroad. Most notably, there is no reciprocity involved; only single sided taking from Canadian medical students. Second, the medical sides of too many global health issues are symptoms of much larger issues (i.e. the social determinants of health) and medical students (and doctors) so often miss the boat here. Third, medical school electives are not socially accountable. Fourth, too many medical students do their electives in a country that speaks a language other than a language spoken by that student. Communication is so vital in human interaction. Again, I know some will say that individuals can communicate with each other in other ways than language alone–I am not talking about superficial body language. You cannot get the same level of interaction with someone through facial expressions and gesturing that you can actually speaking with someone. So, unless a student is willing to take the time to learn the language (and I mean really learn, not just bring a Lonely Planet guide to_____) they should ensure they go to a country where they can actually engage in the community. Fifth, there is a great need for improvements in global health pedagogy as well as curricula both before going abroad, while abroad, and after–again, a huge topic.

 

Setting aside that things like the IFMSA exchange programs are explicitly about reciprocity, I don't see what the problem is. Not all experiences necessarily imply giving and taking in equal measure and you have offered no compelling reason or argument to suggest that this is morally problematic. Second, are you suggesting that students will somehow gain a worsened appreciation for global health issues by doing an international elective? At this point, you are positing a patronizing argument for Canadian medical students, some of whom (myself included) are very involved with global health issues. Third, socially accountable to whom? Why? On the subject of language, I quite agree that it is desirable - and probably necessary - for students to take some time to become acquainted with local customs and language before departure. Such "pre-departure" training actually occurs via home school global health programs.

[leviathan]

I agree with Astark. International electives are not designed as charity work for that country; they are designed for you to gain medical education and experience from a different sociocultural perspective. It is also to gain experience from a different medical perspective, too, when you see how the practice of medicine varies internationally.

 

Regardless, I don't think anyone who does an international elective needs to defend their reasons for going. It has nothing to do with what benefits the country does or does not get by you being there. I've never heard of journalists reporting on the devastating effects of medical students doing electives in foreign countries.

[Firsttimer]

I think this is generally ridiculous and patronizing for people in the host country.

 

I wholly disagree that this is ridiculous and patronizing for people in the host country, especially given the fact that it is the host countries that are complaining. I've been working in international health for three years now and the general consensus in the country that I am working in is one of dissatisfaction with the way SOME (not all) so-called global health experiences function–and these critiques are not exclusive to medical electives by any means. Even a cursory dip into literature on international electives and global health will show the dissatisfaction that host countries have.

 

I guess from your post and my own, we just have a philosophical difference in thought, which is not entirely surprising as the system is still generally stuck in your school of thought.

 

Setting aside that things like the IFMSA exchange programs are explicitly about reciprocity, I don't see what the problem is. Not all experiences necessarily imply giving and taking in equal measure and you have offered no compelling reason or argument to suggest that this is morally problematic.

 

In terms of social accountability and moral issues in this area, Health Canada and the World Health Organization both provide detailed information on how social accountability and reciprocity are defined. One point on social accountability (among many) is to avoid exploitation. Again, I recognize that there are differences of opinion here. Many people in our capitalist society have no problem with exploitation.

[Firsttimer]

I agree with Astark. International electives are not designed as charity work for that country; they are designed for you to gain medical education and experience from a different sociocultural perspective. It is also to gain experience from a different medical perspective, too, when you see how the practice of medicine varies internationally.

 

I understand what electives are designed for. I understand the benefits they CAN bring to a student that is receptive to learn. I also understand there are big problems with their design. I am not proposing that the medical elective be done away with, just improved.

 

Regardless, I don't think anyone who does an international elective needs to defend their reasons for going. It has nothing to do with what benefits the country does or does not get by you being there. I've never heard of journalists reporting on the devastating effects of medical students doing electives in foreign countries.

 

I disagree. I think everyone that does a medical elective should defend their reasons for going. While benefiting a country is a bit of a stretch, one should always consider the impact they are going to have on a community, especially when we are discussing working in a country foreign to ours. Medical tourism is an ever-growing issue that stems from people that do not think they need to defend their reasons for going abroad. This is exactly the attitude that needs to be done away with; the way physicians practice medicine should always be held accountable, especially when it comes to practicing outside your own country.

 

That said, there are some medical schools that are really working hard on creating a spirit of reciprocity. At a conference this year I talked to this professor in Community Health at the University of Saskatchewan who has made it a big part of her life to make medical electives worthwhile for all involved. They have done some excellent work there.

[leviathan]

No offense firsttimer, but you greatly overestimate the impact medical students have on *anything*. We're pretty useless overall, and you can't really think a 2-4 week elective means anything.

 

If you want to have a debate about poaching trained physicians from foreign countries, or doing residencies abroad and then leaving, then you have a valid topic to discuss.

 

But that's just my opinion...

[Firsttimer]

Leviathan, no offence taken , though I would contest what you have said on two levels. Specifically my sentiment towards the medical school elective (and, by extension, biomedical global health) both has nothing to do with impact as well as everything to do with impact. With regard to the former, this goes down to basic ethical philosophy–does the impact of our actions dictate the ethical right or wrong, or should we look deeper than the impact? While stealing $100 from a bank is not going to hurt the bank, it is still obviously wrong. Specifically on international electives, should we judge what is right or wrong by who it affects?

 

Moreover, how do you really know what impact your elective is having. Again, I have been heavily involved in global health for a long time and there is most certainly a distrust developing for Western doctors doing work in the cultural context I was in. This impact cannot be overstated.

 

With regard to the former, this is what I hope can be changed. Through more thought in the medical community perhaps we can create a more effective international elective if we change its meaning. Maybe medical students can make a change? Should we not at least try??

[A-Stark]

I wholly disagree that this is ridiculous and patronizing for people in the host country, especially given the fact that it is the host countries that are complaining. I've been working in international health for three years now and the general consensus in the country that I am working in is one of dissatisfaction with the way SOME (not all) so-called global health experiences function–and these critiques are not exclusive to medical electives by any means. Even a cursory dip into literature on international electives and global health will show the dissatisfaction that host countries have.

 

All host countries? About what? I'd say that there's a world of difference between international electives organized by Canadian schools directly and the sort of privately-organized short-term trips that exist.

 

I guess from your post and my own, we just have a philosophical difference in thought, which is not entirely surprising as the system is still generally stuck in your school of thought.

 

And what school of thought would that be?

 

In terms of social accountability and moral issues in this area, Health Canada and the World Health Organization both provide detailed information on how social accountability and reciprocity are defined. One point on social accountability (among many) is to avoid exploitation. Again, I recognize that there are differences of opinion here. Many people in our capitalist society have no problem with exploitation.

 

Avoiding exploitation is necessary, yes, but you haven't given any examples of such exploitation. I don't see how this impacts electives by medical students a great deal, but when it comes to "premeds", there are significant problems with many programs that allow them to be involved in patient care (whether in clinics or the OR) in ways that would not be allowed in Canada.

[Firsttimer]

All host countries? About what? I'd say that there's a world of difference between international electives organized by Canadian schools directly and the sort of privately-organized short-term trips that exist.

 

Of course, I am not capable of speaking for all host countries–only the one that I have been working in and one's that I have read in the literature on the subject or through friends that work in development. I shouldn't say countries either as, with anything, there are differences of opinion and, so too, it is not really governments that are complaining, but those working in development, medical professions, or other health fields.

 

And what school of thought would that be?

 

What I refer to is modernism. I suppose school of thought is a bad term to use as what I am referring to is more of a cultural discourse that still pervades western medical thought (though many other fields have stepped into the postmodern/post-structuralist era). A great book to read is "The Birth of the Clinic" by Michel Foucault. He discusses a great many subjects, but there is an emphasis on describing how modern medical discourse differs from what preceded it.

 

Avoiding exploitation is necessary, yes, but you haven't given any examples of such exploitation. I don't see how this impacts electives by medical students a great deal, but when it comes to "premeds", there are significant problems with many programs that allow them to be involved in patient care (whether in clinics or the OR) in ways that would not be allowed in Canada.

 

There are too many examples of outside the area of medical electives as you have indicated. In terms of medical electives, I have already outlined how they are exploitation. A medical student goes abroad, obtains (in cases where the student is receptive to learning and not just holidaying–which happens a great deal) an excellent learning experience, and then leaves (usually permanently). It is one-sided–i.e. exploitive.

[A-Stark]

What I refer to is modernism. I suppose school of thought is a bad term to use as what I am referring to is more of a cultural discourse that still pervades western medical thought (though many other fields have stepped into the postmodern/post-structuralist era). A great book to read is "The Birth of the Clinic" by Michel Foucault. He discusses a great many subjects, but there is an emphasis on describing how modern medical discourse differs from what preceded it.

 

I'm not interested in postmodern navel-gazing. Lots of "modern discourse" differs from what preceded it. So what?

 

There are too many examples of outside the area of medical electives as you have indicated. In terms of medical electives, I have already outlined how they are exploitation. A medical student goes abroad, obtains (in cases where the student is receptive to learning and not just holidaying–which happens a great deal) an excellent learning experience, and then leaves (usually permanently). It is one-sided–i.e. exploitive.

 

And what's exploitative about it? This implies some sort of coercion or unfair extraction of resources and time from the host country. Do such students not pay for their experience and do their hosts not receive them willingly? Are people in host country harmed by this experience? How? Why? "Robbing them of their knowledge" is not a satisfactory answer.

[Firsttimer]

I guess we'll leave it at that then. It's obvious we come from completely opposing viewpoints and the discussion breaks down at a philosophical disagreement. That said, there is good fodder for people sitting on either side of the argument to chew on.

[A-Stark]

No, I don't think this is at core of "philosophical disagreement" unless you're simply defining "exploitation" to mean whatever you want it to mean. I haven't read one sentence describing how host countries are harmed - in general - by international electives.

[Firsttimer]

I think this is generally ridiculous and patronizing for people in the host country. Robbing the country of "knowledge"? If you take pictures of the locals, does that amount to robbing them of their souls too? It's fair to say that many doctors would be "better off" spending time focusing on their patients rather than teaching, but I don't see what the difference is. If they're interested in teaching foreign students, then it is not "neo-colonial" for them to choose to do so. You are arguing as if Canadian students are travelling abroad to exploit the unsuspecting natives.

 

 

Well, A-Stark, it comes down to more than just the doctor in these situations, there are the patients (and this is the philosophical difference I speak of–modern medicine removes the patient). Again, at least in the cultural context I work in, while the doctors do complain about the impact of foreign medical students, it is the patient that is being exploited. I cannot even count the times I have heard medical students discuss the "freaky medicine" that they were able to practice on patients. Yes, "freaky medicine" is a direct quote. It is the patient that is being exploited the most. I work with impoverished groups in a Latin American context, and they are not fond of the one-off medical tourism that can be the medical elective. Terming it exploitation does not come from me, but individuals that I have worked with. They are well-versed in colonial and neo-colonial engagement in their country. But it doesn't stop with just me. My colleagues that work in global health and international development echo my experiences.

 

There are of course well-organized medical electives that dramatically reduce the negative impact (and perhaps Dal does just that), but there still are an enormous amount of students that just pick up and go to wherever they can make a contact. Again, my intentions are not to do away with the medical elective, but to improve them, give them a longer lasting impact.

 

And, like it or not, navel-gazing is a part of our current cultural climate. You may not be interested in it, but your future patients are.

[Mamie]

Come on. "Modern medicine removes the patient"? Have you ever practiced modern medicine? How in heaven's name could you possibly practice anything but patient-centered care in this day and age? We don't just discuss disease entities and science without considering our specific patient. Nor do we ever embark on a plan of care without the full understanding and agreement of our patients (of course after much discussion and explanation with said patient).

 

I really have nothing to say about the debate surrounding international electives, but in any debate you should probably check your facts before stating them.

[Firsttimer]

Come on. "Modern medicine removes the patient"? Have you ever practiced modern medicine? How in heaven's name could you possibly practice anything but patient-centered care in this day and age? We don't just discuss disease entities and science without considering our specific patient. Nor do we ever embark on a plan of care without the full understanding and agreement of our patients (of course after much discussion and explanation with said patient).

 

I really have nothing to say about the debate surrounding international electives, but in any debate you should probably check your facts before stating them.

 

Whoops, sorry Mamie, I recognize you probably are not aware of what modern medical practice is (science undergrads unfortunately don't learn this ). The term modern is not referring to the definition of modern as being recent times, but to the term modernism, which is something much more complex (tricky terminology, I know). Post-modern is what some compare modern to in this context, and the modern medical practice is what took place in medical practice for a great deal of time including all of the 20th century.

 

You are right, patient-centred care is a reaction to the modern-medical practice, and a breath of relief for the patient (especially given the incredible amount of repulsive human experimentation that preceded patient-centred care), but the west is still heavily engaged in modern medical discourse.

[Firsttimer]

Sorry, I should have given examples. Probably the easiest way to explain the modern medical doctor is to discuss the television show, "House". Doctor House is the quintessential modern medical doctor. As he constantly reiterates, doctors don't need to speak to the patient. On the other hand, his colleagues represent the changing scenery of modern medical praxis (and the style that medical school is trying to achieve now). Just as you say, they practice patient-centred care.

[A-Stark]

House is probably one of the most unrealistic depictions of medicine (modern or otherwise) on television. If doctors don't need to speak to the patient, then why the emphasis (not to mention time) on learning to take histories? As it's often said, 80% of the diagnosis comes from the history. More importantly, the importance of talking to patients has been emphasized since Osler at the very least, who is rightly called one of the fathers of modern medicine. A paragraph from his wiki bio:

 

He liked to say, "He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all." He is also remembered for saying, "If you listen carefully to the patient they will tell you the diagnosis" which emphasises the importance of taking a good history.

 

How much medicine have you practiced?