Physician re-evaluates medical school training process, profession in lecture

Dr. Larry Weed, M.D., president and founder of PKC Incorporated and professor of medicine emeritus at the University of Vermont College of Medicine, spoke about the medical field to a roomful of pre-med students this past Friday. In his lecture entitled “New Premises and New Tools for Medical Care and Medical Education: Your Role, Your Responsibilities, Your Opportunities,” Weed addressed the inadequacies of the medical profession and mindset and possible solutions to improve quality of care.

Weed began his lecture with an inquiry into what doctors do and the institutions, undergraduate colleges, universities and medical schools, that shape them. “The medical profession is in a major crisis and no one is noticing,” Weed said.

Because doctors go to excellent colleges and medical schools, he said, the public thinks that they must know what they are doing. But there is an information problem in the medical field. There is, he said, an enormous body of knowledge one needs to know, so large that it is impossible for one person to contain it all. “The mind can’t do what the public thinks it’s doing,” Weed said.

In addition, because the profession only takes the best and brightest, the pre-med students worry about getting good grades. “They don’t ask, ‘What am I trying to do? What is this profession?’” Weed said.

He pointed out that the education that medical schools provide has not changed. According to Weed, education holds time and task constant, but varies level of achievement with grades. He feels it should be the other way around, for this emphasis encourages guessing, and with medicine one cannot afford to get things wrong. “Patients are not multiple choice exams,” Weed said. “You don’t want 75 percent treatment.”

To combat large amounts of information necessary for the profession, doctors began to specialize, he said. They began to treat only one body system. Cardiologists investigate heart conditions, oncologists treat cancer and so on. Patients, however, do not specialize, Weed pointed out. Specialists would only know how to diagnosis and treat their particular conditions and could often miss others. “Doctors are trying to do the whole thing,” he said.

Weed believes the solution lies in greater organization, thoroughness and responsibility. While he was teaching at the Yale University School of Medicine, Weed was astounded that students could not make sound, defensible diagnoses. He created a computerized system which “match[es] the patient data with a wide range of knowledge from the medical literature, protocols and guidelines” to suggest possible diagnoses. This eliminates much human error from slips in memory or lack of organization.

Known as Product Knowledge Couplers, or Couplers for short, a significant number of doctors nationwide draw on this informational tool through a network of “patient specific clinical entities [of] signs symptoms, research knowledge and the relationship between them.”

Weed views the Couplers as “another way to couple the world’s knowledge to the people who need it.”

He feels an ordered system is necessary because the rate of error in medicine is too high. “Doctors are famous for lousy handwriting and lousy records,” Weed said. He pointed out that in a recent American Medical Association (AMA) study, only 20 percent of family doctors could properly identify when their patients had heart problems.

Weed and his company are continually building Couplers and expanding the databases as new medical literature comes out.

Throughout his lecture, Weed made use of the blackboard to diagram his ideas and drew on quotes from Sir Francis Bacon, Leo Tolstoy and Edna St. Vincent Millay.

Weed received his M.D. degree from Columbia University College of Physicians and Surgeons. He then went on to join the University of Vermont College Medicine faculty as professor of medicine in 1969 after holding positions at the University of Pennsylvania, Walter Reed Hospital, Johns Hopkins Hospital, the Yale University School of Medicine, Eastern Maine General Hospital and Case Western Reserve University.

From 1969 to 1982, while professor of Medicine at the University of Vermont, Weed was Principal Investigator for an NCHSR-funded research project, the computerized Problem-Oriented Medical Information System (PROMIS), a large minicomputer-based system implementing the problem oriented medical record on several wards of the Medical Center Hospital of Vermont. Weed, in collaboration with Richard Hertzberg, shareholder and lead programmer for PKC, founded PKC Corporation in 1982 to develop information tools that address key needs in the practice of medicine through the development and use of the problem-oriented record.

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