[india-drug] Re: Teaching Pharmacology and Therapeutics (19)

["manjula datta" <manjulad@yahoo.com>]

Teaching Pharmacology and Therapeutics (19)
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Dear Friends,
   
  I have been thinking about this issue and talking to Dr. Sunitha Mittal, and another friend, Dr. Sujith Chandy, a pharmacologist from CMC Vellore who also follows this list closely. Here is a summary of our thoughts:
   
  The main issue is : Why do doctors learn prescription practices from Medical Reps?
   
  Our discussions on this group has revealed the following reasons:
   
  1. The TINA factor - They do not get proper training in Med Schools, and so they turn to who ever gives them information.
   
  2. Greed: They prescribe the drugs that give them the greatest returns, regardless of what it costs or whether the patient can afford it. 
   
  3. Give and take: Again, even though we may not classify this as greed, it still is falling prey to inducements.
   
  We can't do anything about Greed. Such people will continue to be there in any profession and Medicine is no exception.
   
  But there are some things we can do about the other two assuming that proper information would make the large majority - the middle belly as we call them - do  the right thing.
   
  What are the Lacunae? Our discussion shows these as the lacune:
   
  1. Training is inadequate: We confuse Pharmacology with Therapeutics. We teach the former to students who don't even know anything about Pathology or clinical symptoms. It is a lot of information about drugs and molecules and how they are absorbed and eliminated from the body. And the children learn all the big names and the exam questions, but little else
   
  2.  Where to get the information? There are a few, but not enough drug information centres. And the fresh graduates do not know much about these. So no one refers to them.
   
  3. Learning is very theoritical: Rarely is the problem based approach taken in teaching pharmacology. Indeed therapeutics stops with the drugs and their action. Never is a student exposed to how many brands of the same drugs are available? why are some brands costlier than the others and questions of that sort.
   
  4. The undergrads. have no mentors and no mechanisms for CMEs.
   
  So what can we do??
   
  We talked of two things:
   
  1. An e-Course, where people can register, and learn about how prescriptions can be rationalised. This course can be for two -four week and can include some of the topics suggested by Dr. Y.K. Gupta.
   
  2. An RUD workshop for the House surgeons during their internship - public health postings. We can concentrate on the thirty important medicines. 
   
  Both can be evaluated??
   
  Any thoughts on these?
   
  Manjula Datta 

Manjula Datta                  
Professor of Epidemiology            
The Tamilnadu Dr. MGR Medical University
69, Anna Salai, Guindy
Chennai 600032.
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