With each class, Wingard and her students try to determine: What questions did a doctor ask that made the patient feel even worse in an already difficult situation? Were there other ways to obtain the same information? How would the patient have wanted the doctor to act?
Many times, the doctors come under heavy fire from patients--a perspective that some students take into account.
"I felt there were some (patients) I take with a grain of salt. The patient is always looking at it from the patient's point of view. But a doctor is always busy. They are limited in their time," said Chang, 22, a first-year medical student.
To Wingard's chagrin, all but two of the 25 students in her class are women. It's a ratio that she hopes may one day even out. Mario Ruiz, a second-year medical student, said it took a while getting used to being among so many women in a class.
But because he believes he needs to be able to understand female patients in his family care practice, Ruiz signed up for the course.
"I needed to be more attuned to how females speak. They tend to think differently and approach life differently than we (males) do," said Ruiz, 26. "Hopefully, this will make me a better rounded, more sensitive physician."
For Chang and others, the class opens up areas of medicine they thought they already understood. In the class on breast cancer, patients described how they felt having a breast surgically removed, how long it took for the emotional scars to heal.
"You hear so much about breast cancer, you think you are not going to learn anything new," Chang said. "But I learned a lot about losing a breast--the emotional side."
In taking the course, Serr suddenly realized how much was missing from her other classes.
"We had psychology class lectures on depression but postpartum depression was never mentioned," said Serr, 24, a second-year medical student. "Courses like this address questions and issues that are lacking in medical education."
The problems facing women patients and women doctors, many critics say, are a reflection of the profession, which has slowly evolved to include increasing numbers of women.
In recent years, a growing chorus has protested government funding of research studies that fail to include women. One federally funded study, for instance, looked at 22,000 men to analyze the effects of aspirin in preventing heart attacks.
In response, the National Institutes of Health launched the Office for Research on Women's Health in September, 1990--a gesture that officials hope will send a strong signal to the medical community. The office touts a $500-million budget, which will be used for studies of health issues that affect women, such as osteoporosis, heart disease, and cancer.
"It is our hope that medical schools and the practicing community will take an even greater interest in the health concerns of American women," said NIH spokesman Mark Stern. "We hope this has a positive impact in medical schools."
Doctors and medical school officials say they are getting the message.
"There are more women in medicine, more women in health care and these women are making us more aware of things we had not been doing," said Dr. William Jacott, a trustee of the American Medical Assn. and a family physician at the University of Minnesota. "It's become pretty clear that many of our studies, initiatives, and directions have not been in the direction of women's health care. Part of that has been historical--not deliberate."
Today, the quickly changing landscape of medical practice has pushed most schools to evaluate their curriculum as well as the doctors they produce.
Among many schools, the curriculum itself has undergone a face-lift. Today, schools routinely offer classes in medical ethics. In 1979, 10 medical schools offered an elective course on death and dying. This year, 115 schools offer it as a required course.
At UCSD, the curriculum includes what might have once been condemned as "touchy-feely" classes such as "Achieving Well-Being: Stress Management for Health Professionals and Their Patients."
"Overall, probably every medical school in the country has been looking at its curriculum for ways it can teach better," said Dr. Gerard N. Burrow, dean of UCSD's School of Medicine.
But the changes reach further, affecting the very admissions process.
Medical school entrance exams, the Medical College Admissions Tests, or MCATS, were revamped last year. The new tests--administered to almost 40,000 prospective medical students a year--include essays meant to gauge students' ability to think and write. The changes, officials say, came in response to criticism that the test required rote memorization of facts.
"There's a lot of concern among patients that medical schools are turning out callous, insensitive, greedy physicians. I don't think it's an unrealistic assessment," said Dr. Michael Wilkes, professor of medicine at UCLA's medical school and chairman of a new segment of the curriculum called the doctoring program, which is designed to bring the student into realistic situations and help them understand the patient's perspective.
"I haven't talked with a patient in years who hasn't complained about the way doctors treated them, kept them waiting, and treated them with no respect," Wilkes said. "Have you ever had an encounter with a doctor that you \o7 enjoyed?\f7 "
