Teach healthcare, not just medicine

A FEW WEEKS back, a 48-year-old man arrived at a local free clinic where I sometimes work. He'd lost his health insurance two years ago and recently enrolled in Medi-Cal, the state health insurance program for the poor. Now he receives care for his diabetes, high blood pressure, heart failure and depression at our clinic, primarily staffed by resident physicians like me.

"Every time I come here, I meet a new doctor. Don't make me tell you everything about me all over again," he said. But the rotating staff wasn't his main concern. After his last visit, he hadn't been able to get all his medicine. Medi-Cal caps the number of prescriptions that can be filled at six per month, so he got only a portion of the drugs he needed.

By his next visit to the clinic two months later, several prescriptions had run out despite the pharmacist's efforts to find other ways to fill them. The patient complained about frequent headaches and dizziness; his blood pressure and diabetes were out of control. "That last doctor, he was nice and all," he told me, "but he didn't know I wouldn't get all my medicines."

He was probably right. Resident physicians -- who are getting post-medical-school clinical training to be certified in a specialty such as internal, pediatric or family medicine -- provide the bulk of the care for the poor or uninsured at local clinics and hospitals. In general, our clinical training is excellent. Yet we're not taught about important aspects of our healthcare system, such as Medicare or Medi-Cal, even though their policies profoundly affect our patients.

National surveys of medical students and residents confirm this critical knowledge gap. In a 2005 national survey of medical students by Harvard University researchers, 96% of respondents agreed that understanding healthcare policy is important for their work and careers. Yet fewer than 30% of them could estimate the number of uninsured Americans.

A separate group of Harvard researchers found that half of physicians had no training during residency in dealing with patients from different cultures -- a particular concern in diverse Los Angeles. UCLA researchers, including myself, are currently surveying Los Angeles County residents to understand the training gap here. The results so far are not encouraging.