Monday, August 20, 2012

Are Doctors Smart?

     The IQ comparison for sixty-five different jobs and professions is illustrated in the following chart, put together as part of a University of Wisconsin study.  The IQ for medical doctors is the highest, ranging from 107 to 133.  College professors rank next, with a range of 98 to 133.  Here it is:

     A high IQ score is unlikely to guarantee success in any profession--there are just too many other qualities that factor into a person's work success, and IQ tests don't measure them.
      Most patients assume doctors are smart from a book-learning standpoint.  I guess that's true--board-certified doctors have all been through seven to fifteen years of medical training, and we all must stay informed daily of changes in our fields.
     I make it a habit to read a medical journal article every day, usually more.  In family practice it's necessary to take standardized exams every seven years to maintain board certification.  Most physicians have to study hard for this exam because it covers areas of medical practice that are outside our daily purview.  In my case, for instance, I stopped doing obstetrics after completing residency.  I don't keep up with inpatient medicine, either, preferring instead to keep people out of the hospital rather than taking care of them in the hospital.  So I have to study for these parts of the test every seven years.
     IQ is a measurement of analytical, mathematical and spatial thinking.  Computers are good at those things, too--so if IQ tests measured everything that matters, computers could treat patients.  Some people may think they can--but not me.
     An IQ of 100 is, by definition, average.  Mentally disabled people score below 70, and geniuses are said to have scores of 145 or greater.  So doctors, by and large, are not geniuses.
     In 1983, Howard Gardner proposed the theory of multiple intelligences.  He categorized nine types of intelligence:  logical, spatial, linguistic, kinesthetic, musical, interpersonal, intrapersonal, naturalistic, and existential.  Since then he has fine-tuned his theory and made it applicable to teaching, paying special attention to students who don't look smart in the public school system.  Public schools value logical/mathematical abilities, and linguistic fluency.  Coaches in public schools value spatial and kinesthetic intelligence.  A child who has a different set of abilities won't be recognized by most teachers as smart.  But kids in school seem to know about one another's special proclivities, and they segregate themselves into close-knit groups based on their particular forms of intelligence:  the nerds, the jocks, the literary/journalist types, the band kids, honor students, preps, hipsters (skateboarders and alternative musicians), and hippies (rock climbers, bikers, wilderness hikers).   These kids turn into adults who enter professions that favor particular forms of intelligence:  engineers, lawyers, people who write computer programs, athletes, painters, musicians, teachers, psychotherapists, administrators, salesmen, literary writers, and mountain climbers, to name a few.
     Gardner's theory destroyed the idea of IQ as a static measurement of overall ability.  No one is a genius across all nine areas of agility, and everyone is likely to be intelligent in some area.  The beauty of his system is that it recognizes people as individuals with genius-abilities in domains that haven't been included in logic-oriented IQ tests.
     Are doctors smart?  That depends.  Real intelligence in doctors depends on their ability to integrate their knowledge--including self-knowledge--with a number of different interpersonal skills, and to use what they know in complex communications with people from all kinds of backgrounds, in all kinds of emotional states.
     All doctors can memorize facts and protocols from books, and develop logical treatment plans for patients with heart failure or cancer or anemia.  But these concrete abilities are like hammers and hoes in the hands of people without the skills to use them, if doctors don't have emotional intelligence or a standard of ethics.  Interpersonal skills are imperative in the medical profession.  When medical school applicants are interviewed, their ability to convey warmth and curiosity are factors that are essential to acceptance into the profession.  Doctors need a minimum of three kinds of intelligence to be smart:  a)  logical IQ;  b)  emotional IQ:  and, c)  ethical IQ.  The higher they "score" in these areas, and the more balanced across all three, the better doctors are likely to be at doctoring.
     Emotional IQ is extremely important for doctors, because they have to identify and relate to a wide range of personality types.  Patients won't forgive doctors who don't "care."  But caring is perceived by patients in a variety of ways that are based on their personalities.  Some patients need logical explanations in order to feel as though a doctor cares about them;  some need plenty of face time;  some need eye contact;  some need physical touching;  some hate to be kept waiting and need speedy treatment;  some need smiles and hugs;  some need to be on a first name basis with the doctor;  some need to have boundaries enforced;  and some need a prescription--even if they don't need one.
     Doctors who don't know how to reach patients won't be of much help treating them--whatever degree of book-learning and logic they bring to their work.  And doctors who don't share the ethics of the community in which they work will have a hard time recruiting patients, too.  Ethics is extremely important in medicine.  I have on occasion consulted a medical ethicist about complex patient situations--for example, how to proceed with an HIV-positive patient who refuses to tell partners about his/her status, or what my obligation is when a patient is selling drugs on the street, or whether a parent has a right to withhold potentially life-saving but painful treatment from a child.  Many such ethics problems confront doctors every day, and we have to live with ambiguity as we urge patients along paths of self-care that aren't always certain.
     But the personal ethics of a doctor is different, and of paramount importance in medicine.  Will the doctor always act in the best interests of the patient?  Is the doctor fair and honest?  How honest should a doctor be with patients?  Does the doctor care more about money than people?  Is the doctor too lazy to research important new aspects of a patient's disease?  Does the doctor really care about people?  When the doctor and patient disagree about what treatment is needed, what does the doctor end up doing?  Should insurance restrictions--which are based on maximizing profits--come before the doctor's judgment about what's best for a patient?  If the doctor and the insurance company disagree, what should the doctor do?  Does the government have a right to tell doctors how to practice medicine?  Should anyone be able to interfere in the doctor-patient relationship?
     Doctors who take the ethics of their profession seriously, and who are sensitive enough to relate to people even when sickness causes them to regress, and who can stay abreast of an art that is constantly being impacted by changes in science--must be smart, very smart, to do their jobs well.

1 comment:

  1. Assuming your innocence - which I think is a safe bet based on your heartfelt and numerous posts (many of which I have now read or scanned) - or not, and beyond the outrage and sympathy your "case" deserves, what should concern the rest of us Americans is the nightmarish power of the feds. Clearly a principle like habeas corpus for property seizures should be in place so that whatever possibly understandable emergency actions might be required by the FBI in situations of real danger, must soon thereafter be followed by court filed charges. Not being a lawyer or otherwise apparently informed enough on our civil rights, I don't know how we got to this point and this obviously wide avenue - make that "boulevard" - for abuse by all too human agents of a too powerful government. I am actually very close to a Fed Prosecutor in another part of the country who deals with violent crime, and am sympathetic to the work he does. I will ask him about this case and the principle at work.

    On another note, it is my understanding that Medicare is significantly more efficient in terms of administrative costs than private insurance, but that lacking investigators leaves it open to much fraud. Is this merely a matter of balance and doing it better, or is there some structural change that would better address the problem? Given our over the top health care costs - literally - when compared to other developed countries, what are we doing wrong in this area? My understanding is that other countries feature more - not less - government involvement, whether the system is totally socialized (the UK?) or insurance driven (Germany?).