Sir, Stephen Brearley (letter, Sept 4) mentions that the scientific study of pharmacology has almost disappeared from modern curricula. Similarly many of the new medical schools have dropped formal study of pathology, despite it playing such an important part in the diagnosis and management of so many patients. However, the killer observation that he makes is that “diagnosis is too difficult” for modern students in final examinations.
Few outside the profession, and not enough within, understand the importance of an accurate diagnosis before any kind of treatment. Too many believe that diagnosis can be achieved by dogged adherence to a textbook algorithm, whereas in practice it requires the analysis and interpretation of all the data acquired from history taking, observation and carefully selected tests.
The ability to solve an often complex problem and arrive at the correct diagnosis demands a fundamental understanding of disease mechanisms, that is the science of pathology. By this means the correct treatment, be it masterly inactivity, drug treatment, or anything from minor to major surgery, may be administered. The perils of inappropriate therapy are known only too well, but given a correct diagnosis someone with the appropriate training can then perform the procedure required.
Both education and training are, of course, required. Here in Cambridge our medical course retains a strong scientific underpinning. The first graduates from the new medical schools are just beginning to emerge and it will be interesting to compare their progress and impact in the years ahead with those from the more traditional courses.
Dr Derek G. D. Wight
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Retired Histopathologist, Cambridge