Your articles on health inequality this week included excellent coverage of the government’s project to shift the emphasis of healthcare from treatment at the clinic and hospital to prevention through public health initiatives (Downing Street’s radical plan for the NHS: shifting it from treatment to prevention, 29 June). However, one key element is missing from the analysis that has frustrated the implementation of such necessary innovations: the way that undergraduate students are educated and socialised into medicine within longstanding conservative curricula.
Historically, doctors gain an identity that is grounded in the sanctity of the “clinic” (primarily the hospital) as a well-patrolled territory with idiosyncratic rituals and language. Patients are kept on the other side of the fence. Medical education traditionally affords little work-based experience in the first two years, but after that students gain increasing exposure to clinical work. However, this is largely focused on secondary care (hospital and clinic) settings, and on cure rather than prevention.
