STAT readers on teaching medical students about intellectual disabilities, sobering centers, and annual wellness visits

STAT now publishes selected Letters to the Editor received in response to First Opinion essays to encourage robust, good-faith discussion about difficult issues. Submit a Letter to the Editor here, or find the submission form at the end of any First Opinion essay.

“U.S. medical schools aren’t teaching future doctors about 7.4 million of their patients,” by Romila Santra

This article is excellent and highlights the extra challenges people with intellectual and developmental (IDD) disabilities face in getting care. I’m so glad Ms. Santra wrote about her family’s experiences. Identifying the problem is the first step in solving it. I’m hoping more medical schools make teaching how to care for people with IDD a requirement. I’m always grateful when we find a good doctor for my son with IDD.

— Maureen Piotrowski

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I heartily endorse this call for necessary curriculum changes at U.S. medical schools. What surprised me in this article: so many U.S. medical schools do require any level of training. Some doctors don’t look me in the eye. Some maintain their distance. Some refuse to answer my simple questions. And some approach me like just like another human being who has an uncommon point of view. I’m 66, have had a number of serious health problems since childhood, and have dealt with hundreds of doctors. I count those who belong in the last group on the fingers of one hand.

— Michael Doran

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We write to clarify some details described in this commentary. The Association of American Medical Colleges (AAMC) and our member schools are deeply committed to training the next generation of physicians to assess and treat all patients, including those with disabilities. We are actively working to improve medical education in serving those persons with intellectual and developmental disabilities (IDD). For example, we are a founding member of the national action collaborative, ABC3: Action to Build Clinical Confidence and Culture, which is a multistakeholder national effort to scale strategies to engage and better prepare general clinicians for serving persons with IDD. The data referenced in the commentary is from the Liaison Committee on Medical Education (LCME) Medical School Annual Questionnaire Part II. This annual survey is sent to U.S. M.D.-granting medical schools. Although not managed by the AAMC, we present these data on our website to support understanding of medical school curriculum. This article references a data chart regarding topics in medical school curriculum phases. The statement “Thirty of the 155 medical schools across the United States provide no curricular content about developmental disabilities” is inaccurate. The most recent data (2021-2022), in which 155 medical schools responded to the survey, shows that 140 medical schools reported developmental disabilities in one or both phases of the curriculum as defined by the survey. Of the 140 medical schools responding to this topic, 125 medical schools reported developmental disability in the pre-clerkship phase, and 117 medical schools reported developmental disability in the clerkship phase. And, critically, pre-clerkship and clerkship as defined by the survey were not mutually exclusive — medical schools could select either or both phases when indicating where a topic is covered. The survey does not include a method for medical schools to indicate a specific topic was not covered. All questions on the survey were voluntary — medical schools may not have responded to individual questions for various reasons. Thank you for the opportunity to clarify these points.

— Lisa Howley, Association of American Medical Colleges

Editor’s note: This article has been updated in light of Howley’s response. 

“It’s time to rethink the Medicare annual wellness visit,” by Jeffrey Millstein

One of the reasons I retired was because I was expected to perform these annual exams that made no sense to me. I had a busy practice and felt like I was wasting my time meeting with the worried well who wanted to exploit a free service. You are so right, rarely can you have a wellness visit and not find a diagnosis that needed to be addressed. And as you said, billing for these just upsets the patient. It is about time to do away with this nonsensical mandate.

— James Gallant

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I believe Dr. Millstein’s interpretation of the Medicare Annual Wellness visit is a common myth among physicians who have been trained on “how to get paid with the minimum of effort.” Certainly, that is one view of medicine. However, the Medicare Annual Wellness visit also offers the opportunity to provide much better care. I don’t see any need for Medicare to change the description. I do see the need for clinicians to improve their practice by properly including these optional functions when beneficial.

— Daniel Russler, M.D.

“Sobering centers offer a safe place to recover from intoxication. Every community should have one,” by Shannon Smith-Bernardin

Funding is fascinating. The tobacco companies now pay, opioids now pay, but the scared alcohol empire doesn’t. Alcohol is a social cost that should be borne by the industry. Plenty of studies show use of alcohol results in double-digit addictions. The role of government is to level the playing field. The burden of addiction should be borne by the addicting product. Good job moving the patient to a possible choice to change in the sobering centers. Now have those profiting pay their fair share.

— Scott Swift, retired physician

“Europe’s lessons for the U.S. on how to cover weight loss drugs,” by George Hampton

This is a self-serving pharma article that discusses a complex issue from a pharmacological perspective alone (and his interest in his company’s profits). How about tackling obesity at a broader level at its source? Farmer subsidies for fat/sugar food ingredients, and a clamp down or tax on fat fast-food merchants like McDonalds etc. etc. American tastes for this trash food won’t change overnight, but some financial extraction for their societal costs may help the health industry attempt to fix this obesity epidemic.

— Gene Smythe, M.D.

“Health care AI requires a new Hippocratic oath,” by Peter Shen

The question is: Do any AI applications currently used in medicine come anywhere close to meeting these minimal ethical standards?

—Michael Doran