Medical education
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The modern version of the Hippocratic Oath requires doctors to swear that they will apply, for the benefit of the sick, all measures that are required, avoiding the twin traps of overtreatment and therapeutic nihilism. This paper explores the magnitude of the problem of overtreatment and undertreatment and the potential sources of these treatment errors. ⋯ Doctors are at risk of falling into the twin traps of overtreatment and therapeutic nihilism. Further research should explore how to avoid these traps, but it may require deliberate reflection on problems to be solved to counteract the influence of factors that are beyond the patient's problem.
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Medical educators in the U.S.A. perceive the teaching of palliative care competencies as important, medical students experience it as valuable and effective, and demographic and societal forces fuel its necessity. Although it is encouraged by the Association of American Medical Colleges, the only palliative care-related mandate in U.S. medical schools is the Liaison Committee on Medical Education directive that end-of-life (EoL) care be included in medical school curricula, reinforcing the problematic conflation of EoL and palliative care. ⋯ Given the reality of overstrained medical school curricula, developmentally appropriate, basic palliative care competencies should be defined and integrated into each year of the medical school curriculum, taking care to circumvent the twin threats of curricular overload and educational abandonment.