Dr. Simone Gold
speaker
456 appearances
3 recordings
2 series
first heard Jan 2025
last heard Jun 2025
Dr. Simone Gold’s voice in public audio — every appearance, attributed to the second.
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I sometimes joke that I'm bilingual. It's just... One in the same to me. One wasn't easier or better. They were completely different. And I was very comfortable in both.
Right, so I'm so glad to be able to sit here and explain this to you. They could not be more different. Medical school is a lot of work. It would be 12-hour days, 15-hour days, including classes. And you were presented with material by a teacher. You scribbled notes as fast as you could or you typed them. And you would memorize them, you'd learn them, you'd regurgitate them.
And you really were only being led to ask approved questions because you had specific material. It might be like doing a reading comprehension test. You read a paragraph, you ask the questions on that paragraph. So I would say there was no critical thinking. It's certainly no critical thinking in the first two years of medical school. It's not.
Right, right. Exactly. into the third year of medical school, we would do hospital rotations and you'd be at the bedside. So you were expected to read up about the disease that the patients had on your service. And you could ask questions about that situation. But the senior physician on rounds would answer those questions.
So they were still, in retrospect, in comparison to law, very circumscribed, very circumscribed. Why this drug? Why this treatment? How long should the treatment be? How's the oxygen level? It was almost mechanical. in comparison to law. It was never outside the box. It was always within the box.
That is true, but you're even being a smidge generous because it's always changing, even in medicine. It's always changing the direction of new medicines, new treatments, new tests. Right. It's just so different. So, for example,
You would be learning – if somebody came in with a heart attack or chest pain, you would do X, Y, Z. But next year, there might be a different lab test, and you would just add that lab test to your group of lab tests. You never actually deleted a lab test. You just kept adding and adding and adding. I mention that because our healthcare expenses are out of control. So you would never –
think about, well, what's the critical improvement on this test versus that test? Let's just eliminate this test. I came up with that very directly. There was a test when I was growing up, it was called the CK, the CKMB that was elevated in heart attacks. Then the troponin test came out that was much more specific, much more sensitive.
And I would say to my instructors, why are we not eliminating the CK test? It's not as specific, it's not as sensitive. Nobody knew. We just did them all.
You multiply false positives. That's a big problem. You multiply the false positives. You chase red herrings all the time. And I think, worse of all, you were not teaching the practitioners... to think and maneuver in new times, right? Because they should be paying attention. Oh, the troponin test, it is more sensitive, it is more specific. I will eliminate this other test.
We were never taught to think how to maneuver and grow. I would say we would not talk to grow. We were taught to stay here and maybe expand a little bit, more testing. I'm not sure if this all makes sense.
I think you're exactly right. So first of all, I was quite weak in biostatistics, for example. It was not a strong suit of mine and it never precluded me from becoming an excellent physician. Right, right. So we would always have classes on statistics. Nobody was very good at them. Honestly, it was something we all dreaded. We're not good at it.
We are not at all trained how to recognize good research from bad research.
Terrible. You know, I vaguely remember, but... I was coming at this from the perspective, some of the headlines at NIH-funded studies were so kind of foolish. I didn't even understand why we were doing these kinds of studies, funding them. But we were not really taught how to finally distinguish good from bad.
And Dr. Joseph Latipo, who I'm sure you know, about a year or two years ago, he tweeted out that one of the problems in medical training is doctors simply don't know how to analyze data critically. I would say 100%. I learned virtually nothing like that in medical school and a little bit in my residency training. And I never, I wouldn't have, I'm not even sure I would deserve a C- in my abilities.
Yes, 100%. First of all, I didn't even understand the difference between physician and scientist. But I'm validating that American medical schools do not teach critical reasoning skills and they do not teach us how to analyze science, for sure. That is...
The diagnosis is all of it. And I'll just digress a little bit here just because I share with you some of my training. So I had a very unusual circumstance because I went to my internship, which was my first year of residency. Then I went to law school. Then I went back to residency training. In that three or four years, something had changed in American medical training. What years were these?
This was around 1990. Yeah, okay. So what happened was, perhaps you've heard of the Libby Zion scandal. What had happened in America was a young girl had gone to the emergency department and she was very sick and she was sitting in this emergency department. She ends up dying. Turned out her father, I think was a reporter for the New York Times, very well connected person.
And he decided that this happened because the medical residents were so tired and sleep deprived and overworked. So in the years that I was away, in the years that I was away, but I'm going to blow your mind a little bit, because in the years I was away, they changed how resident physicians were trained. Up until that moment, so in my internship, in my first year, we routinely did 36-hour shifts.
It started 7 or 8 in the morning, you go to 7 or 8 the next night, you crash, you go to sleep, and then you have a couple more days of like 8 to 6 or 8 to 7, and then you come back every third or fourth day to do that. There's no question that it's brutal.
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