Barry Blackwell: Adumbration - Comment by Samuel Gershon 

This is a very important and insightful document. It raises many issues that are diluting the quality of medical education, and therefore, the quality of medical care. There are many causes for this in today’s interconnected causalities. Many medical centers have centralised control of physician’s style of practice by having a master appointment center making doctors’ appointments for them without knowing anything about the particular patient. The appointments are classified as first visit and follow up with the latter getting about a 12 min allocation. There are medical centers which are producing a profit but curtailing expenditures for medical staff and for staff time for medical education. I am familiar with several examples of this, where staff time for teaching is curtailed and to facilitate this, some topics are cut from the curriculum, e.g., clozapine and lithium. I hope that opening this issue up for wider discussion  will be followed up by other articles elaborating on these issues. I would like to open up the pressures on scientific journals and the enormous cost cutting instituted by publishers. We should not believe for a moment that these costs are not paid for in other ways, which end up diminishing the value of some published material.

Samuel Gershon

October 29, 2015