Modern medicine is failing in three critical areas: mental health, chronic disease, and prevention at the cost of trillions of wasted dollars and untold suffering.
The problem runs deep. In my earlier KevinMD post, “Medicine’s mental health crisis: why the system is failing us,” I described the “mind-body split” theory of the 16th and 17th-century Scientific Revolution as guiding medicine and medical education since that time. It cordoned off mental and other psychosocial issues to the church and left medicine responsible for just physical problems. That framework doubled life expectancy over the last century, but it no longer serves us well. The theory fails in the three most common problems in modern health care mental health care, chronic disease care, and prevention.
While other sciences were just as reductionist at the outset of the last century, they have all evolved to the holistic systems view during the 1900s looking at all parts of a problem rather than just one part, as medicine continues to do. This raises the unwelcome prospect that, despite its initial successes, medicine has not kept up scientifically, arguably becoming nonscientific.
Medicine’s resistance stems from two entrenched educational practices that keep us stuck.
- Over 7+ years of professional training, only 2 percent of total teaching time is devoted to mental health and other psychosocial issues.
- It relies on rote learning over critical thinking, the need for memorization stifling thinking out of the physical disease box.
We should not be surprised that physicians seem brainwashed. Importantly, this afflicts not just practicing clinicians but also physician leaders who make decisions about the direction of medicine and medical education.
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Thus, if one is concerned about mental health, chronic disease, prevention, costs, and the specter of a nonscientific medicine, we would look to change medical education practices. And we have a precedent for this in medicine over one hundred years ago.
After the isolated focus on physical diseases became the most scientific approach in American clinical medicine in the late 1800s, the American Medical Association expressed concern that many medical schools had not adopted it, suspecting they still taught prescientific practices such as bloodletting and application of leeches. The AMA, as the dominant figure governing medical education at that time, asked the Carnegie Foundation to investigate all medical schools to determine if their teaching was based on the mind-body split theory and its focus on physical diseases although reductionistic, it was the most scientific approach at the time. Abraham Flexner led the investigation, and his 1910 report confirmed the suspicion that nearly all schools failed to measure up. The AMA, acting via state licensure control, closed many of the proprietary schools and required vastly improved teaching practices in those that remained.
Thus, the then-governing authorities ensured that medical schools taught the most scientific approach available at the time.
It is time for a “second Flexner Report” to again ensure that medical education is based on the most scientific thinking of our time. Because of the health care and cost problems above, an independent commission of experts (Presidential, Congressional, private foundation, National Academy of Medicine) would investigate all medical schools. Predictably, they will find two things:
- Curriculums still based on outdated, non-systems science.
- Graduates ill-prepared to conduct mental health care, chronic disease care, and prevention driving an extraordinary waste of money in the trillions of dollars.
When the new report is released, the public will be understandably enraged at such dereliction and will demand, through its politicians, that medical education and medicine itself adopt the best current scientific thinking. Given medicine’s resistance to this change since the 1960s, the public will also demand medical care and medical education be governed by an independent federal agency analogous to the Federal Reserve that governs banking.
This article is discussed on The Podcast by KevinMD: Reimagining medical education for the 21st century.
Robert C. Smith is a University Distinguished Professor of Medicine and Psychiatry Emeritus at Michigan State University. His group defined the first evidence-based patient-centered interview, published as Smith’s Patient-Centered Interviewing: An Evidence-Based Method (McGraw Hill, 4th edition, 2018). They also identified the first evidence-based primary care mental health model, published as Essentials of Psychiatry in Primary Care: Behavioral Health in the Medical Setting (McGraw Hill, 2019). Educators use both books to teach medical, nursing, and other health care learners in the U.S. and abroad.
Fed up with medicine’s resistance to improving training in mental health care, Smith decided to take the problem to the public and wrote Has Medicine Lost Its Mind? (Prometheus Books, 2025). It describes the poor state of mental health care in the U.S., why medicine ignores it, what needs to be done, and how the public can accomplish this politically.
His scholarship spans patient-centered interviewing, medically unexplained symptoms, the biopsychosocial model, and mental health training in primary care, with work appearing in Annals of Internal Medicine, the Journal of General Internal Medicine, Patient Education and Counseling, and Social Science & Medicine. It includes the invited opinion piece “The mental health crisis: Only top down regulation will cure medicine’s folly” in PLOS Mental Health. He writes at robertcsmithmd.com and shares updates on Facebook, LinkedIn, and X.
