A new paradigm?

A friend of mine once considered going to officer candidate school (OCS). Of course, he didn't realize this was for folks who want a commission in the armed services, and when we let him know, he reconsidered. However, I don't think that OCS is a bad thing. In fact, I think that things like OCS are quite useful sometimes.

One thing that I think medical school is lacking is training student doctors what it means to be a doctor. There is the education and interviewing and a lot of other aspects that go into medical education. However, I think that a lot of medical schools lack training in the professionalism and ethical behavior of being a doctor. Certainly every school teaches medical ethics, but it is in the safe environment of a classroom. It lacks the thing that OCS excels at: put someone in a real situation and watch them squirm.

An intern I was working with was managing a patient in the clinic, and I saw the patient on a sick visit, and one look at this poor patient was enough to admit him to the hospital. It was a judgment call, but one that the intern should have been able to make. Why didn't the intern admit?

I was the admitting resident and had 3 admissions from the clinic. None of the residents or attendings had contacted me to let me know. Two patients were having acute CHF exacerbations. One was an acute asthma exacerbation. After seeing these three patients, I transferred one on the cardiac stepdown unit, and one patient went to the ICU. Why didn't any of their doctors contact me about the acuity of their patients?

I think that medical school needs to teach doctors to make good decisions, because if you don't want to make good decisions, you shouldn't be a doctor. Being a doctor is all about making decisions. You may not make the right calls all the time, but you must continually question your decision making process, and evaluate yourself critically.

And after confronting all of the medical personnel mentioned above, several mentioned their poor decisions based on workload. They were too busy to do the right thing, and they all recognized that there was a right decision and a wrong one, and that they had not made the right call. But it took being confronted about it. I wasn't mean or rude. After all, in some cases, I was a resident questioning an attending. But if I didn't confront these folks, would they have learned?

I had a part time job once where my boss was a former marine. Let me tell you, having a marine for a boss is a mixed blessing. It turned a pretty easy job into a LOT of work. But the job had relatively little direct supervision. If I did a shitty job, no one would really know. But I always did my best.

My boss recognized me in a meeting, and I was completely stupefied. What had I done other than what was expected? And I realize now that what I had done was something quite simple, but something worth recognition. Without any desire for reward or recognition, with no one looking over my shoulder, I had done my best, because if I was going to do something, then it should be done right.

And I was talking to my boss about being a marine, and he told me that they teach marines something simple but profound. A marine should always do the right thing, even when no one is looking, because that is the best way to judge a man. And I agree. I think that if you can very accurately judge the character of a man by what he does when no one is looking, and by what he does when he is under pressure. Does he do what is right or what is easy?

I told my marine boss that I wanted to be a doctor, and he told me that I would be excellent. What did he know about being a doctor, I thought to myself. He told me that excellence is all about being excellent in all things. And if I can do a good job with essentially meaningless work, then how much better I would be at something where I can make a difference.

And I'll tell you right now, when I see students and residents, I let them know that you can know Robbins word for word, but that won't make you a good doctor. You measure a doctor by how he cares for his patients. And when I was a senior resident, the folks I came down hardest on weren't the ignorant, but on the lazy. I have no sympathy for laziness or arrogance. How can you ever look at yourself in the mirror if you don't do what is right when someone's life is in the balance?

If I could teach that to a medical student, just one, then that would be enough to change the world.

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