Friday, January 19, 2007

Role reversal

In 119 days, I will be Dr. Nathan. At that point, I'll have to start teaching med students and passing on what little knowledge I already have. As Dr. Lest said a few days ago, if we don't teach those behind us, there will be no doctors eventually.

So today I had an opportunity to warm up to this, and I may have learned more than he did. There's a third year med student on my team, and today I delegated two patients from my load to him, to examine and write notes on. And being a third year, he did some pretty bad exams, and wrote some pretty bad notes. Here's where I made my mistake. As the next guy up the chain, it really is my responsibilty to make sure his work is as good as I can make it before I pass it up the chain. But I didn't. I let his notes get passed on to the intern without correction. And later, when the third year was off doing something else, the intern started telling me what he thought of his notes.

In a scientific profession, a great deal of your collegue's opinion of you is formed by your writing, and muddy reasoning doesn't win you friends. Not here anyway. And once you get off on that track, any quirk or slip becomes fodder to form a progressively worse opinion. So after the notes fiasco, I'm afraid my third year has a long uphill fight to get a good grade. The plan, according to my intern, is to "ream some sense into him. The way you learn is by getting chewed out, so you don't make the same mistake twice. If that guy doesn't hate me by the end of this rotation, I haven't done my job."

See you run into this type of person a lot in medicine, at least (and especially) in surgery residencies. They aren't bad people, per se, they just have a very hostile attitude and a firm belief in the wisdom of imparting wisdom through beatings. I'm not one of them, but I should have seen that coming.

But on the other hand there is some wisdom to what he said. By this point, he should be able to write a good note. And in residency, you have to be able to put up with a lot of drudgery and thankless work to take care of patients. Though it is often minutiae, the minutiae matter in medicine. Even the easy going guys know this. Another, much more chill intern, when discussing his plans for teaching next year when he is a resident, said "really, your interns should be terrified of you for six months. Otherwise they won't be conscientious enough."

I guess in the long term, the most important thing is that the med student/intern/resident takes care of their patients without hurting them. But I think a close second goal is preserving peace between us all. The universe is a big enough enemy most days in the hospital, without creating more.

I think I'm a tolerable teacher, but now I have a twofold motivation to be better. One, making good doctors out of those behind me, and two, equipping them them to avoid the pain of getting chewed out by others with more punitive styles.

So, third year, let me show you how to write a note...


medstudentitis said...

Wow. That's not too long until you're a real doc! Self-prescribing here you come!

The experience of this third year is why I'm scared of clerkship!

Nathan said...

I'm sure you'll do fine. The best equipment to take into your interactions with a resident is a thick skin. But listen to their corrections. Even the mean-spirited ones.

Ibid said...

In the humanities we study the "science" of error correction up one side and down the other. The conventional wisdom is: the student who feels motivated rather than beaten down will do better. I think there's some truth to that. On the other hand, motivation can come in many forms.