Monday, October 20, 2014

For Reference: People Never to Become

The Workaholic
On internal medicine I worked with a resident who terrified me. I don't mean that she was malignant. She terrified me because when I looked at her I saw a possible future self, a self that I could all too easily become. She had just gone through a family death and had obviously thrown herself into her work. She worked almost constantly: at five in the morning she was checking her interns' patients' charts from home, and at nine or ten she finally left the night team alone in the resident lounge.

How could I possibly be attracted to that, you ask? She was incredible! She was constantly energized, she seemed to know everything, and she managed complex patients with ease. She was chic, funny, friendly, and beautiful. 

The first time I encountered her was actually on my OB/GYN rotation. Gyn was consulted on an ICU patient of hers. The patient had widely metastatic cancer, was comatose, and was intubated. The patient looked agonized and the family members looked weary. This resident strode into the room, looked at the people in front of her, and (with grace, directness, and ease) began a conversation about withdrawing from the ventilator. Two minutes later the patient was extubated. Wow, I thought. That's a doctor who gets things done. That's someone who cares about people. 

I was incredulous to find out that this was my upper-level resident on wards. I was so excited. But I soon slipped from hero-worship into terror. Ever since that wards month, I've been careful not to become the Workaholic. It's hard! I have been getting up in the four- and five-o'clocks for all three of my audition rotations. My odd jobs keep me busy, and mealtime and prayer time are constantly threatened. But I've seen the danger at the end of the workaholic road, and it's awful. So I'll fight to make time for deep relationships, character development, and personal enrichment.

The Malignant Attending
Someone please remind me when I'm an attending to build people up. There are two forms of mechanical air exchange and there are two forms of medical education: high pressure and gentle encouragement.

The first model, which we'll call the "Sergeant" method, is horrible. In this model, every mistake is loudly called out and the student is made to feel small. "What are you doing? Use your brain!" my attending on my second away rotation has told me. "That's stupid," and "How many times do I have to tell you?" are commonly heard in his OR. He swats hands instead of using words to say "[give me the] suction," or "off [with the retractor you're holding]." This behavior extends to the OR staff, residents, other physicians, and basically anyone other than the attending. I've seen several very childish displays. My current attending openly champions this form of teaching, stating that it's the sergeant who saves his men's lives by laying instincts into them. But habits don't have to be formed by negative conditioning.

I have always thought that the most effective way to teach is the Socratic method. Applied to clinical education, this would look like a gentle person asking, "Tell me what you read last night," and letting the student talk. This would say, after a student conducted a history or physical or did some procedure: "Tell me what you did right and what you'll do differently next time."

In the OR, the residents and I exchange many looks when we work with this attending. "Never throw your subordinates under the bus," one whispered to me one day when the attending was out of earshot. Mentally, I vowed never to do so. It's horrible. Not only does it make your students feel like dirt and resent you, it leads to passive-aggressive behavior in staff, it makes residents believe you're a senile joke, it makes everyone eager for your retirement, and it makes you habituated to treating people like slaves and objects.

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