I used to show my patients the phrase “The Saints are going to the bowl this year” to test comprehension; I could tell if they understood it if they laughed.
Well, the Saints did it. They went to the Superbowl. They won. We won. Who dat say New Orleans couldn’t come back, couldn’t win. WHO DAT, WORLD!
This month, I am taking an Advanced Clinical Teaching course taught by our Internal Medicine Program Director, Chief of the Charity Hospital system, and one of the best teachers I have ever had: Jeff Wiese, MD. He describes the course as an “Inside the Actor’s Studio” approach to clinical coaching, not teaching, as he asserts that medicine is a performance sport. The ultimate goal is to help us evolve from the earlier phases of teaching (where the motivation is self-reaffirmation of extent of knowledge and external validation though commendation and teaching awards) to the last phase of teaching (where teaching is only about helping your learner develop the skills and understanding to become a better clinician for his or her patients).
His first axiom of teaching is “Understanding is more important than truth.” This, for me and a great number of clinicians and scientists, is difficult to reconcile with the innate compulsion to strive for perfection in knowledge and practice (that theoretically is a selection criteria for medical school, at least until medical students start believing “P=MD”). However, I believe it is the essential foil to the most common, paralyzing mistakes in teaching medicine: the temptation to fill lectures with every nuanced detail and exception, and the inability to empower students. Knowledge is not empowering. Trying to convey large amounts of knowledge can, in fact, be very disempowering as it reminds learners how much they do not know. Understanding and developing methods of understanding are empowering. Without fully recognizing it, this is exactly what I sought to accomplish with the Doctors Ought to Care school health education program I co-led as a second year medical student: we were reshaping lesson plans to give young people the tools with which to better their health, stay motivated, and learn more.
Reflecting on this past week and the weeks ahead, I am thrilled by this month’s potential: I am going to be a much better teacher and a much better clinician than I otherwise would be. If nothing else, this month is giving me the time to build a repertoire of lesson plans, talks, and methods (including “advanced organizers”) to address areas of Neurology as well as the areas in Internal Medicine I find most important to my future practice. A few months ago, I was tempted by delusional hopes of being able to read all of Adam and Victor’s Principles of Neurology or Harrison’s Principles of Internal Medicine before starting my intern year. This is a result of the ways I have been taught previously: that there is so much knowledge out there and that I simply do not know enough. Even if I had the time for that, though, most of that knowledge would have been stored in short-term memory and would have disappeared by the time I started my Neurology residency. Now, as I develop methods and “canned talks”, I am learning, retaining, and understanding more than I otherwise could. I have already developed talks on the differential diagnoses of headaches and spinal cord disorders (one subject I have never previously had a good grasp on). I am hoping to cover the major topics in Neurology by the end of the month and to have somewhere between twenty and thirty prepared talks (spanning Neurology and Internal Medicine) by the time I start my intern year. I have not felt this motivated to learn in a long time.
Five years ago, Dr. Paul Farmer was invited to be a guest lecturer for my Social Analysis course at Harvard College. The course opened my mind to the needs of the world with respect to public health and medicine. While my primary demographic interests in medicine are more oriented to domestic, urban, inner-city populations, one sentence in Dr. Farmer’s talk with respect to international medicine bothered me for quite some time. In an effort to call upon our sympathy and recruit motivation to support efforts to bring first world medicine and people to third world, resource-poor settings as Partners in Health was doing with Haiti, he said that in the end, it all comes down to one thing: mercy. At the time, my skeptical mind wondered, “Is this pseudo-religious/spiritual talk of mercy really going to convince a cynical, selfish human race to help those in need thousands of miles away?”
That was the year of Hurricane Katrina. Even in the chaos and the demonstrations of the worst part of human nature, the vast majority of humanity on display was that of grace under fire-and mercy. The past four years of my life as a listener of stories is filled with anecdotes like an easy-going counselor at my school jumping in his fishing boat to ferry neighbors and strangers from rooftops to safety, the sending of food to my parents and other survivors stuck in a flooded hospital from people all over the country, and the rapid response of firemen and policemen who flew down from New York City who felt they owed something to New Orleans, one of the cities that donated fire trucks and equipment to NYC after September 11, 2001. Despite the cynicism, so many people around the U.S. and around the world helped New Orleans rise out of the ashes to the city it is today: as fun-loving, free-spirited, and full of life as before.
Now, another group of people is in desperate need. To the vast majority of humanity that recognizes our oneness as a people, as one human race united by an everlasting desire to grow and find a better future, ignore the cynicism and skepticism and do what you can to help those suffering in the wake of a terrible natural disaster.
Stand with Haiti – Partners in Health
