The Lowest Common Denominator

“Negative ads move numbers, they may, but do we have to go to the lowest common denominator? I don’t think so.” – Senator John McCain

I believe that the attitudes, beliefs, and conduct of our leaders are often reflective of our own: by their example, we consciously or subconsciously find guidelines for acceptable behavior. Unfortunately, I suspect that we are consistently lowering expectations and standards of behavior as we repeatedly aim for the lowest common denominator. While I was disappointed when George W. Bush was elected President of the U.S. for the first time in 2000, I was deeply disturbed when he was reelected in 2004: to me, that result spoke to the generalized acceptance of proven mediocre leadership. Instead of seeking leadership demonstrating intelligence, wisdom, and a deeper and more sophisticated understanding of issues facing our country, many voters preferred leaders who they believe are “more like me.” Speaking in the vernacular, oversimplifying stances on issues, and focusing more on appearance of decisions and actions than on the substance of the decisions and actions appears to have been sufficient for much of the past eight years. While it is fortunate that these tactics have been less successful for the McCain-Palin campaign, it is still disheartening seeing prominent examples of the celebration of unapologetic incompetence.

Unfortunately, I think that the lowering of expectations and standards sometimes penetrates into the training of future physicians in medical school. One of the best trends in medical school education has been the transitioning of preclinical courses to Pass/Fail grading: this new policy has created a widespread change in the attitudes of medical students toward cooperation and teamwork, particularly since today’s medical students were once subjected to the cutthroat atmosphere of premedical education. Accordingly, medical students now like to talk about “gunners,” students who have few or no bounds in what they might do to accomplish the highest level of academic achievement, as social pariahs. Another popular saying is “P=MD”, suggesting that passing is sufficient and perhaps even the ideal goal (e.g. exert the minimum effort that is sufficient to pass).

While I am sympathetic to all of these notions, it worries me where this road might lead. For much of my life, I have bought into the idea that “if I want something done right, I will have to do it myself,” but I have spent the past several years learning, practicing, and teaching leadership through empowerment of others and highly supportive teamwork. In my eyes, the highest priority for a team is the task at hand, not the rewards for each individual, because a good team takes care of each of its members and does not overuse or abuse any member. Last year during a training session led by fourth year medical students to prepare us (second year students) for life on the wards, I spent a great deal of time thinking about the notion of “sandbagging” and the warnings that the senior students had about this behavior. “Sandbagging” typically occurs when a student makes a teammate look bad in the eyes of the residents or attending physician. What bothered me most about this idea was that the fourth year students could not provide a clear definition of this behavior: on the one hand, answering a question asked directly to another student is obviously inappropriate and easy to avoid, but how far do the boundaries of this behavior extend? With this in mind, I was very surprised when a fellow student privately accused me of sandbagging when I asked questions about the student’s patient (that I had helped admit from the ED while on call) and demonstrated some knowledge of the patient’s social history that the student had not elicited. I was immediately apologetic and felt bad about any effect of my actions on his feelings or appearance, but as I thought about the situation more, my remorse turned to questioning and even anger. Later, the resident on the team assured me that my action was not inappropriate, did not seem like sandbagging, and was reflective of the nature of a clinical team: each member contributes and each member should be involved in the care of each of the team’s patients. What, then, was the nature and purpose of the impassioned accusation?

Something seems very wrong to me when our country entertains or supports the idea of electing politicians who lack a sophisticated understanding of policy issues and are proud of their ignorance. Something seems very wrong to me when one’s appearance (as a medical student) is a greater priority than furthering discussion on a patient’s medical care. I, for one, do not buy into the culture of desirable mediocrity, and it helps me better appreciate my classmates and colleagues who show excellence with grace and give me something to aspire to and are willing to help me learn.

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