Miracles We Have Seen
Page 38
It was not until I became responsible for attesting to the professional maturation of medical students that I was able to see this issue in much sharper focus and with larger scope. The fact of the matter is that the value systems of our entering medical students seem, in many ways, more diverse than ever before, possibly reflecting their cultural diversity. These differences in values are revealed in one-on-one conversations with students when they come to our attention for “misdeeds,” and also in seminars where, in a supportive environment, they are free to express a wide range of reactions they would have to specific circumstances. These differences do not lie with specific groups of students—gender, ethnicity, and age don’t seem to matter. While I can’t be certain, I suspect that prior life experience is what matters most.
The interactions I have had with medical students have provided me with deep insight and poignancy, and have guided my determination to help our trainees with their professional transformation when they need it or want it. And I share this as examples of the ways miracles in training can actually happen, if only we spend the time and invest in our trainees.
All of the students who are referred to me because of unprofessional or inappropriate behavior and interactions with others had performed admirably in the objective aspects of our clinical doctoring courses, in the examinations on history taking and physical examination, and on essays related to doctor-patient interactions and medical ethics. They knew what to say when asked directly. But they were having trouble with the “softer” part of professional transformation: they might have had disrespectful arguments with classmates, not shown up on time for rounds or conferences, or expressed dismissive attitudes to course preparation. They should not be doing these things, right? So, why were they? Some were distressed in their personal lives, and often we can find this out and help them. Others may have simply come from environments where these behaviors are accepted or tolerated, where the kinds of role models I was fortunate enough to encounter simply don’t exist, and the students see their actions as innately acceptable and available for them to choose as they wish. Why should they change the way they are acting?
My interventions with these students are based on my observations over forty years in an academic medical center. When I meet with them to discuss these kinds of troubling issues, I encourage the student to be honest and truthful about the incidents they have been involved in, and I encourage them to capture the emotion of the moment and describe it as best as they can. And then I ask them if they are wondering why I, or others, are concerned about their behaviors. Interestingly, students are often surprised their behaviors have been noticed by the faculty and deans, and, even more disquieting, they often don’t understand why we are concerned! So I offer to explain to them, simply and concisely, my philosophy of being a physician who behaves professionally.
To start, I explain that my intent is to help them to take advantage of all the wonderful future “perks” that go along with becoming a physician. One of the ways to maximize their advantages in the future is to be very aware of how their behaviors are affecting others. The cultivation of desirable behaviors, leaving behind those that are “off-putting,” during the training process allows those behaviors to become professional habits they will carry forward with them into any arena they enter in the future. Whether patient care, laboratory or clinical research, or the vast array of alternative careers physicians can find themselves in today, professionalism is the key element for success and fulfillment. I tell them cultivating desirable behaviors allows all others (patients, colleagues, staff, visitors, etc.) in your environment to potentially accord you a special status, respect, and acceptance that can ease your way forward in your career. Your opinion will be sought, you will be on the short list considered for new opportunities for leadership, and many more doors will “magically” open up for you. Those who do not pay attention to the ways they affect others often lose out on opportunities for which another’s selection, nomination, or recommendation of them is an important part of the process of advancement. I tell them if they don’t become sensitive to the impact they have on others, they will someday wonder why they are not chosen for positions they seek. And they will feel less satisfied with their careers. The importance of making these desirable interpersonal behaviors habits of performance cannot be overemphasized, as they often transfer into the kinds of appropriate interpersonal behaviors young physicians will demonstrate in their patient interactions. Ultimately, the doctor’s relationship with his or her patients is the true metric by which a physician’s merit and standing should rest.
Remarkably, while the total number of these professionalism counseling conversations with students is relatively small, in more than half, the real miracle occurs soon thereafter. Within a week of graduation, or some other time during their final year of study, a small note appears under my office door. It typically says such things as: “Thank you, for the conversation we had, for the insights you provided . . . my world has improved greatly since our conversation . . . people now consider me for new opportunities and leadership . . . my patients seem pleased with my performance as their ‘doctor’ . . . I’m not sure this would have happened if we hadn’t spoken about the importance of managing how other people see me . . . I had no idea how important this might be.”
I have always been struck by the personal poignancy of these notes, and gratified that something as simple as straightforward and heartfelt conversations can have on a physician’s future.
And so, in addition to the glorious experience of taking care of patients with myriad medical issues over my career, I have been even more blessed to have had the opportunity to provide guidance to medical students and physicians-in-training for over three and a half decades. When a professionally transformative event occurs for one of my students, I am ever grateful and cognizant of the large number of individuals who will benefit in the future from that single transformation. I am grateful that, along the way, I have been part of a more explicit curriculum that helps our students and physi-
cians-in-training become the kind of professionals we would all select to take care of our family members.
Just as it is with caring for patients, we are also blessed in this work to care for those who come after us as physicians, as the Hippocratic Oath demands, and ensure their best health and well-being in preparation for their professional future.
For Hafferty’s paper on the curricula for educating medical students, see:
Hafferty FW, “Beyond Curriculum Reform, Confronting Medicine’s Hidden Curriculum,” Academic Medicine 1998; 73: 403–407.
EPILOGUE
The editor of this book (Dr. Rotbart), as well as his literary agent (Lisa Leshne, the Leshne Agency) and contracts manager (Deirdre Smerillo, Smerillo Associates) are taking no income from this project. Rather, 100 percent of net proceeds from advances and royalties resulting from the sales of this book will be divided among charities designated by each of the contributing essayists and, in some cases, by their patients. Those charities are listed below in hopes readers might also consider supporting these worthy causes.
Alliance for Children
Alyn Children’s Hospital
American Cancer Society
American Heart Association
American Lung Association of the Northeast
Arapahoe Philharmonic Orchestra
Arkansas Children’s Hospital Foundation
Autism Speaks
Bay Area Cancer Connections
Big Brothers, Big Sisters
Catholic Relief Services
Children’s Hospital Colorado Center for Cancer and Blood Disorders
Children’s Hospital Colorado Child Health Clinic
Children’s Hospital Colorado Foundation
Children’s Hospital Colorado Special Care Clinic
Children’s Hospital of Philadelphia Alumni Organization
Children’s Hospital of Philadelphia Hematology Research
Christ Episcopal Church, Charlottesville, VA
Colorado I Have a Dream Foundation
Colorado Humane Society
CURE Childhood Cancer
DAT Minyan
Denver Dumb Friends League
Department of Pediatrics, Mount Sinai Medical Center, New York
Donate Life Northwest
Fast for Feast
Footwork, the International Podoconiosis Initiative
Joni and Friends
Head and Neck Cancer Strategic Initiative Fund, Ohio State University
The Health Wagon
Janet Weis Children’s Hospital Pediatric Rural Trauma Initiative
Jersey Shore University Medical Center Foundation
Jewish Federation of Philadelphia
Juvenile Diabetes Research Foundation
Kawasaki Disease Foundation
Kempe Center for the Prevention of Child Abuse and Neglect
The Kempe Foundation
Lazarus Family Fund at the AMA Foundation
LDS Philanthropies
Living Room Ministries International, Kimbilio Hospice
Lucille Packard Children’s Hospital
Lucille Packard Children’s Hospital OB Family Fund
March of Dimes Foundation
Medical College of Wisconsin, CNS Infections Fund
National Brain Tumor Society
National Medical Fellowships
National Multiple Sclerosis Society
Natural Areas Conservancy, New York, NY
Operation Breakthrough
Reach Out and Read Colorado
Roundup River Ranch: A SeriousFun Children’s Network Camp
Saint Rock Haiti Foundation
Samfund, Boston
Save a Child’s Heart Foundation
Save the Children
Sensory Processing Disorder Foundation
S.L.E. Lupus Foundation/Lupus Research Institute
Society for Vascular Surgery Foundation
Special Fund of Rabbi Joshua Skoff at Park Synagogue, Pepper Pike, OH
Special Fund of Rabbi Wesley Gardenswartz at Temple Emanuel, Newton, MA
Surgical Infection Society Foundation for Education and Research
Tygerberg Children’s Hospital Trust
University at Buffalo, School of Management
University at Buffalo, Jacobs School of Medicine and Biomedical Sciences
Washington University School of Medicine Dr. Frank O. Richards Medical Student Scholarship Prize
Wounded Warrior Project
ABOUT THE AUTHOR
Dr. Harley Rotbart has been a nationally renowned pediatric specialist, parenting expert, speaker, and educator for over three decades. He is Professor and Vice Chair Emeritus of Pediatrics at the University of Colorado School of Medicine and Children’s Hospital Colorado. He is the author of more than 175 medical and scientific publications, and four previous books for general audiences: 940 Saturdays; No Regrets Parenting; Germ Proof Your Kids; and The On Deck Circle of Life, which was endorsed by baseball Hall of Famer Cal Ripken Jr.
Dr. Rotbart has been named to Best Doctors in America every year since 1996, as well as receiving numerous other national and local awards for re-search, teaching, and clinical work. He serves on the Advisory Boards of Parents Magazine and Parents.com and makes numerous media appearances every year, including two recent satellite media tours with American Idol finalists to promote influenza prevention. Dr. Rotbart is a regular contributor to Parents Magazine and the New York Times, is a consultant to national and local media outlets, and writes his own blog at www.harleyrotbart.com. “Coach Harley” coached youth baseball and basketball for sixteen years, including eight years at the high school level.
Dr. Rotbart and his wife, Sara, live in Denver, Colorado, and are the parents of three grown kids, each a miracle in his or her own way.