Interesting discussions

Today I attended a school of medicine committee meeting where one of the agenda items involved a discussion about teaching behavior change counseling techniques to medical students. As part of the discussion, a concern was raised about identifying and teaching skills for students to deal with their own personal biases that might affect their patient care... primarily biases that center around choices patients make that are not in the best interest of their health. And whether or not students personally make some of those same choices and how that impacts their patient care. Interesting discussion.

Which led me to remember something that happened to me during medical school and residency, and some lingering thoughts about how the things that happen TO us during training also create some biases that have the potential for affecting our patient care.

Have you ever read the book House of God? I hadn't read it until medical school. There was a great deal of discussion about that book among a group of my peers at some point and I was pretty out of the loop, having not read it. So, as a first year medical student, I read it. I was horrified and apalled that anyone could possibly conceive of health professionals thinking about and acting toward their patients in some of the ways described. Horrified. And personally insulted, actually. Certainly I would never do such things. Would I?

Five years later, as a second year resident, I read the book again. (Because, let's face it, who has time as an intern to read anything not absolutely necessary and related to what might confront you immediately or in the next 24 hours?!) My experience this time was vastly different. Vastly. So much that I'm at least a little bit ashamed. I remember laughing until tears ran out my eyes at some points. I remember completely identifying with some of the circumstances and situations described. At the time, I remember thinking how naive and idealistic I was as a first year medical student.

Now, a good number of years removed (we won't go into detail about how many) from the supreme endurance test of q3 call blocks and 100+ hour work weeks (yes, I pre-date duty hour restrictions), I once again have a different perspective. I think about discussions among my current faculty peers, about how we seem to do our best to "train out" some of the very best qualities in medical students and residents. We all seem to lose some of our humanity in the process. I like to think that these days that I'm a lot closer to the humanity and idealism I started out with than to the ridiculously over-fatigued and callous R2 I became for a time.

I invite your thoughts and reflections on this topic...