Doctors and Teachers
My friend Saul Weiner is one of the most interesting people I know. I’m just finishing his second book, called On Becoming a Healer. Although the book’s primary audience is young doctors at various stages of their training, I knew that what he had to say about medical training would interest me because we’ve had a number of conversations over the years about the parallels between medical education and teacher education. Domains that you might think had little overlap are in fact first cousins in the challenges and pitfalls they present and, most importantly, in the ways they either spotlight or neglect the importance of nurturing caring relationships between practitioner and client.
Before I elaborate on those parallels, let me back up to provide some context. Saul is a clinician, administrator and researcher who works out of both the University of Illinois Chicago Hospital and the VA Hospital. He’s got an amazing story to tell about his journey to success, accomplishment and professional recognition. He has a severe learning disability which made for an incredibly arduous school history. Before he was diagnosed, he was viewed by his schools and teachers as intellectually deficient, but he was determined nevertheless from early on to become a doctor. His experience in medical school was atypical, largely because he could make no sense of the lectures which were, and continue to be, the primary form of instruction in many medical schools. Instead, he had to skip the classes and spend countless hours poring over notes of the lectures which he memorized to regurgitate at exams which he could only complete because of the extra time he was allotted.
The actual clinical and research work calls on a different set of skills than those needed to jump through the academic hoops required by the medical school gatekeepers, so Saul’s reputation grew quickly once through those gates. His first book Listening for What Matters: Avoiding Contextual Errors in Health Care, is the report of one of the most brilliant and intriguing research projects I’ve ever encountered. I love telling people about it, though I feel my telling never quite captures that brilliance. Saul is an engaging writer, so I refer you to the book for details, but here’s the essence of it. Saul and his team trained a group of actors to play patients with specific sets of presenting symptoms. Armed with hidden tape recorders, the actors visited a number of doctors, all of whom had volunteered to be part of the project with the understanding that they would not know at the time which of the patients passing through their waiting rooms was part of the research work. The doctors were promised anonymity and assurances that none of the findings would be used against them.
The results were dramatic. Doctors were not good listeners. Too often they were more focused on completing the tasks that went with every patient visit – completing check lists, entering notes on the computer – than they were in listening to what the patients were telling them. Procedures that they report conducting in their notes did not in fact happen. As a result, doctors missed critical contextual cues that could inform their thinking about what needed to be done for the patient. For example, if a patient mentions by the way that he’s lost his job, the medication prescribed for his condition may not be affordable unless the doctor picks up on that context clue and prescribes a generic substitute. When that patient, on a future visit, reports not having used it, the doctor might brand him as uncooperative because he missed the all-important contextual clue about his unemployment. Attending to the contextual clues dropped by the faux patients would also affect the kinds of testing ordered and the medications prescribed in ways that could ultimately save the system and the individual patient substantial amounts of money.
As Saul says, Listening for What Matters is a report of a research project; On Becoming a Healer is a reflection on lessons learned from his own experience as a medical student, medical educator and clinician. But you can see the roots of the latter in the former. And here is where our interests and perspectives coincide. If you’ve read my posts, you’ve probably noticed that many revolve around the belief that the success of everything a teacher learns in his/her (I’ll stay with her from here on) training is dependent on her ability to establish relationships with her students. No teaching strategies or curricula can be successful unless they are planted in the rich soil of authentic caring conveyed convincingly by the teacher.
Our terminology doesn’t always match up, but I think we’re pointing to the same flaws in the preparation and subsequent practice in our respective fields. I talk about the trend in teacher education toward preparing classroom mechanics rather than educators. Saul’s book is a plea for growing healers, not mere technicians. I think about teachers who are able to serve the whole child, rather than just her academic/cognitive side. Although he doesn’t use the term explicitly, Saul wants doctors to see the whole patient – someone who moves within a specific cultural context, not just an accretion of physical symptoms.
In 2010, Doug Lemov, a former Teach for America teacher and staff person, published a book called Teach Like a Champion, a manual of moves and strategies that novice teachers could practice and implement to manage their classrooms and build a structure that would enable their students to learn. It’s the ultimate guide for the Classroom Mechanic. There’s a place for it, but a teacher who doesn’t reach far beyond this toward engaging with her students and caring deeply about them is not going to have a long happy career in the classroom. I was able to stay in the classroom for so many years because I viewed the swirl of life that surrounded me as if I were living a novel every day. Saul describes similar attempts during medical school to teach people exactly how to conduct an interview with a patient, complete with a list of scripted questions which, it is hoped, will quickly lead to an unequivocal diagnosis.
When Saul looks at the doctors he’s encountered as students or colleagues, those who appear happy and fulfilled are engaged in ways that enable them to put up with the irreducible amount of crap that is part of every profession. They can look beyond their check lists and computer notes because they care about their patients and are curious enough about their lives to demonstrate that care through the questions they direct to patients who are likely to experience that as not really coming from real curiosity and interest in them as individuals.
Both doctors and teachers can settle for performing their duties according to the book – keeping up with electronic records, submitting grades on time, prescribing appropriate drugs, planning lessons that conform to state standards, but there is so much more they can offer their students/patients and so much more satisfaction they can derive from their work, if they are willing to step outside their professional personas and present themselves as real people to those they serve, people with vulnerabilities, people who don’t have all the answers, people who fail sometimes. That’s when they can become healers, not technicians, educators, not classroom mechanics.