Blog | Friday, October 4, 2019

The tough and no-nonsense teacher of medicine that we should all want


The best teacher of medicine I ever had was during my medical residency. He was a tough old-school physician, trained at one of the premier institutions in the country, and specialized in pulmonology and intensive care. Before I had even rotated through the ICU, I had seen him around on the medical floors—and must admit I didn't like him very much at first. He seemed extremely serious, not particularly friendly to any staff around him, and was very strict about what was happening with any of his patients—always wanting things done in a certain way. He wasn't overtly rude, just not a “warm and fuzzy type” in any shape or form. A co-resident told me that he was a great physician, and despite any lack in social skills, was “the doctor I would always want caring for any sick relative of mine.”

My ICU rotations started mid-way through my intern year (this was back in the day when we still did grueling 30-hour calls, often every 3 days). Having him as my attending though, quickly changed any negative perceptions I may have prematurely had. Quite simply, he was an absolutely brilliant doctor, who knew just about everything there was to know about critical care. He could quote any major paper or research study from the last decade, and remembered every little detail about each one of his patients, who actually really liked and respected him (he always communicated surprisingly well with patients and their families).

Teaching-wise, he was completely no-nonsense, and always had us on our toes. We made sure we had everything right before we presented to him, and he would tear us to shreds if we stuffed up on any important issue. We looked forward to his inevitable rapid-fire questions and read around every disease that we were dealing with. He was a tough, tough boss—but without question the outstanding teacher whom we all wished to learn from. If you wanted to be treated nice or molly coddled, he was not the one. He would evaluate us and be brutally honest about any areas we fell short.

At the end of my residency, I stayed behind for an extra week unpaid, just to rotate with him one more time and learn whatever I could. I'll never forget that during that last week, he pointed to two rooms that had patients of similar age and medical histories. They had both been admitted the day before with a similar degree of pneumonia. One was sedated on a ventilator, and the other was sitting up, looking well, and ready to leave the ICU. He said something along the lines of: “Look at that, such similar people and such different responses to the same illness. I predict that during your career the biggest breakthrough will be in the field of genetics. We'll be able to do a saliva test and predict exactly how people will respond to any illness.” I wouldn't bet against that coming sooner than we think.

As I shook hands with him on my last day and said goodbye before embarking on life as an attending physician, he paid me one the best compliments of my residency: “Call me when you're Chief of Medicine very soon.” Although that didn't end up being my chosen career path, I was delighted that a man of his distinction said that to me, and it gave me quite a boost.

He remains my favorite teacher, as I know he has been for many others too. He won an array of teaching awards and accolades. My fear however, is that we are fast losing mentors like him in our modern culture of learning. Teachers like him are becoming a dying breed because a very different sort of teaching environment is now being encouraged. In fact, we are rapidly approaching a point where an attending like him would be frowned upon. I'm sure though, if you honestly ask most medical students, interns and residents—they would rather be taught by a tough attending like him any day. The current trend (and this applies everywhere, not just medicine) is for teachers to be more like their students “friend.” I believe this is a big mistake. From talking to some of the younger teachers of medicine at some of our larger academic institutions, I even get the feeling that many of them are almost afraid of getting negative evaluations from their students, so want to please them as much as possible. Again, another big mistake and paradigm shift. I can assure you that if there's one thing the doctor above didn't care about, it's what his students thought about him or trying to be their best friend.

When I was a medical student in the United Kingdom, I also came through the system at a time when I got to work with some proper old-school professors. Some of them, if they ever saw the male medical students slouching when we were walking around together on rounds, or folding our arms casually, would physically grab our back and shoulders and tell us to stand up straight! At the time none of us minded whatsoever (we actually found it funny). I am not suggesting a return to military-style academics, or allowing any inappropriately strict or condescending behavior, but I hope in this new era, we can balance the need for a more gentle approach–with that more traditional respected tough teacher approach—that any student worth their salt secretly likes and craves. I hope future generation learners of medicine, or any profession, always have a chance to be taught by someone like my ICU attending.

Suneel Dhand is an internal medicine physician, author and speaker. He is the founder of DocSpeak Communications and co-founder at DocsDox. He blogs at his self-titled site, where this post first appeared.