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No respect
EDITORIAL
No Respect As I prepare for yet another graduation ceremony, I start to wonder about the things we have taught our residents as they grapple with the next phase of life. We have probably shown them all we know in the operating room, clinic, lecture hall, office, or even the local pub after a hard day. I am sure that most of them are probably beaming with confidence and cannot wait to "do it their way," or even the "right way." I can remember that feeling vividly almost 20 years ago. I thought I knew everything and could fix even more. I did not think that there was anything I had not learned, but little did I know ... But did you ever think about what we did not teach the residents ... and perhaps really should have? Did you ever ponder the possibility that you may have let your own residents escape your clutches without teaching them some fundamental tenets of existence in the world of medicine? Or worse yet, did you let them escape without teaching them the things that you did not get when you yourself were a resident ... but wish you had? That may be our most odious sin of all. What about respect? It seems like a simple little word ... respect. Yet sometimes I am not sure we all know exactly what it means. Or perhaps we only know what it means on a selective basis. No one has any doubt when he or she is the beneficiary of such. Few have any cause to reflect when most patients call us "doctor" and genuinely "respect" our position in society. Even fewer pause when they strut into the operating room, ready to perform a surgical procedure. Everyone thinks, "Sure, I know what respect is ... it is what I deserve." Well, what about the patients? Have we ever really thought about respect for patients? Have we ever thought for a second to train our residents about respect for our patients? The most arrogant will retort, "Well, of course I respect my patients, and my residents learn how to respect patients just by watching me." Well, it is this observational method of education that may indeed be the fatal flaw and may represent the largest void in our educational system. An indigent patient comes in and is taken to the emergency room at 2 AM after a particularly violent injury. The resident first sees and assesses the situation, and determines that there is a complex open dislocation of the foot. The attending is rousted from bed and tells the resident, "Go
John M. Schuberth, DPM
ahead and take care of it," hangs up the phone, and dissolves back into oblivion. The resident is gleeful, not appreciating the possibility that he has never seen this injury pattern before. The next day, the chief of surgery calls you while you are in the middle of a case, demanding to speak to you. Two things pass through your mind. First, "I respect the chief of surgery, so I better see what he wants," and second. "I am sure he won't be upset because I did not come in to attend to the indigent." Turns out. he wants you to take care of his wife's corn on her little toe so she can attend the socialite function later that evening. "Have her come on in. I'll take care of it between cases." How about the day when you are scheduled to operate on 2 patients with bunions on a particular day? One patient is Bob, the janitor, an overweight diabetic who takes poor care of himself. and the other is Mr Smith. the high-profile executive at a local business. They are both simple bunions, and yet you say to the resident. "I better do Mr Smith because he is a VIP." These 2 examples of the asymmetric administration of respect may seem rather extreme, but I am not so sure they are not more commonplace than extreme. Less blatant examples of the selective delivery of respect seem to occur all the time, and it seems to pass from one generation to the VOLUME 42, NUMBER 4, JULY/AUGUST 2003
171
next. Even the smartest resident is not immune to the examples we project. I still remember only a few graduation speeches in the 15 or so that I have witnessed, but 1 in particular I am unlikely to ever forget. The essence of the message was to respect the patient without regard to social class or status, difficulty or simplicity of his or her problem, or the patient's ability to pay. Further, it suggested that we try and get inside the patient and understand the problem from his or her perspective, even if he or she has agendas and motives other than complete resolution of his or her chief complaint. Sure, they may want more narcotics, an extension of their disability, a parking placard, and every other social entitlement, but if that is what they perceive they need ... why not? The impact of this speech pervades my daily practice life.
172
THE JOURNAL OF FOOT & ANKLE SURGERY
I would like to believe it is continuing to mold my character and cause an evolution of behavior that should not have taken 20 years to culminate. It brought me back to the sanctity of the relationship with the patient. But it is not enough to just read a passage such as this, as this is just my musing. To cement this behavioral change in your soul, it may just be necessary to observe a model of this mentality. I have been lucky enough to observe the maker of that memorable graduation address and I aspire to emulate his approach to the practice of medicine. My sense is that he knows who he is, but this is not about dragging someone out of the closet. It is about respect ... give it a try.
John M. Schuberth, DPM Editor
No Respect As I prepare for yet another graduation ceremony, I start to wonder about the things we have taught our residents as they grapple with the next phase of life. We have probably shown them all we know in the operating room, clinic, lecture hall, office, or even the local pub after a hard day. I am sure that most of them are probably beaming with confidence and cannot wait to "do it their way," or even the "right way." I can remember that feeling vividly almost 20 years ago. I thought I knew everything and could fix even more. I did not think that there was anything I had not learned, but little did I know ... But did you ever think about what we did not teach the residents ... and perhaps really should have? Did you ever ponder the possibility that you may have let your own residents escape your clutches without teaching them some fundamental tenets of existence in the world of medicine? Or worse yet, did you let them escape without teaching them the things that you did not get when you yourself were a resident ... but wish you had? That may be our most odious sin of all. What about respect? It seems like a simple little word ... respect. Yet sometimes I am not sure we all know exactly what it means. Or perhaps we only know what it means on a selective basis. No one has any doubt when he or she is the beneficiary of such. Few have any cause to reflect when most patients call us "doctor" and genuinely "respect" our position in society. Even fewer pause when they strut into the operating room, ready to perform a surgical procedure. Everyone thinks, "Sure, I know what respect is ... it is what I deserve." Well, what about the patients? Have we ever really thought about respect for patients? Have we ever thought for a second to train our residents about respect for our patients? The most arrogant will retort, "Well, of course I respect my patients, and my residents learn how to respect patients just by watching me." Well, it is this observational method of education that may indeed be the fatal flaw and may represent the largest void in our educational system. An indigent patient comes in and is taken to the emergency room at 2 AM after a particularly violent injury. The resident first sees and assesses the situation, and determines that there is a complex open dislocation of the foot. The attending is rousted from bed and tells the resident, "Go
John M. Schuberth, DPM
ahead and take care of it," hangs up the phone, and dissolves back into oblivion. The resident is gleeful, not appreciating the possibility that he has never seen this injury pattern before. The next day, the chief of surgery calls you while you are in the middle of a case, demanding to speak to you. Two things pass through your mind. First, "I respect the chief of surgery, so I better see what he wants," and second. "I am sure he won't be upset because I did not come in to attend to the indigent." Turns out. he wants you to take care of his wife's corn on her little toe so she can attend the socialite function later that evening. "Have her come on in. I'll take care of it between cases." How about the day when you are scheduled to operate on 2 patients with bunions on a particular day? One patient is Bob, the janitor, an overweight diabetic who takes poor care of himself. and the other is Mr Smith. the high-profile executive at a local business. They are both simple bunions, and yet you say to the resident. "I better do Mr Smith because he is a VIP." These 2 examples of the asymmetric administration of respect may seem rather extreme, but I am not so sure they are not more commonplace than extreme. Less blatant examples of the selective delivery of respect seem to occur all the time, and it seems to pass from one generation to the VOLUME 42, NUMBER 4, JULY/AUGUST 2003
171
next. Even the smartest resident is not immune to the examples we project. I still remember only a few graduation speeches in the 15 or so that I have witnessed, but 1 in particular I am unlikely to ever forget. The essence of the message was to respect the patient without regard to social class or status, difficulty or simplicity of his or her problem, or the patient's ability to pay. Further, it suggested that we try and get inside the patient and understand the problem from his or her perspective, even if he or she has agendas and motives other than complete resolution of his or her chief complaint. Sure, they may want more narcotics, an extension of their disability, a parking placard, and every other social entitlement, but if that is what they perceive they need ... why not? The impact of this speech pervades my daily practice life.
172
THE JOURNAL OF FOOT & ANKLE SURGERY
I would like to believe it is continuing to mold my character and cause an evolution of behavior that should not have taken 20 years to culminate. It brought me back to the sanctity of the relationship with the patient. But it is not enough to just read a passage such as this, as this is just my musing. To cement this behavioral change in your soul, it may just be necessary to observe a model of this mentality. I have been lucky enough to observe the maker of that memorable graduation address and I aspire to emulate his approach to the practice of medicine. My sense is that he knows who he is, but this is not about dragging someone out of the closet. It is about respect ... give it a try.
John M. Schuberth, DPM Editor