Learning in Practice: Experiences and Perceptions of High-Scoring Physicians

One day while presenting a patient to me, a medical student suddenly burst into tears while discussing the patient’s feet. Now, since feet usually are not tearjerkers (unless, of course, they are very pungent feet), it was clear that something was bothering her. Until then, the student had appeared reserved, quiet, and somewhat sullen, doing all her work, but lacking the same bright-eyed enthusiasm as her colleagues. However, after this emotional outburst, she revealed that her long-term relationship had just fallen apart. Now, while I could have easily switched the topic back to feet (which in general is not a good idea in most conversations), this was a natural segue to an open discussion about the challenges of maintaining relationships and medical careers. Suddenly the teaching session began resembling an Oprah Winfrey show as the other students and housestaff eagerly contributed their own relationship “war stories.” One resident related how he had kept falling asleep while spending time with his former girlfriend and could barely stay awake while she was breaking up with him. Another resident recalled how a rather cowardly former boyfriend ended their relationship suddenly by sending a text message to her pager while she was on call. Others talked about how hard it was to stay focused and project enthusiasm at school and work when their relationships hit potholes. Moreover, the rigors of training often prevented them from recognizing when their significant others were unhappy, needed something, cheated on them, or even completely changed their appearances. Many of us have gone through relationship difficulties during medical school, postgraduate training, and beyond. Those that haven’t are either very fortunate or need to get out of the hospital more often to actually have relationships. You can know all the medical facts in the world, but inability to manage your life outside training and work may impair your ability to be a good physician. After all, unhappy physicians often do not make very good physicians. So are we neglecting the “heart” when training future physicians? While many textbooks teach students and residents how to interpret blood gases or treat Lyme disease, none really tell them how to handle complicated relationship issues and the interplay between one’s medical career and personal life. Our value as educators comes from not only our scientific and medical expertise, but also insights from our own life experiences. In many cases, we can serve as role models personally as well as professionally. Sometimes frank discussions can help students and housestaff learn how to better deal with relationship issues. These discussions can also help us better understand the people that we are teaching and, in turn, make us better teachers. After all, what’s the use of focusing on the feet, when the problem is with the “heart.” Bruce Y. Lee, MD, MBA

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