Can Being the Best of the Best Make Us Collectively the Worst? The happy medium in diversity, unity, and empathy.

Imagine a class where someone educated you in the ways of socially appropriate action, emotional intelligence even.  A course constructed in a Socratic fashion, public forum question and response format whereby the prompt is usually always something along the lines of "A patient presents with xyz health concern confounded by xyz social and environmental factors, all muddled amongst this xyz moral dilemma woven into this vignette. As a provider, you use your ethically sound judgment to consider a solution that will simultaneously CYA and also be impressively upstanding

Do you:

A)Choose the distracter answer because you weren't paying attention to the entire last 50 minutes

B)Choose choice B, because it isn't choice A and you really don't care

C)Choose C, which uses recognizable words from the lecture and seems neither radical nor vague

D)Choose D, which has carefully crafted semantics with an emphasis on one word that renders the answer  technically invalid but is appealing nonetheless

And such is the redundancy of Medical Ethics and Law, which is not so much boring just because of the subject material and of little fault of the instructor, but maybe because we think we all just know better. 

We shouldn't have to hear this, be subjected to the make-believe gravity of a hypothetical situation of ignoring patient autonomy in this vignette about a ventilator and Health Agents and etc, because of course we would do the right thing.  Of course we are above the obvious flaws of inattentiveness, or negligence, or carelessness.  Of course we would, when put in a situation that is more than about being a good diagnostician or shot-giver or band-aid applier, use both common sense and emotional acuity and of course we would never make a novice mistake like not consider a patient's rights or blow off their caregiver or make an insensitive joke because they don't speak English and just like we suspected, aren't compliant with their Metformin and are huge and now borderline comatose. Of course, we are better than that.

But sometimes, amidst the groans and eye rolls and gossip and general apathy that will invariably come with classroom boredom, the drone of laptop typing and neurotic Facebook skimming and the creeping depression that seems to coincide with shorter days and colder weather and a nostalgia for summer,  I have to wonder if we are as emotionally, empathetically aware as we staunchly claim to be.  If we are as 'of course' as we'd like to think.

And while I don't doubt the selflessness and capacity to give that we all have to work as future physicians, those whose lives and decision-making revolves around their patients, I think we often are guilty of forgetting.  I am; I have forgotten many times that I have chosen a profession that is not always all about me. 

Think about what people say, or said, when you told them you were going to medical school.  Put aside, for a moment, the initial shock or even expectation, and consider the things you were told, verbally, would happen to you.  For the most part it was optimism and excitatory support (for my mom and grandma, probably a huge sigh of "thank god, she has a future beyond street performance and painting"), but you would be hard-pressed to find a matriculate that didn't say they weren't warned about how hard it would be, about the trials of exams and late nights and lack of sleep and miscellaneous debbie-downer-word-of-wisdom doled before they packed their bags for their 4 year journey.   And yea, so much of that is true!  I do stay up late, I do take exams (and hopefully pass them), it is hard, and it should be, and I don't sleep very much, unless it's an accident.

But always implied with those ubiquitous debbie-downerisms was the expectation that this was something of a bold sacrifice, an acknowledgement of accomplishment but also one of understated heroism: you, Chosen and Accepted, one who bears great weight of academia and endures the cold hard winter of caffeine and perpetual standardized testing all for the selfless fee of 250,000 dollars.  For a moment, you are recognized and reaffirmed that what you are doing is not at all about you, because it honestly sounds more sadistic than it does a fun new adventure, so you must, you have to, truly want this for some higher purpose than just the social recognition, the embroidered credentials on a white coat. Right?

But consider this. You've made it in, you are part of the crème de la crème, walking and learning amongst the finest and brightest from the land, collaborating and supporting one another in a 200-person sized medical paradise, compelled by the competitive atmosphere but all looking in the same direction toward the same selfless goal: to work for the betterment of the health of our communities, to advance in science and education and technology.  Of course.

And for all of those virtues and necessary benevolence that got you here in the first place, no one is immune from gossip, jealousy, pride, or self-interest.  As a whole entity, medical students are intelligent and motivated, successful academically and to some degree, socially, at least according to our AACOMAS application or preliminary interview. But like anyone else, we are subject to the same baggage, frivolous drama, propagating or feeding into slander or whatever. We have physiologic and psychological urges like everyone else; we do what we want and say what we want without thinking of the repercussions.  Big surprise, this is nothing new.  Most certainly, we are not saints.  But what we easily forget is that although we don't wear the big hat yet, we do wear the short white coat.

To most people, this is the universal sign of medical gumshoe.  The bottom of the totem pole.  The all-too-clean, too-crisp, awkwardly boxy reminder that we don't know enough just yet; we are in practice, we are mistake-makers, and in a sense, the short white coat serves as your scapegoat, your loophole from too much reprimand and finger-wagging.

Underneath those short coats are hundreds of applicants, many of which are chosen specifically for being "statistical outliers,": not just the intellectually competent, but the non-traditional, second career applicant, the impressively devout and human rights activist, the insane prodigy published in nine journals, the Big Ten athlete whose medical school journey was an afterthought.

And this very eclectic social milieu, seemingly homogenous with a sea of short white coats, creates a bit of a dissonance from one another, I think. Just how interesting each of us is can be, in a sense, a conflict of interest. I would venture to say 99% of us want the same thing: to make a noticeable, if at the very least positive, contribution to healthcare, in whatever capacity of specialty speaks to you.

Of course.

But what is most interesting to me is how often we fall back on our personal vices, our status of "short coat" as an excuse for making our poor unprofessional behavior admissible. We maintain the perpetual student attitude of "not my fault, not my problem, not yet."   We insist that, of course, when we graduate, when the time is right, we would do the right thing.  Of course  we know that treating one another poorly, spreading unsubstantiated water-cooler talk is stupid and silly and of course, assuming the worst in people is only something we do transiently, we will forget all that when we have to work together. 

And you may argue, "So what if I hook up with nine of my classmates without concern for the feelings of my colleagues? So what if I don't do anything to stop cheating, so what if I don't put an end to inflammatory rumors.  So what if I notice someone who needs help, but don't necessarily do anything?" Of course, if this was the real world, if this was not merely school, if this was my hypothetical, vignette-crafted patient, of course, I would help them.

We are in a profession that is all about taking care of people, but sometimes, it startles me how very little we often take care of one another.  This is hard work.  It is hard to smile at someone you don't know when they look miserable, it is hard to abstain from deprecating comments about a classmate (maybe one day, your boss, your best friend, your best man),  when everyone else is.  It is hard to remember sometimes, that empathy is not a class, it's not an algorithm.  It should (and I believe it is), a basic tenet of your character.  But in a land of short white coats, where it is easy to deflect the blame to our inexperience or intellectual naiveté, we should always remember that crafting and working on our emotional intelligence is an active process.

October is Community Outreach month (I know I know, everything is a "Month" of Something), but I write this because it's hard to give people the benefit of the doubt sometimes, let alone reach out to them. The parallels between high school superficiality, click-like behavior, and other forms of emptiness can be striking with the attitudes we find in medical school. We are students, sure, and have been for what seems like forever.  But after we are done hiding behind our books and our laptops and our short white coats, after we are done with Tegrity and scrounging for empty classrooms like animals finding their dens, we are adults.  Technically, we have been adults for a long time now.  But we are human, we forget.

So in addition to being the empathetic, community-service driven pillars of society you can be, I challenge you to start locally.  Start by helping the person in the seat next to you.  Start today, because it might make all the difference to them tomorrow.   

But of course, you already knew that.