Spark [Robert_Klitzman]_When_Doctors_Become_Patients(Boo | Seite 286

Improving Education 275
communication was best instilled not explicitly through lectures, but
implicitly through role-modeling. Jessica, the pediatrician with cancer,
tried to instruct students and residents informally, by example:
. . . almost by osmosis. They observe me. I try to get across . . . the
way I relate to patients and parents. It’s just very informal. That’s
part of pediatrics. But I am especially informal.
These approaches get communicated subtlely, indirectly.
Some doctors attempted to achieve educational goals by other means,
similarly trying to draw on student emotions. But, given the medical
profession’s prevailing ‘‘macho’’ culture, they were not always success-
ful. One ill physician described how on rounds once a medical student
had said bluntly to a patient, ‘‘You have cancer.’’ The chief of medicine
then turned to the student and said, ‘‘You, get out of this room! You are
hereby kicked out of this medical school. And I will make sure you never
get into another medical school in this country.’’ Crushed and confused,
the medical student slowly stumbled out of the room. At the last pos-
sible moment, the chief said, ‘‘Come back. I just wanted to make you
aware of what it’s like to be given a death sentence.’’ Such a pedagogical
approach may foster sensitivity, but not reduce the hierarchy in medicine
between doctors and patients, or instill humanity.
Not surprisingly, some questioned or viewed skeptically the ability to
teach compassion to medical students. Others concluded that such
training might have unclear efficacy, but was still worthwhile. Jerry, the
surgeon-lawyer with HIV, said:
I go back and forth: students are either going to have that sensi-
tivity and treat patients in a kind and decent way or not. Every year,
I spoke to the third-year students about being an HIV-positive
physician and being gay. I thought at times that it was good, but at
other times that that was something you can’t train. It’s still good
to teach them . . . but I wonder if it does any good.
Cynicism lingered about the ability of education to make students
more empathetic. Albert, who had an MI on the highway, said:
Med school applicants want to work in soup kitchens all their life,
and practice urban-missionary medicine. But many physicians
won’t get out of bed at night to see a patient. So, I’m a cynic. My
partners . . . are compassionate, caring. I don’t know how well you