Category Archives: teaching techniques

MD, the Authority

We used to sign passports. We were one of the few that could, along with police officers, lawyers, some other professionals. Authority figures. We’re so much an authority figure, that we can’t be put on juries. We’d sway the group, apparently. You can often change the date of an actual court proceeding for adequate reason.

AuthorityCreative Commons License neiljs via Compfight

Ah, to be the authority. That’s one of the goals of the self publishing industry. Research and publish a book: you’re an authority. It just sort of stops all the questions.


Where does this stop? Where does the practice of medicine not involve the influence of authority? The patient calls to book an appointment. They’re advised when you’re available. They wait for their appointed time, then wait as you finish with prior patients. You sit behind a desk, and strive to keep your eyes on them as you type their presenting problem, that issue that they can’t solve, without your help. They tell you things they won’t tell anyone else, and show you things no one else sees.


They sit to be examined, you stand to examine. We can take this example further, but we won’t. You take appropriate measures to drape, but a drape is a drape.


Then they redress, and sit in their little chair, and await the… “diagnosis.” The encapsulation of all their symptoms, all their worries and emotions, all the impact on their life, into a one or two word label.




Then you tell them what to expect, what will come next, the effect it will have, what do next.

You hand them the script that only you can give, and often terminate the interview.


That’s a trick you do with your pet, to enforce dominance. Run around the table a few times, throw the ball, but then, hey, that’s it. The end. You’re in charge. The pack has to have a dominance hierarchy.


In your entire professional life, you’re at the top. You may have an accountant, an advising lawyer, and an MBA for an office manager. You may give that manager almost full reign. But you’re it.


The authority.


So what do you do when you don’t know? What do you say when you don’t know that answer, when you’re not absolutely sure? Because hey, you’ve written it down. You’re the authority. If you say it’s x, y, or z, that’s what it is.


Outside of medicine, who cares. Let’s be honest. If you say you really know how fission works, how the soap works in your sink, how chloroplasts convert photons, who really cares if you’re wrong. What does it matter. Who really cares.


Are you one of the people that always has to have an answer? Do you feel you have to know, to show that you know?


Medicine matters. When your resident asks you, and you don’t know, what do you say? When your patient bares her soul, completely exposing herself, when she turns to you with her palms up, desperate to know, desperate to get better, and you don’t know, what do you say?


How do I recognize a good doc?


When I see one that knows what she doesn’t know.


And admits it.

The Unsafe Resident.

There are labels, and then there are labels. Good, bad, ugly. Then there’s the one that will absolutely kill your resident, or intern, or medical student. Or colleague. Grey World via Compfight Unsafe.   Let’s be careful when we use that one. Nothing burns like that, nothing sucks like that, nothing taints like that. ItContinue Reading

Stories work, statistics don’t.

Narratives have become required activities for family medicine residents. And usually bring muted groans and eye rolls. If not stated explicitly, most residents question the utility of this activity, and at best look at it as a hurdle, a necessary exercise. You can see some at Alberto Racatumba via Compfight “Stories beat statistics, andContinue Reading

Medical Classroom community and Character Values

How can one create a safe, moral and supportive community in your little classroom of first year medical students? How can a teacher affect the medical classroom community? What about just flying by the seat of your pants?  Sure, maybe they said, “Start tomorrow!” “We always need experienced physicians, we need you now.” “You’ll learnContinue Reading

Teacher, what is your measuring stick?

How do you measure student performance? The standard answer is by formal assessments, both formative and summative. There’s also the “impression” one gets, the day to day work on the ward or in the clinic. The case by case discussion, the questions asked, the creative paths taken. I put up some wainscotting on the weekend,Continue Reading

Historical cognitive developmental theory, all mumbo jumbo?

Piaget (Huitt and Hummel, 2003), Vygotsky (Schultz, 2004), and Erikson (Boeree, 2006) are cognitive developmental theorists. In 2015 is it all mumbo jumbo? Is this even worth looking at from the perspective of a medical educator? Is there anything to be learned from all this effort?   Gladwell (2008) studies the occurrence of high performanceContinue Reading