So yesterday we had a return visit from one of my most and
least favorite of instructors. Yes, he
really is both. On the one hand, he is
plainspoken in a classroom that is often full of new and baffling
terminology. He is extremely interactive
in his teaching, and after hours on end of PowerPoint lectures I really to
appreciate that. He always seems to
understand exactly what we know and don’t know (this is an obnoxiously big
problem in my classes so far, more on that another day). However.
He tends to air his biases loud and clear, and often words things in ways
that mange to be simultaneously offensive, human, and funny.
This gets to the heart of one of the most difficult issues
I’ve had with medical school so far: how do we maintain appropriate respect,
teach professional behavior, and nurture compassion without stifling the human
beings that we already are in a haze of serious tones and somber
thoughtfulness? An excellent example of
this is the dissection lab. It is
extremely important to be respectful of our donors (the people whose bodies we
are dissecting), and I never at any point in this post want there to be any
confusion about that. But the process of
lab itself is very stressful for a hundred different reasons: being bluntly
faced with a dead body, surviving your first few months in medical school,
breathing all the preservative fumes. And
dissecting is not easy. Sooner or later you
look up at the clock and realize that for the past two hours your entire world
has been narrowed to a few square inches of tissue in which you’re trying to
sort out what’s important and what’s not and what you have in your hands mostly
just looks like a mess. My thumb was
slightly numb and tingly for a week after I spent four hours doing the same
motion with the same dissection tool. In
this situation you need some humor, some lighter conversation. Whether it’s gossiping about your team-mates
love lives or trash talking each other’s home teams, we can’t spend every
second of our time in the lab being consciously respectful and survive.
That doesn’t mean that anything goes, there are always
lines. But where exactly should we put
them? What’s offensive and what’s not varies: person to person, place to place,
day to day and throughout time. I’m sure
that if we polled enough people, we could find someone who thinks sports trash
talk is too much, much less talking about sex lives over a dissecting table. But more important is that these issues aren’t
limited to gross human dissection. In
the lecture hall there are no patients, no bodies to remind us of the
consequences of our speech. Combine this
with an odd tendency medical school instructors have to try and treat students
as future colleagues (and sometimes, I think, a desperation to get a response from
the sleepy hall) and we get these gems (paraphrased, of course):
“In pediatrics we have funny looking kids, he’s [a
hypothetical patient in a photograph] a funny looking adult”
“This [part of the physical shoulder exam] is really fun,
because they jump – because it feels really weird, you’re dislocating their
shoulder.”
Both of these were very awkward moments for me. On the one hand I definitely thought both of
those things. And I believe it’s
important to take time to acknowledge such reactions, to recognize that we’re its
natural to think and feel certain responses – appropriate or not. This can help us sift through all the crazy
things we do think and feel and help us separate what’s okay and what’s
not. On the other hand when there are
instructors involved we should be more careful.
Can an instructor talking about irreverent and inappropriate responses
help to facilitate important conversations about mental health, emotional
responses and professional behavior? Yes.
Should an instructor be modeling potentially inappropriate responses
without taking the time to reflect on and explore them? I don’t think so. Because the bigger point is that these are
just things I personally noticed. What did someone else, someone with a
different perspective, notice and think about that I didn’t, that no one
pointed out to me or brought to my attention?
What did I accidentally learn?
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