Horror. Was 7 year old with endocarditis

[Guest guest]

Hi Hugo,

 

Nice analysis of the situation. I agree that no clinical issue is too difficult

or dangerous to ask about or present. How to ask a question or present a case

is essential. And that's what this is about. It takes a lot of respect from

both the teacher and student.

 

While I was a humble 3rd year student going to grand rounds (or small group

diagnostics), I used to get in an hour early at 6 AM. I'd read patient charts,

flip through my Merck and try to figure out what the attending was going to ask

the intern and residents that I was working for. By 7 AM we'd all file into to

grand rounds, and the tension would be palpable. I figured my job as a 3rd year

was to be like a " idiot shield " for my intern who had to do a 36 hour shift

every 3rd shift. This guy was in worse shape than some of his patients.

 

So I'd raise my hand to the first question of the attending physician. He'd

smile and call on me. I'd state the particular patient's charted pathologies,

state the current vitals and prognosis and make suggestions regarding treatment

protocols. This had two effects, the most important of which was laughter ...

and secondly it broke the ice for further conversation. Bear in mind that the

lowliest form of life in the acute care setting was a 3rd year student. I had

the responsibility to break the ice for my intern, demonstrate bravery and learn

how to verbally communicate with the attending. It meant creating respect and

community.

 

What's more important? Becoming a " great healer " or serving the interests of

the patient and medical paradigm? Bravery and service over the long term is my

prescription for arriving to any level of being a physician, teacher or parent.

 

Hugo, your notion of a parent or teacher presenting " boundaries " within which to

struggle with ideas is pretty much the key. Personally I call these boundaries

" community " . Community exist only when there is mutual respect. Mutual

disrespect is the definition of conflict or war. A successful struggle with

one's developmental stages requires a strong community with clear boundaries ...

that is, lots of mutual respect.

 

I like the way you stated this, Hugo.

 

Respectfully and gratefully,

Emmanuel Segmen

 

---------------

Hugo Ramiro wrote:

Hi all, I just had a thought about this whole discussion.

I wondered what this list felt regarding master-disciple relationships? My

personal take below.

There are popular misconceptions about master-disciple relationships, no doubt

exacerbated by well-known cases where the relationship became poisoned and

public. One of the misconceptions I believe we have is that the disciple,

through submission, relinquishes all power. This is not true. Submission is a

form of demonstrating love and respect; it is identical to the way one submits

to one's parents (in a healthy parent-child relationship). A parent or master

has no illusions about the child or student breaking away from and (hopefully)

surpassing them one day - in fact, this is the goal. The child or student, in a

healthy relationship, never loses touch with their autonomy and personal power,

they will simply ///choose/// not to impose themselves on their parent or chosen

mentor without good reason.

 

In my experience, a good master / mentor has good boundaries, and while they

might not have tolerance for bs on the part of the student, and may be

unforgiving of less-than-student's-best, they will be appreciative of a student

who confronts them with class when a disagreement crops up. I've never had any

of my teachers be upset with me if I've " argued " with them while treating myself

with class, and treating them with class. I've never felt, conversely, that it

would be right for a master or mentor to treat /me/ with class. Care and honesty

yes, but class no.

 

It seems to me that alarms should be rung in potentially serious cases, and

even if the " target " of the alarm has been " misjudged " , there is no doubt in my

mind that someone else on the list will benefit tremendously from witnessing the

exchange.

 

I wonder if similar attitudes would be workable in this case. I believe at

least some of us can imagine the trouble that our teachers have helped to keep

us out of (when we've listened).

 

It has been my impression that the best students don't get sidelined by

criticism - all that is necessary is to not shoot the messenger and get the

point.

 

What a horror to imagine a patient dying as a result of carelessness!

 

Hugo