The Harvard Way

S. Walker

JAMA 1985 Oct 11;254(14):1903-5.

 There are times, every day, I need to swallow the urge to cry. And I need to keep telling myself that I'll be a good doctor. Maybe it's just a product of the place where I was raised. People there were unassuming, and usually kind at first meeting. Here there is no "Nice to meet you," there isn't even a chance to make a mistake. They assume you already have.

They have a way of making you feel worthless. Where they're coming from, or why they feel so superior, I don't know, but I think it's ironic. We work like slaves, get very little sleep, and have no formal didactic teaching on which to base our knowledge of the vast field of surgery. And if we don't perform well on standardized tests – there's no explaining - there's no help – there can be no suggestions. We just get degrading letters in our mailboxes about how poorly we have performed, encouraging us to get into a study program. Excuse me, but I thought that was supposed to be part of the residency!

This is supposed to be the Mecca of medicine – and probably the country’s most renowned medical city. You’d think they'd be proud to share their knowledge; after all, it's a "teaching institution." Well, they've taught me to feel afraid, worthless, ashamed, and often that I don't "deserve" to be a doctor. Physicians don't have the respect they once had. It's our own fault; we have demonized ourselves.

In two months I'll pack up and go home – by my own choice. I know that I am a good, caring doctor. But my self-worth and sense of competency have had to come from within. They've done everything they can to tear it down. This experience did not build character, strength, or "make a man" out of me. I am not and never will be one of the "good old boys." It has only given me many months of disappointment and sorrow. It is sad that people so bright and so famous have lost the ability to do a simple thing – to treat all people as equals. Someday we may all be in a situation where we can't handle the rejection anymore.

JAMA Editors' Comments:

"This personal view generated a good many letters to JAMA. Some agreed with the author’s assessment of the often arduous training of surgeons at Harvard, and others, particularly faculty at Harvard Medical School, protested the singling out of their institution. The editors of JAMA stated that in publishing this article, "The Journal allows its readers to reach their own conclusions concerning the motives, balance, and accuracy of the piece."

Will You Forgive Me for Saving You?

by Toree McGowan

I remember the day I first met you. It was a quiet Sunday, early in the morning. I heard a commotion out by the check-in desk, and your mom’s scream: “My baby’s not breathing!” The first time I saw you was in your mom’s arms. Heartbreakingly, you weren’t snuggled like a baby should be, or even limp. Your tiny body was twitching, seizing. The cold clinical term “decorticate posturing” that flashed in the physician part of my brain seemed too rigid to be applied to your chubby toddler arms.

This is a moving medical meditation.  Well worth reading.  NEJM has made it available FREE.

Toree McGowan, MD, FACEP

Comment of Brian Maurer, Pedicatric PA-C: Dr Torree McGowan’s moving piece “Will You Forgive Me For Saving You?” broaches the fine line between beneficence and malfeasance that clinicians who labor on the front lines in medical practice frequently face: when does medical intervention ultimately do more harm than good? As clinicians, we are trained to do everything in our power to save the life of a patient entrusted to our care, knowing full well that in some instances the ultimate outcome may be less than desirable, not only for the patient, but also for those whose lives will be burdened with her care for years to come. The pain that the clinician carries—call it survivor guilt—testifies to the heightened degree of moral distress experienced, distress that many times persists indefinitely. Hemingway once wrote that he “had gotten rid of a lot of things by writing about them.” That might be true for Dr McGowan in this case, though I suspect her clinician wound may prove to be a difficult one to heal.

Comment of Shay Bintliff, retired pediatrician and E.R. doc:
Having spent the first fifteen years of my medical career as a Pediatric Birth Defects specialist, then the next forty years as an Emergency Room specialist, I so identify with Dr. McGowen’s experience with this patient. Telling this very, and yes, sad special story from her heart  she shares her emotions without hesitation. She is able to share with readers the lessons that she will carry forth and pass on to others in her medical practice.  YES, our patients are our best teachers if only our hearts and minds are open to them. Dr. McGowan has learned this early in her career and I am one  of many who appreciate her sharing her story!!