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On the Shoulders
Jonathan Virkler
(Dedicated to Dr. Walter Bo)
I had always thought that putting on the white coat would make me feel a little bit more like a doctor. In my mind, there was this series of well-defined steps by which one became a physician: anatomy lab, physical examination routines, interview techniques, board exams, the white coat. I had assumed that once I could speak the language, perform the skills, master the information, and dress the part, I would be ready. Taking those steps, however, has shown me that I was mistaken.
Several of my milestones are now behind me, and several more are still to come. I have survived the anatomy lab, I have interviewed patients, I have performed the exams, and I have donned the coat (albeit the short one). I still feel, however, very far removed from the actual practice of the physician, and I no longer believe that the steps that lay in front of me will draw me any closer. These steps are steps of my own creation- they are simply pomp and circumstance. Becoming a physician is not a series of steps, but rather an evolution, something akin to growing up.
Medical school is perhaps very similar to the coming-of-age rites that we have read about: as students we are on the brink of our profession, on the verge of our adulthood, and we are thrown out into school to read and study, to digest and assimilate information, to learn to survive on our own, and to come back as the grown physician. And when we come back, now dressed in our white coats, we will be something different than when we left.
Ubiquitous in these rites, in these stories of transition to manhood, is the wise elder, the leader, the teacher. In these tales of maturation, it is always the father figure who walks his son into the wilderness, imparting wisdom while on the trail, and then leaves the son to his own devices. The words of the father, however, are always integral to the growth of the son, and always the son comes back to the father wiser for having listened. So it is with our medical education.
Perhaps I do not feel the part of the doctor because I am surrounded by doctors, and in the constant act of comparison I find that I do not measure up. As I put on my white coat, I see the doctors who wear it so much better; as I practice my exam, perform my interview, impart empathy to my patient, I watch my teachers perform more swiftly, interview more insightfully, and care with more depth than I feel I will ever grasp. My teachers are something to aspire to, a measuring stick upon which I constantly find myself lacking.
And yet, they teach us. They play the part of the wise father, giving advice and counsel to the son. They teach physical exams and anatomy class, interviewing and pharmacology, all the while subtly imparting professionalism and ethics. And they do so as equals.
My first glimpse of this came in small group cases, in which I studied under Dr. Walter Bo and Dr. Paul Laurienti. I had been warned of Dr. Bo in advance, and had heard the stories of his quizzing and questioning. Walking into small group for the first time, I was terrified. I knew that I could not hold my own with practiced physicians, and I expected them to remind me of that fact. I was surprised to find, however, that they respected us as much as we respected them, and I began to realize the depth of their dedication to the medical profession and to our training.
In the anatomy lab, it was never a burden when Dr. Bo approached us to question us on our latest assignment or to show us a specimen. It became a challenge, to see if we could stand up to Dr. Bo, to see if we were worthy of his respect. Each time he approached, it was our own coming of age, a microcosm of the entire medical school experience. Did we belong there, and would we survive? These were our tests.
I have since studied under many professors, each of them unique in his or her own right but each similar in that they all urged us to learn and to become better doctors. I have found myself often thinking, “I want to be a physician like this professor,” or, “I want to have the skills of that one.” I would be surprised if my classmates have not found themselves thinking the same thing, for there are role models around every corner.
And so my goal is no longer to wear the white coat well, or to perform the exam to perfection; rather, my goal is to earn the respect that has been given to me by my teachers. If at some point I find that I can stand in a circle of physicians and consider them peers and equals, at that point I will have found success. And I will remember that the reason I can consider myself a peer is because I was once a student, and learned from them, and remembered the wisdom of the teachers.
As students, we stand not on the information that we memorize or the skills that we learn, but rather on the shoulders of those who have come before us. Without the teacher, there would be no student; without the father, the child will never come of age. And though I may learn the physical exam from a textbook, I will learn to perform it with care and compassion from my teacher.
This passing on from teacher to student is as old as the medical profession itself, for Hippocrates reminds us all, “to hold him who has taught me this art as equal to my parents…[and] to give a share of precepts and oral instruction and the other learning to my sons and to the sons of him who has instructed me.” This is a part of our oath, to learn from our teacher, to respect him as a parent, and to pass on to the future generations. Each of us, as student physicians, stands on the shoulders of generations before us, and relies upon our teachers for guidance, until we too shall become the teachers. It is a calling to aspire to, and we should find ourselves blessed to be called, and to have the shoulders of so many to stand upon. |