Viva La Difference
Doctors today are specialists. Rather than criticizing colleagues for their narrow focus, why can’t we appreciate them for what they bring to the mix?
We in the medical profession tend
to cultivate particular skill sets. I, for instance,
am a resident in internal medicine, focusing on managing
chronic medical conditions. My med school buddy, Alex,
is training as a surgeon. He spends the bulk of his
time studying techniques of operating—mastering anatomic details that
are but a distant med school memory for me. Alex and
I are doctors with distinct roles. What I’ve
noticed, though, is a tendency among physicians to
condemn colleagues for not having the same skill sets
as our own. It becomes easier to criticize than to
educate, to judge rather than to understand.
An example of what I’m talking about occurred
at one of my department's morbidity and mortality (M&M)
conferences a few months ago. These confidential meetings,
held periodically in different clinical specialties,
go over real cases in which human or system imperfections
might have harmed the very patients we were seeking
to help. By discussing the cases in safe surroundings,
young physicians learn to make necessary adjustments
to their clinical reasoning and to develop critical
inward-thinking skills. No notes. No outside observers.
This time, the featured case was Mr. D., a patient
who had needed surgery urgently but not emergently.
Before he went to the operating room, his chronic medical
illnesses landed him on the Medicine inpatient service
for an appropriate “tuning-up.” After days
of tests and adjusting medications, Mr. D. had his
operation. He was then transferred to a surgical floor,
where surgeons took charge of managing his postoperative
care as well as his multiple chronic conditions. His
surgical issues were handled without complication,
but his medical conditions weren’t cared for
as effectively. The patient suffered serious—but
So, here’s what was a little disappointing
about our M&M discussion that day. Our chance to
thoughtfully dissect our own mistakes focused instead
on what went wrong once the patient had left our department's
care. We took a long look in the mirror—and critiqued
someone else. So much for hard-hitting self-assessment.
From my internship, I recall another instance of
what I’m talking about. Our team sent a complicated
patient for an operation. The surgery went well, but
after a few days of recovery, the patient was transferred
back to our internal medicine team. Later, during rounds,
the admitting intern commented on how the surgeons
had managed the chronic medical conditions. “They
did nothing for this patient!”
The medical students in the group—one of whom
was planning a surgical career—looked stunned.
And then, our attending physician gave a response so
refreshing it will stick with me permanently. “But,
you know, I am a terrible surgeon.”
And therein lies the key: When it comes to the toughest
challenges, specialization helps more than it hurts.
Corporate executives agree that this holds true for
most industries. If my transatlantic flight from New
York to London encounters unexpected engine troubles
as it prepares to land. I want a veteran pilot who
knows every instrument panel in the cockpit like the
back of his/her hand. I want an air traffic controller
whose mastery of ground-based guidance systems can
advise the crew about the safest approach. And perhaps
most importantly, I want those people to be working
seamlessly toward their common goal.
Ingredients for success in medicine are perhaps even
more interdependent. If a member of my family develops
jaundice with a mass at the head of the pancreas, I
will do everything I can to enlist a surgeon who has
done thousands of these type resections. I will hope
for a savvy anesthesiologist to administer life-sustaining
medicines during the procedure. And I will count on
a well-trained team of ICU physicians and nurses to
ensure a safe postoperative recovery.
That division of labor and skills yields unquestionable
benefits for patients. But it also creates an important
obligation: We as physicians owe it to ourselves to
remember the lens through which our colleagues in other
specialties view patients. And that recognition should
foster a spirit of proactive partnership, not finger-pointing
or lazy, retrospective judgments.
Certainly we can agree that we’re all here
to provide the best care we can to patients. I’m
convinced that one way we honor that duty is by educating
our colleagues—and by being educated by them.
Such partnerships make for better decision-making earlier
in a patient’s clinical care. In the long run,
I suspect, they might also make for fewer cases to
discuss at M&M.
Dan Munoz is a second-year resident in the Department of Medicine.