Tuesday, September 27, 2011

Atul Gawande, "Personal Best"

My cheeks burned; I was mortified. I wished I’d never asked him along. I tried to be rational about the situation—the patient did fine. But I had let Osteen see my judgment fail; I’d let him see that I may not be who I want to be.

This is why it will never be easy to submit to coaching, especially for those who are well along in their career. I’m ostensibly an expert. I’d finished long ago with the days of being tested and observed. I am supposed to be past needing such things. Why should I expose myself to scrutiny and fault-finding?

Atul Gawande has a nice piece in the upcoming New Yorker on the potential value (and concerns) of coaching for non-athletes. We've been kicking around the idea of professional coaching for trainees (students and residents) in our medical education reform discussions, but it's interesting to see the idea applied to already practicing physicians and teachers as a parallel to elite athletes: yes, you're the best, but how do you become even better?

It's interesting that Gawande couches this experience in terms of getting better results, defined for him as fewer surgical complications and errors. Errors in medicine mean death and disfigurement. They mean lawsuits. They mean an erosion of the trust of your patient. The messaging here is to open yourself up to the scrutiny of errors in the quest of making fewer. Discomfort now for a higher purpose later, which is basically the story of becoming a doctor in the first place.

The hardest thing that we teach the students to do is how to say, "I don't know the answer to that." That lesson becomes harder and harder the further along in their training the students travel. It's almost as they learn how capricious the human body can be, they need to instill some certainty into their lives in order to function. In decision-making, that's a help and a hindrance. And if that hindrance is poor patient outcomes, then we owe it to society to push for uncomfortable critique even for the experts because the rewards are absolutely worth it.

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