Part of medical education is to learn limitations

There is a strong relationship comparing sports to the military, business, and also to medicine.  Young athletes, in their late teens and early 20s, are mostly brawn and use their strength and speed to achieve success early in their professional careers.  As the athlete matures in their late 20s and early 30s, the physiologic processes slowly decrease and efficiency and maturity and other cerebral skills emerge.

There are 2 rainbow arcs that describe this brawn-brain interaction.  The arc of brawn rises earlier than the arc of brain-based skills, which appear later only when brawn starts on its down slope and intersects with the rising arc of experience that peak performance occurs.

The same 2 arcs probably take place in every medical doctor’s career.  Young doctors are full of energy and knowledge.  It is only after years in practice that the doctors develop maturity of their clinical skills that makes them peak performers.

When I was a newly minted urologist in 1978 I was referred a Crohn’s patient who complained of foul smelling urine and passing “bubbles” in her urine.  I worked her up and diagnosed a colovesical fistula.  I called the referring doctor and told him that I could surgically correct this with the assistance of a general surgeon.  The gastroenterologist said, “Neil, I am going to do you a favor and not allow you to operate on her.  She has terrible nutrition and has a history of multiple fistulae and would not heal and she would likely be made worse by the surgery.”  What a valuable lesson that was helpful in my early maturation as a physician.  I was able to learn that I couldn’t cure everything and that were times when keeping the scalpel on the shelf was in the best interest of the patient.

I think part of our medical education is to learn our limitations.  My best lesson I learned was to always think of our actions appearing on the front page of the paper or on 60 Minutes.  Always ask yourself, “Would I want my decision to appear in public?” or “Is this decision or action in the best interest of the patient?”  If the answer to both questions is yes, you will not be making an error where your brawn gets in the way of your brain.

Neil Baum is a urologist at Touro Infirmary and author of Marketing Your Clinical Practices: Ethically, Effectively, Economically. He can be reached at his self-titled site, Neil Baum, MDor on Facebook and Twitter.

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