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Academic Medicine:
50 Years Ago

Doctor Means Teacher

Shapiro, Irving

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Clinical Assistant in Preventive Medicine and Community Health, State University Medical Center at New York City; Director, Health Education Division, Health Insurance Plan of Greater New York, New York, NY

“Doctor Means Teacher,” The Journal of Medical Education, 1951;2:125–129.

The word “doctor” is derived from the Latin, docco, which means “to teach.” But the word “teacher,” as well as the word “learning,” means different things to many people. There seems to be agreement, however, that if more citizens had more knowledge, and the will to act in certain areas, we would have healthier communities. How does the physician, vis-à-vis the patient and the public, play his role as teacher? Is he being equipped to do so in medical schools today? Or even more basically, does the medical student see himself as one who can influence behavior significantly, as a teacher in need of special understanding and “know-how?”

The Long Island College of Medicine, now the College of Medicine of State University of New York Medical Center at New York City, started a series of three hour seminars in the fall of 1947 to find the answers to these questions….

The attempt to define “learning” is always interesting, for often students find the concept of “knowing” linked with “doing” a strange new one. Agreement is reached, however, that the transmission of knowledge or fact alone, or the retention of fact or experience in the consciousness, are not, by themselves, adequate working definitions of learning. The goal is, of course, to help people act on sound knowledge.

But people are rarely moved to action on the basis of fact alone. Respect, dignity, participation and emotional satisfaction are essential components of successful motivation for action. In “the doctor and his patient” area, does the physician encourage learning? Significant in affecting behavior are what he does or does not say, the manner in which he speaks, his actions with or without words, the procedures he follows, the office setting.

During this part of each seminar, the students engage in two experimental activities which have proven highly successful and popular. Flowing from the discussion of the importance of the doctor's appreciation of the tension and unexpressed fears or questions a patient may have, the group engages in “role playing.” Thus, to test, in a recognizedly artificial setting, the ability of the doctor to provide explanation and to give assurance to a patient, one of the students assumes the role of the physician, and another the role of the patient. The “patient” is described briefly, as, for example, a “middle aged shoemaker, with high school education, married, with three children.” His “complaint” may be “elevated blood pressure,” discovered during a routine examination.

The two students usually play their roles with considerable earnestness and imagination, while the observing students make mental notes. Factors which come under scrutiny, and which are later discussed at some length, include the choice of words spoken by the “doctor”; his answers to or evasions of the “patient's” questions; his appreciation of those “patient” concerns only hinted at; his consideration of anxieties which might logically be presumed and which merit exploration; and his methods of placing the “patient” at ease, or of providing him with an opportunity to express himself.

The second activity … grows out of the discussion of how doctors could give some patients simple, clear and adequate explanations for certain conditions….

Blank sheets of paper are distributed by the discussion leader and another “patient” is hypothecated, with some medical problem requiring explanation. It may be that the “patient” has a cystic kidney, necessitating its removal, and an enlarged prostate. The students are asked to make a sketch designed to supplement a verbal explanation of the condition and of the surgical action necessary. The discussion leader secretly notes the time it takes each student to complete his sketch. When the last student has finished his drawing, all the sheets are collected by the discussion leader who sorts them for the purpose of illustrating certain points in sequence. The students are asked to guess how long the sketching took, and, invariably, the guesses are too high. Rarely does it take the slowest longer than 2 minutes to complete his sketch.

One by one the sketches are returned to their makers who proceed to discuss and explain the problem, using the sketch, as if the rest of the group represents the patient. At the end, there is animated discussion about the merits and faults, the telling points and the oversights, of the various performances. Some of the factors discussed concern size of the drawing, portrayal of parts necessary of the patient, sight and appearance of operative scars, explanation of function, bodily compensation, assurance of continued abilities, use of analogy, and choice of words. It also becomes evident to the group that all the sketches were useful, no matter how crudely drawn.

These two activities, role playing and sketching, prove successful because of the student participation necessary, and because there is learning from each other in direct relation to personal effort…. Other subjects discussed during this first segment of the seminar session include the role played in the learning process by office secretaries and nurses; patients' questions, asked and unasked; use of pamphlets and other literature; physical examination and diagnostic procedures; office and hospital settings and routines….

© 2001 Association of American Medical Colleges

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