On Feedback
22. Feedback is important regardless of the line of work, but even more so in ours—in which patients’ lives and liability are at stake. Feedback should be a two-way street, and we all need it if the goal is to improve. In medicine, where we must work hard to achieve our goals, we need to quell arrogance and remain humble. Some of our most important lessons come from experiences that are uncomfortable, and sometimes painful, but they should always occur in a supportive setting where we can feel safe to be vulnerable and readily learn from our mistakes and those of others.
We can learn from Groucho Marx, who once said, “Learn from the mistakes of others. You can never live long enough to make them all yourself.”
On Burnout
23. Know your patient. Obtain these four data points on every patient: where they’re from, who they live with, what they like to do and how their illness impacts their life. These are useful memory anchors, and they add meaning to the work we do.
Burnout in medicine is real, and it may not be the long hours that cause burnout
so much as the economic pressures
driving productivity and increased time spent interfacing with computers that are dehumanizing medicine. We need to preserve the humanity in medicine, not only for our patients, but also for ourselves. The reward of treating rheumatoid arthritis is trivial compared to that of treating “a 30-year-old concert pianist and father of newborn twins who has rheumatoid arthritis.”
24. Be kind to yourself. Our failures in medicine can have grave consequences for others; to do what we do, we need to have a plan for these setbacks, because they will happen. If we can’t take care of ourselves and preserve ourselves, we won’t be able to help anyone ever again. This is why it is critical the healthcare environment be one of support and safety.
On Clinical Teaching
25. To be a good clinical educator, follow three rules:
- Be kind;
- Think aloud; and
- Stick to the basics.
This was a lesson from a master clinical educator who humbly simplified his masterful teaching approach to just these three rules: Treat your colleagues with kindness and respect to cultivate a culture conducive to optimal learning. Thinking aloud demystifies the process of clinical reasoning by modeling it for learners. And sticking to the basics, such as the rules described herein, reinforces foundational skills in the practice of medicine and rheumatology.
