The Yale Journal for Humanities in Medicine

Notes from a Healer

Teacher and Student

Brian T. Maurer
btmaurer1@comcast.net

“The whole art of teaching is only the art of awakening the natural curiosity of young minds for the purpose of satisfying it afterwards.” —Anatole France, novelist, essayist, Nobel laureate (1844-1924)

“…the pupil and the teacher working together on the same lines, only one a little ahead of the other. This is the ideal towards which we should move.” —Sir William Osler

The new student is here, and I’m in a panic.

It’s been a while since I’ve precepted a student-in-training. Already it’s apparent that I, as teacher, have neglected to do my homework.

I haven’t taken the time to memorize a few irrelevant esoteric facts that I can drop casually in conversation with the student to impress her with my superior medical knowledge. It’s been a long time since I’ve looked at lists of differential diagnoses for the common cold and acute diarrhea. I wonder how well I’ll perform in teaching someone recently schooled in the most up-to-date medical syndromes and latest procedures.

What’s the gold standard these days in evaluating a child in the Emergency Room for suspected appendicitis—abdominal ultrasound, or CT scan? With or without contrast? Sedimentation rate or C-reactive protein?

How inadequate I feel, still practicing in the Dark Ages—taking a history and listening to the belly with my stethoscope, gently pressing the diaphragm into the right lower quadrant to assess for local tenderness, all the while telling the child that I’m “just listening.”

The last time I sent a child to the hospital with an acute appendicitis, I had neglected to order a CBC and urinalysis first. By the time the surgical team got the lab results back, the child’s appendix had already perforated. I suppose they never heard of taking a kid to surgery without first having the numbers from the lab tests in hand.

As long as the initial neurological exam is normal in the child with chronic headaches, I’m still most likely to send her home with instructions to keep a headache diary for three to four weeks without ordering an MRI or CT scan of the brain first.

And I still recommend that parents of spitty babies thicken the infant formula with rice cereal before electing to prescribe proton-pump inhibitors for gastroesophageal reflux. One time I had the audacity to send an emaciated four-week-old baby to our local pediatric surgical group for pyloric stenosis. “What are his electrolytes?” the triage nurse asked me over the phone. “Didn’t order any.” “And the ultrasound study?” “Didn’t do one.” “Then how do you know the kid’s got pyloric stenosis?” she asked me. “He’s four weeks old with a history of projectile vomiting, failure to gain weight, and has a palpable olive in his right upper quadrant,” I said. “What more evidence do you need?”

I shudder to think what sort of pediatrics a young student might learn from the likes of me, someone isolated in clinical practice for three decades.

They say you can teach a chimpanzee to perform surgery. Once, while we were making morning rounds together, one of my early preceptors—an M.D.—remarked to several colleagues in the hospital elevator that the trade of medicine could be learned by non-medical school students as well. (As I recall, they greeted his comments with looks of distain and disbelief.)

Thirty years later, I suppose I’m living proof of that.

About the Author

Brian T. Maurer has practiced pediatric medicine as a Physician Assistant for the past three decades.  As a clinician, he has always gravitated toward the humane aspect in patient care—what he calls the soul of medicine.  Over the past decade, Mr. Maurer has explored the illness narrative as a tool to enhance the education of medical students and cultivate an appreciation for the delivery of humane medical care.  His first book, Patients Are a Virtue, recently reviewed in The Yale Journal for Humanities in Medicine, is a collection of fifty-seven patient vignettes illustrating what Sir William Osler called “the poetry of the commonplace” in clinical medical practice.

Published: May 7, 2007