Screening for jerks

It is a truth universally acknowledged that doctors can be schmucks.  For a profession that deals so directly with people, particularly people at their most vulnerable, we can be surprisingly bad at playing well with others.  The god complex has historically been tolerated, and perhaps even encouraged in subtle ways.  There’s variability between specialties, which tends to go along with the kind of person drawn to being an internist vs a pathologist vs an orthopedic surgeon.  (When I was in medical school, there was a section on how to deal with the stereotypically surly and arrogant behavior of surgeons in the textbook for the rotation.)  The traits that make for effective medical providers, who need to make confident decisions under pressure, can sometimes lead to prickliness or pomposity.  (Not me, though.  I’m always awesome.)

As far as I’m concerned, the best way of dealing with this is to make all doctors work with jaded nurses at inner city hospitals.  The nurses at one of the hospitals where I did my residency had absolutely zero tolerance for any snot-nosed new doctor who thought they were the boss of anyone.  I came across as a wee bit too demanding one night on call, and boy did I never make that mistake again.  (Much of the dressing-down I received was in Tagalog, but the parts that were in English were unmistakably clear.)  As nurses have become more assertive in their roles as colleagues rather than subordinates, some of the problem of swaggering physicians seems to have diminished.

However, communication problems still account for a disgraceful amount of morbidity and mortality.  From the New York Times:

Even more dangerous is when poor communication becomes so endemic that the wrong operations are performed. A 2002 study published in The Annals of Internal Medicine of one such incident found that the patient, doctors and nurses went along with the mistaken treatment because they were used to being kept in the dark about medical procedures. A survey by the Joint Commission, a hospital accreditation group, found communication woes to be among the leading causes of medical errors, which cause as many as 98,000 deaths each year.

As much as I may grumble about the surpassingly tedious “communications skills” training sessions that staff are forced to sit through, a phenomenon that has been pretty consistent in almost all the hospitals where I have worked over the past several years, clearly the problem is sufficient to warrant ongoing efforts to correct it.  Even in my own experience, where nothing as dire as the wrong operation being performed has ever happened, too many parents report seeing other providers (be they the previous pediatrician or a subspecialist at one of the hospitals where we refer) and coming away feeling like they were dismissed, or their questions weren’t answered.  Hell, I can think of plenty of recent examples where I got the brush-off from doctors whose own awesomeness was felt to be self-evident and self-sufficient, and I’m an attending physician at the same hospitals!

So, what’s to be done?  This seems like an interesting approach:

At Virginia Tech Carilion, the nation’s newest medical school, administrators decided against relying solely on grades, test scores and hourlong interviews to determine who got in. Instead, the school invited candidates to the admissions equivalent of speed-dating: nine brief interviews that forced candidates to show they had the social skills to navigate a health care system in which good communication has become critical.

[snip]

At Virginia Tech Carilion, 26 candidates showed up on a Saturday in March and stood with their backs to the doors of 26 small rooms. When a bell sounded, the applicants spun around and read a sheet of paper taped to the door that described an ethical conundrum. Two minutes later, the bell sounded again and the applicants charged into the small rooms and found an interviewer waiting. A chorus of cheerful greetings rang out, and the doors shut. The candidates had eight minutes to discuss that room’s situation. Then they moved to the next room, the next surprise conundrum and the next interviewer, who scored each applicant with a number and sometimes a brief note.

The school asked that the actual questions be kept secret, but some sample questions include whether giving patients unproven alternative remedies is ethical, whether pediatricians should support parents who want to circumcise their baby boys and whether insurance co-pays for medical visits are appropriate.

Sounds good to me.  Apparently these methods have been studied and have a good track record at selecting candidates who will be better at communicating.  Unfortunately, there is no fool-proof test for certain kinds of stupid:

The problems these efforts address are profound. Dr. Leora Horwitz, an assistant professor of medicine at Yale, recalled an incident in her residency at Mount Sinai Medical Center in New York when a medical student marched into the hospital room of an elderly minister surrounded by his wife and several parishioners.

“And he announces in front of everyone: ‘We found the reason for your problem. The syphilis test is positive,’ ” Dr. Horwitz said. “It was a devastating event for the family and the whole church, and this student had no sense for that.”

Well, this particular student was a moron.  A moderately intelligent high school student would know better than to do this.  I am skeptical about any interview method being able to weed out all of the idiots out there.  I gather from the article that the speed interviews are at least somewhat effective:

Using mini interviews to help address these problems, though, left applicants at Virginia Tech Carilion wide-eyed. One said one of her interviewers hated her, so she was thrilled to talk to others. Another said the system was unfair because some of the situations were drawn from news events she had not followed.

I’m really, really hoping the anonymity of that last applicant means she didn’t get in.  (They later give the name of another applicant who ended up getting accepted.)  It’s not fair, you complain?  You weren’t fully prepared for some of the questions because you hadn’t been paying particular attention to those issues?  Boo-freakin’-hoo.  Welcome to the world, kid.  If you think I get to send patients away because I hadn’t been studying up on their specific symptoms the night before, I’ve got a bridge in New York you might be interested in buying.  Most professions require you to adapt to the unexpected.  If these mini interviews keep a few more whiny, entitled college students out of my profession, then they’re worth it for that alone.