This article is more than 5 years old. Information may no longer be current.
Heroes and what they should mean to pediatricians
Click Here to Manage Email Alerts
“It helps a man immensely to be a bit of a hero-worshipper, and the stories of the lives of the masters of medicine do much to stimulate our ambition and rouse our sympathies.” — William Osler, “Chauvinism in Medicine” in Aequanimitas (1889)
“If everybody was satisfied with himself, there would be no heroes.” — Mark Twain, Mark Twain’s Autobiography (1924)
Heroes make the sun rise in the mornin’
Heroes make the moon shine bright at night
Heroes make our lives a little stronger
In the soul of everyone he can be found — The Commodores, “Heroes” (Darrell Jones and Lionel Richie, 1980)
“True heroism is remarkably sober, very undramatic. It is not the urge to surpass all others at whatever cost, but the urge to serve others at whatever cost.” — Arthur Ashe (1943-1993), American tennis player and activist
Where have all the heroes gone? A common refrain frequently followed by the similar construction, heroes are hard to find. I won’t bother you with the many lyrics that contain these assumptions about our public lives. These emotions, however, are also clearly in play in all of our medical professional lives. Pediatricians may not display our ancestry as openly or as frequently as our surgical colleagues, but the debt is as real and the acknowledgment as important.
Professionalism and medical training, two topics I’ve spoken of often, are intricately linked to heroism. The tension between definitions of hero — internal to us all, or limited to a few, driven by dissatisfaction or by the moment — is indeed crucial to our survival and a prime force in our success as a profession, no less than as a society. I am mindful of the use of the word hero, given our nation’s reliance on a new generation of hero/soldiers, and my use here is perhaps anachronistic as it reflects a Goodbye, Mr. Chips view of the world.
William T. Gerson
My intended use of hero is best summarized as Arthur Ashe does by placing it in a social vein. To be sure, I am not referring to celebrity but to the surmounting of the difficulties of our profession with joy and a positive attitude and nourishing these attributes in the next generation. Time separates the hero.
Osler, as is his want, wisely précised the notion of heroism in his quote before expanding the theme to acknowledge the impact of hero worship to fidelity and progress as a profession. My concern is that the heroes of today are kept busy by misplaced priorities. We must do better in acknowledging their importance. Not for their benefit but for our own.
Displaced heroism
A major complaint of mine about medicine today is that some of the mystique has been lost, some of the closeness to our heroes displaced, while our attentions divert from substance to form. Giants didn’t just walk the earth in the past. They remain but have been relegated to a distance by a misguided adherence to the exigencies of current medical life.
Our residents are time-limited, but so is our faculty; not by ACGME but equally by fiat — time to teach or, more significantly, time available to mentor and to be observed is deemed less valuable than billable minutes. We have substituted a rigid bureaucratic system for a rich culture and a diffused responsibility for individual accountability. In the name of quality, we have defeated excellence. A poor trade-off.
A system predicated on excellence without a commitment to excellence also is a recipe for disaster. Excellence and quality can coexist. I can only reflect on my experiences. It took time for me to realize the intricacies of the old system (a humbling realization, comparable perhaps to that of parenthood). The assumed notion of interns left alone to learn on vulnerable patients is as false today as it was in the past. The key was for interns to feel alone while closely being observed. Interns observed by senior residents. Interns and supervising residents watched over by chief residents. Program directors and attending physicians evaluating the totality and head nurses evaluating all. Quite comprehensive.
Limitations on time lead to disaster
Time limitations are also a stealth disrupter of professional development by limiting availability of observing one’s teachers in action. Without the time to observe one’s mentors, we cannot flourish. Different styles and skill sets, as teachers and physicians, are on display to emulate, accept or reject, but ultimately to relish in their variety. Unfortunately, in comparison to today, these moments are often unscripted.
Previous generations benefited from teaching times that were closely scripted because of design — not time limitations. Case conferences where senior faculty performed were critical — how else to learn how to communicate and advocate among colleagues and to acknowledge mistakes. Critical thinking and the public expression thereof has a crucial place in training. Committing to teaching rather than clinic billing is required.
Participating in the active process, not just in the recitation of facts so voluminously collected in our electronic medical records, is the joy of practice. The mystique of the past was not just scenery for the central act. Watching heroes respectfully refer to one another as “Dr.” despite practicing together for years beyond my age, the acknowledgment by a full professor that they did not know the answer, reserving the hallowed position of presenting the case to the most junior house officer or medical student, and observing the heated discussion of pathophysiology and disagreement between division chairs — all were and should be requisite training for physicians — time restrictions or not.
I cannot help myself. In closing, I will bother you with these lyrics: “Heroes are hard to find, we need you, come on and try.” Twisted Sister, “Heroes Are Hard To Find,” Dee Snider, 1998.
For more information:
William T. Gerson, MD, is Clinical Professor of Pediatrics at the University of Vermont College of Medicine and a member of the Infectious Diseases in Children Editorial Board. He can be reached at 52 Timber Lane, S. Burlington, VT 05403; email: William.Gerson@uvm.edu.
Disclosure: Gerson reports no relevant financial disclosures.