I graduate from medical school in two weeks. It has taken me nearly seven years and hundreds of thousands of dollars to get this far. I transitioned from one profession of service into another and truly can’t wait to get after it. I can’t wait to hear the relief in a patient’s voice when I’ve told them that they will be ok. I understand that not every patient or family will get this news but I also can’t wait to be the trusted advocate and teammate for those who get bad news.
Before every flight in the Air Force, I or whomever was leading, would stand up and brief the entire team on how we were going to fly our mission that day. At the beginning was the “motherhood” section or the basics on introductions, weather, objectives, takeoff, route, landing and safely parking the jets. One very short portion of that most basic of presentations described what we would do if one of our airplanes was shot down or crashed. “For RESCAP (Rescue Combat Air Patrol) first be a help not a hindrance. Don’t fly under parachutes or run out of gas. Make sure the area is safe to orbit and then immediately get into the checklists.” Every time I lead a group of fighters into the air I said the words, “be a help not a hindrance.”
Now I find that medicine is the third highest killer of my fellow Americans. Studies estimate that we contribute to the deaths of 210,000-400,000 people through medical errors.1 I have learned first-hand that these numbers are very controversial, leading to agitation and yelling. I would caution any medical student who wants to bring these up during a residency interview! But I’ll do it again. Even if the number is only 98,000 as estimated nearly twenty years ago by the Institute of Medicine2 it is still too high. These numbers tell me that somewhere along the line, for some patients, we are being more hindrance than help.
Our healthcare system is huge and it will take time and work to shift the culture as is needed. We need teams of teams all trying to do it better. We need strong leadership to organize and motivate even the smallest of clinics to improve. We need to build the foundations for this culture shift in our medical schools.
Medical schools should be transformed to emphasize a culture of teamwork with skilled leadership. Admissions should require candidates to be smart enough but should then look for applicants that have the emotional intelligence and desire to lead. Accepted students must have proven teamwork experience and be comfortable in a team.
The curriculum for the first two years should be reduced so that several weeks or even months can be allocated to leadership training and its many components. Our medical practice is so specialized that it is wasteful to spend so much time re-teaching everyone the Krebs cycle or gaucher’s disease (I agree it is a terrible disease but those inflicted should be treated by a specialist.) A leadership and teamwork block during the 1st year could build a solid foundation for future healthcare improvement. It is necessary to stress a culture of teamwork and value improvement to new trainees early and often.
Medical schools should then require fourth year students to return for a mandatory month long leadership and teamwork course. This could emphasize the environment of healthcare, value, legislation and burnout. There are great readings and hands-on exercises that are engaging and would better prepare us for our current healthcare system. This could include facilitated self-reading that would fit well with the current travel schedule.
I will be a medical doctor in two weeks. I am thrilled to enjoy the moment and eager to start my residency! My patients and community will look to me for treatments, reassurance and cures. They will also look to me for leadership and solid teamwork. I feel that I am entering a noble profession with a dangerous culture that can and must be improved. Fortunately, there are many opportunities to enrich our safety and quality starting with the evolution of our medical schools. As my classmates and I move on to our residencies, I know that each of us hopes to be a help to our patients, not a hindrance.
- ALLEN M. How Many Die From Medical Mistakes In U.S. Hospitals? 2013; http://www.npr.org/sections/health-shots/2013/09/20/224507654/how-many-die-from-medical-mistakes-in-u-s-hospitals. Accessed September 10, 2015.
- William Richardson ea. To Err is Human. In: Medicine Io, ed. The National Academy of Sciences: Institute of Medicine; 1999:8.
- Health expenditure per capita (current US$). Data 2017; http://data.worldbank.org/indicator/SH.XPD.PCAP. Accessed April 21, 2017.