The Power of Naivety.

Abstract

From the earliest days of medical education, doctors have been teachers: senior medical students have taught junior medical students, residents have taught senior medical students, and fellows have taught residents. However, I often wonder: Do teachers (doctors) merely teach their students? When I was a third-year resident, a 75-year-old female patient at the hospital told me, “I have been coughing and running a fever for the past 10 days.” At that time, I was part of a team of 4 that also included an attending doctor, fellow, and medical student. As an internal medicine resident, I had experience and was full of confidence in my work. I instructed the medical student on how to perform history taking, physical examinations, laboratory work, and imaging tests as I took care of the patient. I diagnosed her as having bacterial pneumonia and decided to treat her with intravenous antibiotics. On the second day of her admission, I instructed the medical student on the importance of Gram staining of the sputum to determine the effectiveness of treatment for bacterial pneumonia. We confirmed that the bacteria had disappeared from the sputum and therefore decided to continue with the antibiotics that we had been using. “I feel so much better,” the patient said with a big smile on her face when I visited her room on the third day of admission. In fact, after she was admitted to the hospital, her cough and fever improved, and she seemed to be doing well. I was very pleased with her progress. That evening, we gathered to review the day’s work. When reflecting on the patient’s progress, the medical student on the team said, “I don’t have detailed medical knowledge, but instead, I visited the patient many times and listened to her. She told me that she had been having trouble with urinary incontinence when she put pressure on her stomach over the past year. This time, since she started coughing 10 days ago, her urinary incontinence worsened, so she came to the hospital.” The 3 of us were pleasantly surprised to hear this. Of all the members of our team, the medical student was eliciting the information and handling the sensitivity of the topic well while showing the most patient-centered attitude. The patient must have felt embarrassed about disclosing this issue to the rest of us. We then realized that the patient had come to the hospital in the first place not because of her cough, but because of her urinary incontinence. After her fourth day of hospitalization, we taught the patient pelvic floor muscle group training to help her manage the incontinence. After she was discharged on the ninth day, she visited my outpatient clinic regularly. During one of her visits to the clinic, she said contentedly, “My urinary problems have completely improved. I feel very grateful to the medical student. How is she doing?” Japanese artist Taro Okamoto speculated that people who are more naive and/or immature than others might show more potential. 1 In the field of modern medical education, to what extent do we acknowledge the perspective that juniors teach seniors just as much as seniors teach juniors? We teachers should not only teach students but also continue to learn from them humbly and modestly. Acknowledgments: The author wishes to thank Dr. Taigo Sato for his inspiration and encouragement and Drs. Masato Eto and Kayo Kondo for their reading and supporting the submission of this essay.