Pearls Before Swine
I'm a third-year medical student, and I'm starting the second day of my new rotation--a month that I'll spend with a family physician, Dr. Bauer, in his small, efficient home-based office.
Yesterday, my first day, a young woman named Sara came in for "strep throat." She had dark Latina eyes, broad cheekbones and a delicate tattoo of the Chinese character for "dream" on her left wrist. She was 17 and seeking out a primary-care doctor for the first time in her life; I applauded her for taking responsibility for her own health care. Her tonsils were big and purple, covered in pus, but the rapid strep test was negative. She also reported a vaginal discharge. Dr. Bauer wanted to do a pelvic exam to check for a sexually transmitted disease (STD). He started her on antibiotics, ordered some blood tests and told her to return today to discuss her lab results and have the pelvic exam.
Now Sara returns with her mother, wanting to know why the exam was scheduled. Impressed by Sara's thoughtfulness, I tell her that we recommend the test, but assure her that the choice is hers. She looks me in the eye, confidently reports no STD risk and decides to wait on the pelvic exam.
Minutes later, I hear voices rising. Dr. Bauer seems to be, well, having a temper tantrum.
"You came here because I'm a doctor! Do you want to be treated by a doctor or not? I went to medical school! What doyou know?"
Sara and her mother try to respond, but don't get more than a word out before he interrupts. It's not even an argument, really, because Dr. Bauer isn't listening or reasoning with them at all. His words and tone are insulting, arrogant and belittling.
Sara storms out of the office. Her mother stays behind to argue with the receptionist (who happens to be Dr. Bauer's wife), banging a pen into the counter, threatening to report the doctor's behavior. After they're gone, Dr. Bauer remains furious, and though Mrs. Bauer has been supporting him and helping him document the incident, he yells at her also.
I step out of the office, pace the parking lot and say a little prayer for composure.
I don't understand what has happened, or what could justify Dr. Bauer's reaction. I hate to hear people demeaning one another. If I heard a stranger on the street speaking to someone the way Dr. Bauer spoke to Sara, I'd probably intervene. But my position as a student, new to this rotation, doesn't seem to allow me that luxury. It's as if I can't be myself.
I fume behind my book for the rest of the day. I can't look Dr. Bauer in the eye. Throughout the afternoon he and Mrs. Bauer spin the story over and over.
"She just a slut and doesn't want anyone to know it!" Dr. Bauer hisses.
"And her ignorant spic mother doesn't even care," his wife adds loudly.
My face is hot with anger. Their language is not only bigoted, judgmental and mean, it's also deeply offensive to my personal beliefs.
"You see how God winnows them out for us?" Dr. Bauer says, wagging his finger, flaring his nostrils and hiking up his belt like he's ready for a fight. "The Lord didn't allow that awful patient to be in our practice! Cast not your pearls before swine!"
I feel myself physically cringe.
Dr. Bauer's little office is plastered with Christian pamphlets and Bible verses that his children have crayoned onto printer paper. His car has a Jesus license-plate placard and a little crucifix air freshener hanging from its rearview mirror. This is a culture with which I'm well-acquainted; for many years, it was mine.
Though my evolving beliefs are nontraditional, I'm still rather enamored of the person of Jesus. I deeply believe that if God exists, then he or she is reflected in acts of love, compassion, justice, creativity, beauty, generosity. I feel outraged that Dr. Bauer would call his own bold unkindness and disrespect of another human being an act of God.
And yet I remain silent. I feel gagged by my position as a student, a subordinate. So at the end of the day I'm disgusted both with Dr. Bauer and with myself, driving out-of-state plates too fast down a country road.
I take a deep breath, coast, downshift. After a few minutes I call my friend who is a resident. He lets me vent a little, and finally I ask his advice. "Your job is basically to agree for two years," he tells me. "You just have to play the game and learn what you can."
Really? Dr. Bauer didn't breach medical duty, but he did break other rules: He thwarted and denigrated Sara's attempts to make her own medical decisions and to use the healthcare system responsibly. Is this reportable? Do I have any recourse?
The phrase "First, do no harm" resonates in my mind. Doesn't being judgmental, arrogant and verbally abusive count as harm?
Three years ago, a group of professionals decided that I belong in the medical community. They accepted me because they saw my potential to become a healer, and in doing so, they made a promise to teach me how. But now one of my teachers is acting cruelly. How do I refuse his example but still remain his student? And can I still somehow be a healer to Dr. Bauer's patients?
Maybe I should call my school administration and ask to be removed from this rotation, at risk of falling behind by a couple of precious weeks; maybe I should notify the board of medicine.
After a long walk I sit down with trusted friends and rehash my conflicted day. They nod like sages and quietly suggest, "Well, maybe Dr. Bauer can still teach you something." As I open my mouth to disagree, they add, "And maybe he needs you to teach him something as well."
In the end, I decide to stay.
I'll learn what I can from Dr. Bauer and let go of the rest. But I'll also hold onto my beliefs, question what I'm told and see if I can't find a way to be honest and be myself.
There needs to be room for that in medical education--even in Dr. Bauer's tiny office.
About the author:
Kate Lewis DO is thrilled to have graduated from medical school last week. She will pursue family medicine because it is a specialty rich in stories of all sorts, but first she is taking the coming year to volunteer, write and travel before starting her residency in 2011.