Teaching Teamwork

In May, 2011, Atul Gawande gave an insightful commencement address to Harvard’s Medical School graduates.

He reminded the graduates that the practice of medicine had changed markedly, and that increasingly, the best docs are members of teams.

Gawande pointed out that, “The doctors of former generations lament what medicine has become.”

I’m having my graduate-level teacher certification students read the address. On the copy I’m providing them, I’ve lined out “doctors” and “medicine” and written in “teachers” and “education”.

Here’s Gawande’s primary point:

The core structure of medicine—how health care is organized and practiced—emerged in an era when doctors could hold all the key information patients needed in their heads and manage everything required themselves. One needed only an ethic of hard work, a prescription pad, a secretary, and a hospital willing to serve as one’s workshop, loaning a bed and nurses for a patient’s convalescence, maybe an operating room with a few basic tools. We were craftsmen. We could set the fracture, spin the blood, plate the cultures, administer the antiserum. The nature of the knowledge lent itself to prizing autonomy, independence, and self-sufficiency among our highest values, and to designing medicine accordingly. But you can’t hold all the information in your head any longer, and you can’t master all the skills. No one person can work up a patient’s back pain, run the immunoassay, do the physical therapy, protocol the MRI, and direct the treatment of the unexpected cancer found growing in the spine. I don’t even know what it means to “protocol” the MRI.

Today, isn’t it a workplace truism for nearly everyone that “. . . you can’t hold all the information in your head. . . and you can’t master all the skills”?

Gawande adds:

The public’s experience is that we have amazing clinicians and technologies but little consistent sense that they come together to provide an actual system of care, from start to finish, for people. We train, hire, and pay doctors to be cowboys. But it’s pit crews people need.

On my students’ copies, I’ve lined out “doctors” and “people” and substituted “teachers” and “students”.

Gawande acknowledges that medical education fails to teach docs to function like pit crews for patients. The same is true for teacher education.

Too often nursing, medical school, and teacher education faculty wrongly assume that novice nurses, docs, and teachers will naturally, through osmosis, form knowledgeable, skilled, interdependent work teams. Absent intentional team-building curricula, in which case studies would be an integral component, professional apprentices depend upon the modeling of their veteran colleagues, often out-of-step ones pining for old school independence and autonomy.

When in comes to intentionally teaching teamwork, what can and should professional preparation programs do to shift the balance from cowboys to pitcrews? More generally, what can employers do to teach teamwork?

They shouldn’t assume it’s something someone is either born with or not. Effective teamwork can be taught through case studies that illuminate what the best teams do and what commonly trips up most others. And by proactively providing pre-professional students positive examples of excellent teams during their fieldwork.

Why Do Teachers Tolerate a Professional Double-Standard?

In a recent article titled, “What if the Doctor is Wrong?” The Wall Street Journal asserts what you and I already know, that “primary care doctors can misdiagnose common symptoms.In a study 202 patients most commonly complained about abdominal pain, fever, fatigue, shortness of breath and rash. Incorrect diagnoses included: benign viral infection 17%; musculoskeletal pain 10%; asthma/chronic obstructive pulmonary disease 6%; benign skin lesion 4%; and pneumonia 4%. Final correct diagnoses for patients misdiagnosed initially included: cancer 16%; pulmonary embolism 6%; coronary artery disease 5%; aneurysm 8%; appendicitis 6%.

Every profession consists of a mix of hardworking, conscientious, especially caring and skilled people and those who are less so.

I don’t point this out to bash doctors or excuse any teacher that is unprepared, uncaring, and unmotivated. I point it out to ask why politicians, business leaders, state legislators, and other policy makers are so determined to identify and then fire the worst teachers, but no similar efforts are made to rid medicine, dentistry, the law, or other professions of perennial underachievers? Think doctors would find it motivating if we reported their “initial correct diagnosis” percentages in local newspapers and then used those percentages to divide them into different categories of relative effectiveness?

Do we single out teachers for public scoring and scorn because they make a fraction of most doctors, dentists, and lawyers and in our society money, status, and power are intimately interconnected? Do policy makers feel like that they can push them around because of their modest compensation?

 

The Most Difficult Three and a Half Words

A close friend has been experiencing extreme leg pain for over a year. She’s seen a medical conference worth of docs, had tons of tests, and is still lacking the thing she wants most—a diagnosis.

A month ago I went with her to an appointment with a rheumatologist who said the root problem was not rheumatological. Unable to string together the most difficult three and half words, he offered up a boilerplate myofascial something or other hypothesis.

Today we travelled long distance to see The Man at the Pain Center at the hospital in the Big City. I am always in awe of ace doctors. Dr. Ace studied her file for a long time, asked clarifying questions, and then continued with more questions during a physical exam.

In the end, he said, “I’m not clever enough to know what’s wrong.” I dig the way Brits use “clever” instead of “smart”. It’s clever. “There’s still a lot we don’t know about the brain,” he explained. Deeply disappointed, my long-suffering friend pleaded with him for a diagnosis. “I just want to know what’s wrong with me.” At which point he said the three and a half words, “I don’t know.”

Imagine if we lived in a world where one political candidate attacked another about flip-flopping and asked, “How can we be sure you’re not going to change your mind again?” And the candidate responded, “I don’t know.”

Or one in which every financial analyst asked to make predictions about the market in 2012 said, “I don’t know.”

Or one in which a Westpoint political science prof when asked about the lessons of the Iraq War said, “I don’t know.”

Or one in which Christopher Hitchens, when pressed to explain why he was so sure there’s no God had said, “I don’t know.”

Or one in which a man driving aimlessly in a car, when asked by a woman whether he’s going in the right direction said, “I don’t know.”

Or one in which Billy Graham, when asked to explain why he’s so sure there’s life after death said, “I don’t know.”

Or one in which Hilary Clinton, when asked what will be required to bring genuine Middle East peace said, “I don’t know.”

Or one in which Tom Friedman, when asked what the United States must do to reclaim it’s greatness said, “I don’t know.”

Or one in which Bill Gates, when asked why he thinks his teacher evaluation plan is going to improve schooling said, “I don’t know.”

Or one in which a blogger, when asked why he thinks everyone would be well served by greater humility and honesty said, “I don’t know.”