Doctors are used to being the cleverest in the class. Can this be our Achilles’ heel?
Photo Einar Nilsen
The tendency to be loyal to the system, to be the cleverest boy and girl in the class and to do exactly what one is told is currently the greatest threat to doctors’ moral integrity. This was written by Professor Torgeir Bruun Wyller, spokesman for Health Service Action, in the movement’s e-mail list on 22 July 2013. Can he be right?
For several decades Norwegian doctors have been selected on the basis of one characteristic – the ability to gain good grades. Being admitted to medical school has required an almost comically high average grade from upper secondary education. This has proved to be useful to the public health service: doctors’ surgeries have been inhabited by competent and industrious individuals. Norwegian medical practice has been good medical practice. But there is another side to the coin: what is required to succeed in Norwegian schools? One major success factor is the ability to conform. We have followed orders throughout our lives – done all our homework, learned what we should and progressed through an educational system and a health service that to a large extent rewards such behaviour. This is also rewarded at medical school, where the learning of skills and cramming of factual knowledge produces the best results. I myself saw it in black and white when I recently underwent a personality test at work. I scored full house on one of the variables: I was told I was 100 % «adaptable», can adjust to any workplace with ease and feel at home anywhere (1). Loyal to the system? For sure.
I believe that doctors’ cleverness – which in many ways is our hallmark – can also be our Achilles’ heel: we are best at everything we are told to be best at, whether it’s German grammatical cases, biochemical reaction routes or creative DRG coding.
The Swiss psychoanalyst Alice Miller (1923 – 2010) has described a group of people who many doctors may recognise as themselves. They are the pride of their parents, they are outstanding in everything, admired, envied and successful. The problem is that these children are often seen for what they do rather than for what they are. Miller called them «gifted children» (2). From early childhood they distinguish themselves by their capacity for work, their sense of responsibility and their ability to show empathy and care for others. These are the children who sit in the back of the car on family outings and tell jokes and sing songs to keep a bad atmosphere at bay. These are the children who stand on the winners’ rostrum, who are polite, have pleasing features and even more pleasing grade books. In Uro, his book on the anxiety of the modern self, the psychiatrist Finn Skårderud tells us about 13-year-old S who was at a birthday party. After a while he found himself in the kitchen. He was no longer with his friends, but sat with a couple of the mothers. He sat there and listened to their complaints about their difficult marriages – and he comforted them (3).
With all the care they demonstrate, gifted children may seem doomed to a future in the health service – as the good helpers. Skårderud claims that they become super-adaptable (3). But what pleasure do they get out of it? Care’s ugly sister can be a lack of care for oneself. If a person cannot see his own reflection in his cleverness, then depression, emptiness and the meaninglessness of life are lurking round the corner (2). The sadness becomes nameless and incomprehensible and is often manifested physically. «White grief» is grief over the loss of something one does not realise one never has had (3).
Nonetheless it is an oversimplification to claim that doctors are characterised by one personality type as I imply in the title. The traditional differences between doctors and other groups are gradually being smoothed out (4). Several factors contribute to this – for example the great increase in the number of doctors in recent years, and the fact that almost half the new doctors are educated abroad (5). But perhaps Bruun Wyller has a point. There may be more in the following tale than we like to think: Once upon a time there was a social science student, a mathematics student and a medical student who were told to learn the telephone directory by heart. The social science student said, «I refuse. It’s completely meaningless.» The mathematics student said, «I can’t do it. It’s impossible to find any ordered system in these numbers.» The medical student said, «What’s the deadline?»