Thursday, March 24, 2016


Clearly we are advancing human thought, most people would say. They would also extoll the virtues of love and feeling in the same paragraph if not as dangling participles. These are the many who add split infinitives just to (really) get into our minds. Metrics they claim are the virtue beyond all virtues. As if value has the same meaning as price. It is extolled in Yasmina Reza’s “Art” when a newly crowned wealthy man seeks eloquence through his acquisitions; a white canvas. The humor aside, it is telling about acquisitions; When “Scream” bids out as a mega-million winning lottery. The sham continues. Faces change but the human constance remains.

We ascribe relevance through irrelevance, as in value for price and intellect for wealth, although in the latter case it is certainly possible. Let us look at simpler model of understanding.


How do we test a person’s education status?

By the number of degrees he or she holds. The higher the education, the more intellect is perceived. The MD, PhD degrees hold a lot of gravitas or used to in the past. Today degrees are as easy as buying a piece of paper, since “No (one) can be left behind.”

And that brings us to how do we test?

There are expert “test takers” in our midst. Some have gone through the steep ladder of degree acquisitions by knowing and learning the art of passing tests. In fact schools teach the art of test passing and higher scores just so they can get grants from the Feds. Teachers teach the answers to the questions and student learn by rote of things they have absolutely no understanding. Test Prep schools compress the phenomenon even further to “enrich” the student’s mind with jargon filled answers that he or she will regurgitate when the doors are closed, the bell rings and the multiple choice questions are placed in front of her. “Yes, I know the answer to that, its “C!” By golly what a smart lass!

I remember a very smart test taker with degrees filling his pockets threatening to tear a hole in them. He was considered smart, very smart, actually intelligent or shall we say, brilliant. Ask him any question and he would answer, what are my choices? Given the “knowledge” he had acquired, one day he was faced with covering the Intensive Care Unit overnight without a backup resident. It was him and a slew of midnight nurses. Fortunately one of those nurses had years of practical experience. Lo and behold as midnight struck and the bells started clamoring, blood pressures started falling, oxygen levels bottomed, pulse-rates skyrocketed, sodium levels tanked and Potassium levels jumped, his eyes glazed over, muscles became flaccid and a strange thing happened. The resident was found wearing fear in the corner of the room without his booties, shaking from head to toe, fearful of  making any decision. The alert nurse calmed down the nerves of this poor bloke and slowly and steadily she helped with the answers to the horror that faced the clock’s hour face. The resident slept for the last two hours before sunrise in the corner in the Intensive Care with his head in his hands, buried behind his eyeballs in dreams of something or somewhere.

The trauma might have been excessive for him that night, because he resigned his staff position and went home to daddy and mommy. two years later he was working as a in-house Medical Director for a medical firm, barking orders about this and that.

Just as I said earlier, there is a gulf between “value” and “price,” there is difference between “test taking” and experiencing reality. Schools and teachers nowadays prepare little students and adult ones to “pass” a given test for selfish reasons; funding, advancement and tenure. Little students don’t know any better. So they learn what comes their way. The growing neural density, thirsty for information sponges nonsense as knowledge and a future of mediocrity is born.

This nonsense continues even at high levels of “education.” The certification process for physicians through the ABIM is a good case in point. I remember being at a conference in New York at a fancy hotel, where a fairly large room had been set up for breakfast before the educational seminar began. Sitting besides a luminary physician who held a significant power among physician intellectuals. The topic of re-certification came up and I heard him bemoan the fact that he was taking the re-certification exam a third time in three years. “The questions are so esoteric and stupid and have nothing to do with my specialty,” he exclaimed to nodding heads. And when you dig deep (as the saying goes) it is all about raising the "revenues" and the "net asset value."

There are lives in the balance all around us. Every action we take has some ripple effect. Physicians have this burden to bear, the hardest. The practical knowledge of experiential reference and learning daily on the job makes for a wealth of understanding, yet it is being discounted in favor of top-down guidelines based on population medicine.

it is worth remembering that all knowledge is not wisdom, only the applied version need apply there. Just as a child who understands the meaning of the word “lift” and “drag” will become a safer aviator. A child who understands resistance works to reduce it will work it out to deliver more electrical power at the business end of the wire, a physician who understands anatomy and physiology is better able to fix a pathology.

So you see dear reader, the current philosophies of Common Core, test taking principles, guidelines and mandates do not enrich the soul as real “actionable” (I use this word sparingly for fear of retribution) understanding. We must learn to unlearn the idiocy that has been mushed into our spongy brains. We must relearn the basics of understanding. And in the end…

The future will be brighter for all of us. For our children and their children. Lets all vow to stop the tyranny on the children’s and that of the physician’s mind!

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