Appendix 24b - Teaching Exercise

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]

"A Student's View of a Medical Teaching Exercise," published in the New England Journal of Medicine describes a neurology conference at a Boston teaching hospital involving a patient with widespread breast cancer and excruciating pain in her leg:

Neurologist: Can you raise your leg, please.

(He leaned forward to hold her leg.)

Patient: Don't touch me. Everybody wants me to raise this and raise that. I can't do anything with the leg. Don't ask me to do anythin'. I'm not doing anything. I'm a smart woman, you know; I'm not stupid. Y'all think that I'm stupid. I don't know anything about those pictures over there [pointing to the x-ray films], but I'm a smart woman, very smart.

(The patient started to cry.)

Neurologist: It must be very difficult trying to cope with your problems. We will all try to come up with some suitable treatment to help you.

(He signaled to the resident that the session was over.)

Patient: I know that y'all gonna laugh when I leave, oooh Lord. Y'all gonna laugh, oooh Lord.

(The patient was wheeled out of the room as a few people said good-bye.)

Neurologist: Well, that was something. She was obviously volatile and disinhibited, which was probably reflects metastases to her frontal lobes. I thought it best not to persist, for she was obviously being very uncooperative.

The student author reflects on the experience:

I could not help but feel that had the patient been a well-educated woman speaking standard English, the demonstration would have been very different... Furthermore, I believe that if there had been even one nonwhite doctor in that room, adjectives like 'volatile' and disinhibited' might not have been used so readily. Indeed, an appreciation for the patient's frankness might have replaced 'disinhibited,' and admiration of her pride and her effort to control her life might have replaced 'volatile.'[298]


[298] Brewster, A. "A Student's View of a Medical Teaching Exercise." New England Journal of Medicine 329(1993):1971-1972.

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