“THIS PATIENT NEEDS A DOCTOR!”
-Dr. Anna Ledgerwood
I grew up and completed my undergraduate work in Michigan. My state is synonymous with mittens, Faygo, the Great Lakes, the city of Detroit, and a strange card game called Euchre. We do a few things differently: our carbonated sugary beverages are called “pop” no soda, our ginger ale is called “Vernors” and we say “ope” instead of excuse me. Our ideal getaway is “going up north”, which means packing your family and screaming kids into a cramped car, driving 3 hours north to a wifi-less cabin near a lake, then refereeing family arguments for a fun-filled weekend. When we are not fighting with each other we also grill, water ski, swim, explore nature, fish, and spend quality time with each other.
Michigan has a ritualized culture based off of the changing of seasons: Summer means enjoying the sunshine, going up north, and boating, Fall means apple orchards, the changing of the leaves, and pumpkin spiced lattes; Winter means Christmas, ice skating, and snowball fights; Spring means the end of the school year and commiserating with other Michiganders about the unpredictable weather. Now that I live in Los Angeles I enjoy the warm weather but I miss the seasons; they always gave me something to look forward to.
When I applied to medical school in 2012 there were three major medical schools in Michigan: Wayne State in Detroit, University of Michigan in Ann Arbor, and Michigan State in Lansing. After I started my medical education at Wayne State a popular anecdote was told about my school’s philosophy towards medical education. It goes something like this:
“3 medical students arrive at the bedside of a dying patient. All three medical students read the chart and examine the patient. Their attending physicians asks them what they think of the situation. The first medical from Michigan State knows the patient’s life story but has no idea what to do, the second student from University of Michigan knows exactly what is wrong with the patient but has no idea how to treat it, and the third medical student from Wayne State has no idea what is wrong with the patient but knows exactly how to treat it”
The story is not meant to put down the University of Michigan or Michigan State- I consider them valuable colleagues, have worked with them, they are excellent physicians- the point of the story is emphasizing Wayne State’s philosophy of medical education. Wayne State emphasizes experiential learning as the foundation of education.1 Looking back I think the three medical students from the story represent the three factors required for true expertise: knowledge (Univ of Michigan), metacognition (Michigan State), and experience (Wayne State).
Chapter 2 of my book is about why doctors are considered experts. For the purpose of this book an expert is “a person who, over the course of many years, accumulates knowledge, metacognition, and experience that enables him or her to make consistent accurate predictions in uncertain real-life situations”. The chapter answers the question: in a world of people who seem to know what they’re talking about, whom should I trust?
Let’s begin at my 3rd year medical school trauma surgery rotation. Let’s meet Drs. Anna Ledgerwood and Charles Lucas, the two most infamous surgeons at the Wayne State University School of Medicine.
Anna Ledgerwood has a magnetic personality. She trained in an era where there were no women in surgery; it was a classic Boy’s Club. She had to be the most intense person in the room just to survive. Despite her innocent-looking tuft of white hair her tongue has sharpened with age. She expects her residents and medical students to perform at her level whether they like it or not. She speaks with a Midwest accent and larger-than-life personality. Her green eyes can read your thoughts before you speak. She is like the person in gym class who you hope is on your team because you know you will lose if she isn’t. Her kindness is as boundless as her anger. She can hug her patient one minute and erupt at her residents the next.
Charles Lucas has a different style: he can communicate complex thoughts with a single look. He is the kind of person who doesn’t speak many words but when he does everyone listens. He is tall and thin with pale blue-grey eyes. He walks slowly with his hands comfortably folded on his lower back. Dr. Lucas has a different effect on his trainees: even though you might meet him only a few times in your training, he feels like your most trusted mentor. With Ledgerwood you fear her wrath, with Lucas you fear his disappointment. He is the father-figure you never knew you had. I remember him examining a patient before going into the operating room. When she shuddered at his touch he moved his right hand to his chest, produced a rare smile, then said: “cold hands, warm heart”.
Rounds with “the Ls” were quite different from other rotations. Medical students were expected to be encyclopedias of their patients. My first time rounding with Ledgerwood she was appalled I didn’t know where my patient went to high school. From that day forward I knew I had to know literally everything. Literally.
My schedule was as follows: read the night before about my patients’ pathologies, arrive at the hospital at 5am, prepare my oral presentations, get “pimped” on rounds (asked aggressive questions to see if I know things). If I didn’t know the answer within 3 seconds I was in trouble…because then Ledgerwood would ask the exhausted residents detailed questions about pathophysiology. The best medical students knew all the pimp questions so their residents could relax in the background. If your whole team didn’t know the answer Ledgerwood would yell “THIS PATIENT NEED A DOCTOR! ARE YOU THAT DOCTOR? ARE YOU THAT DOCTOR? (as she asked each one of us individually) BECAUSE RIGHT NOW I DON’T SEE ANY DOCTORS!” When she felt especially offended she would walk away in disgust.
Rounding with Ledgerwood was intense-intense, whereas rounds with Lucas were calm-intense. When I didn’t know the answers to Lucas’ questions he would sigh, look down at his feet, and shake his head. The sense of disappointment was overwhelming. Then he wouldn’t let you finish your presentation! He would ask the chief resident to summarize the rest and move on to the next patient. In the world of Lucas and Ledgerwood there was no such thing as “I don’t know”. Doctors have ultimate responsibility for their patients; something “the L’s” took very seriously. Looking back I don’t know which I preferred: Ledgerwood’s wrath or Lucas’ disappointment.
I didn’t realize at the time but my experience with Lucas and Ledgerwood profoundly influenced my philosophy of learning. They introduced me to the work ethic, academic rigor, and professional qualities required to practice medicine at its highest level.
Footnotes
- The specific experiences I mentioned are representative of growing up in the Metro Detroit suburbs. The story is paraphrased from a story I heard and told 1st year medical students and applicants about the philosophy of WSU-SOM.
Airway, Bagel, Coffee 