Informal Curriculum: Lesson 1.

It’s been over a year, but I haven’t for­got­ten about the Infor­mal Cur­ricu­lum.

The first rec­om­men­da­tion in the infor­mal cur­ricu­lum in med­i­cine, which I still believe is “para­mount, the most dif­fi­cult to define, and often chal­leng­ing to imple­ment“1 is to be a per­son.

What does this mean?

Be the best pro­fes­sional per­son you can be. Be a per­son who actively lis­tens to patients, who shows empa­thy and emo­tions. Be cour­te­ous. Show human­ity. Be a person.

Non-psychiatrist physi­cians seem to have an eas­ier time with “being a per­son” than psy­chi­a­trists. Psy­chi­a­trists, as a pop­u­la­tion, can be weird. We can demon­strate excep­tional skills at not being peo­ple. Some­times we come across as intru­sive, awk­ward, and odd.

I get it. I’ve had pecu­liar inter­ac­tions with psy­chi­a­trists who knew I work as a psy­chi­a­trist. That might explain why the con­ver­sa­tions were even more uncom­fort­able than expected. (Those are sto­ries for another day.)

Do note that this rec­om­men­da­tion exhorts you to be a pro­fes­sional per­son. This doesn’t mean that you tell your patients about your rela­tion­ship or health prob­lems, how crappy of a day you’re hav­ing, or why your polit­i­cal views are cor­rect. That stuff makes you a per­son, too, but that doesn’t make you a pro­fes­sional person.

If patients are telling you things that worry them, be a per­son and acknowl­edge their worry. If they tell you some­thing funny and it’s not inap­pro­pri­ate to laugh2, smile and laugh. Talk with them like they’re peo­ple, not dis­eases or case studies.

Be a person.

Patients often want to share a con­nec­tion with their physi­cians. Patients suf­fer and worry. They want to know that you care about their suf­fer­ing or worry. That’s what actual peo­ple3 do: They care about the suf­fer­ing and worry of others.

Be a person.

Why is this para­mount? Why is this my first rec­om­men­da­tion in the infor­mal curriculum?

Because relent­less forces exist in med­ical train­ing and work that can trans­form you into a non-person.

You use words that most peo­ple don’t use. Most peo­ple don’t talk about MELD scores, Glas­gow Coma Scales, or HIV clas­si­fi­ca­tion sys­tems. You see a lot of emo­tional and phys­i­cal anguish. You see peo­ple who are ill. Some­times they cry. Some­times they scream. Some­times you see parts of them that they will never see. Some­times you see them die.

These are the things that can make you turn into a non-person.

So make an effort every day to be a per­son. If you’re not, none of the other sug­ges­tions in the infor­mal cur­ricu­lum will matter.

  1. It is no coin­ci­dence that a topic that is “para­mount, … dif­fi­cult to define, and … chal­leng­ing to imple­ment”, is also dif­fi­cult to write about.
  2. Being a per­son does not mean that you toss clin­i­cal judg­ment and bound­aries away. There are times when you shouldn’t smile and laugh, even if you want to. That topic is beyond the scope of this post.
  3. Yes, there are anec­dotes that peo­ple will share their woes with and find com­fort in a com­puter program.