Staying On A First Name Basis With Professionalism

I enjoyed finally being able to see patients in my third year of podiatry school. The college clinic was clogged with students in white coats and a few patients. Most students were considered fortunate if they cared for one patient on a typical clinic day. I always dragged neighbors from my East Cleveland apartment complex where I worked as a night maintenance man. While I fixed their appliances and unclogged their plumbing, I always inquired about any foot problems. I usually saw at least five patients every clinic day. Since I developed my rapport with these patients as neighbors, they addressed me by my first name rather than “doctor” as the students liked to be called. That was fine with me since I was a student, not a doctor. They knew it and I knew it. One day, a fourth-year student who supervised me along with a resident heard me talking with a patient. “What do you think it is, John?” asked the patient. “It looks like a hangnail,” I answered. “Let me get my tool box and we’ll find out.” A few minutes later the patient said, “Wow! That feels better, John. You sure are handy with them tools.” I said goodbye to the patient and walked him through the maze of white-coated doctor/students to the front door. The fourth-year student was waiting in my cubicle when I returned. He chewed me out for my lack of professionalism for allowing a patient to use my first name and for calling my instruments “tools.” He assured me I wasn’t going to be successful in podiatry if I didn’t start acting like a doctor. He also criticized me for not getting a full set of X-rays. (For a hangnail?) He threw in a criticism of my attire. I wore the standard white coat, white shirt, white pants and necktie. The problem was that my necktie had feet on it. Each foot had six toes. The patients loved the tie. I worried about my lack of professionalism but I disagreed with the fourth-year guy on its definition. Recently, I attended the annual meeting of the Federation of State Medical Boards in April. What was the theme of the meeting? Professionalism. David Stern, MD, PhD, who is from the University of Michigan, defines professionalism as communication skills, excellence, altruism, accountability, compassion, honor and integrity, and respect for others. He did not include what to call yourself and the tools of your trade. He also did not include funny neckties in his definition of professionalism. I wanted to run to a phone, call that fourth-year guy and tell him he was full of crap. He’s probably retired by now. After hearing Dr. Stern’s lecture, I started thinking about professionalism and how we teach it to students and residents in podiatry. There were no classes on medical ethics when I was in school. We learned by observing. Ninety-nine percent of my teachers and mentors set a fine example of professionalism. My teachers, including Drs. Michael Forman, Raymond Suppan and Allan Spencer, set professional standards that I have been trying to meet for the past 30 years. These guys were and always will be my heroes. There were a few teachers who set bad examples of professionalism. Their names have slipped my mind. These people condescended to patients because of race or economic status. They were less than truthful with patients about treatment options and they focused on the revenue potential by referring to patients as “that $2,000 bunion.” The good teachers far outnumbered these bums so they were easy to ignore. Our job is to set a good example to students and young podiatrists. The podiatry colleges need to learn to spot weaknesses in professionalism among students and correct them before graduation. Students who cheat on exams should be dropped from the profession without delay. In college, one cheater got caught with a crib sheet in an anatomy exam and was thrown out of school. One small group figured out how to get access to written tests before the exam. They never got caught but we all knew who they were. I know they did very well on the second-year exams until the heat was on them. Then they went back to the bottom of the class. I keep a list of Dr. Stern’s common values of professionalism in my office. It comes in handy to test my motivation in patient care. I may dig that old foot necktie out just for the heck of it. I still call my instruments tools. Many of my patients call me John. Dr. McCord (pictured) is a Diplomate wtih the American Board of Podiatric Surgery. He practices at the Centralia Medical Center in Centralia, Wash.