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   Throughought How Doctors Think but especially in the Introduction and Chapter One, Jerome Groopman presents the results of many interesting studies about the relationship and rapport between doctors and patients. For instance, social psychologists who study medical interactions have found that patients accurately perceive how doctors feel about them and this limits how they interact with their doctor. Also, patients’ fears and anxities inhibit what they say to doctors. If doctors are aware of this, they can ask particular questions, control their body language, and double-check their own thinking. When a positive rapport is established, Groopman reports, the patient is more likely to share more information that is helpful in making a correct diagnosis and the patient is more likely to comply with the doctor’s prescription.

   As a teacher, much of this resonates with my classroom experience. Certainly, I feel differently toward different students. Although I can make sure that I am fair to all students, to what extent–even while I remain safely within the threshold of what is legally and ethically right–do students key into how I feel about them? Besides being less invested in the lessons and work I design for them, students might be less forthcoming to ask questions, seek help, report what isn’t working for them if I am inadvertently sending the message that I want to keep their discomforts (note the etymology of dis-ease) with the educational experience at a distance. (Isn’t much of “classroom management” a means of keeping student discomfort at bay, of limiting the expression of symptoms or other factors relevant to learning?)  I increasingly appreciate the importance of students asking me questions, telling me what isn’t working–even if it is through their off-task and inappropriate behavior–in order to better teach.

   For all the talk of formative assessment, the immediacy of communication is far more important to me.  Not only do I need to create a rapport that allows the students to report how things are going for them with their learning, but I also need to be perceptive of the indirect ways they are communicating with me. Sure a formative assessment might tell me about progress toward a specific curricular benchmark, but an open, positive relationship allows me to be attuned to how that student is doing overall and to better understand how he or she learns or what general weaknesses he or she has. Formative assessment can give me data about a particular symptom, to use the medical analogy, but only a good, ongoing doctor-patient relationship will allow me to get the whole picture of the student’s academic health and to help remedy any underlying issues.

  One other bit about the emotional/relational aspects of medicine and education. Groopman presents several compelling stories of how doctors misdiagnose patients. One error concerning emotions occurs when a doctor really likes or relates to a patient. Such positive feelings might, for instance, lead a doctor to forgo or delay a diagnostic procedure that is essential but would be taxing on the sick patient. Groopman is an oncologist. He reports how a patient about whom he had grown to care very much was running a fever. The patient was hospitalized for cancer treatment, and they couldn’t pinpoint why this new fever had developed. The young man was very weak and had been through the ringer lately. As Groopman finished a final visit for the day, he decided to give the guy a break and limit all of the moving and jostling required for a thorough exam. Later that night the patient went into shock from an infection that had developed between his buttocks, something Groopman would have found if he follow his desire to go easy on the patient.

   The point I took from this as an educator is that the students we like–the ones who are compliant, similar to us, are neat and clean, etc.–might not get the best care/education from us. It’s easier, I suppose, to overlook the ways the “good” and hard-working kids are not performing up to standard. I am thinking here of the AP and honors kids who are play the game of school very well but are not really pushed to develop their areas of weakness.  As a teacher, this seemingly benign positive emotion can get in the way of doing what is right for the development of that student. 

Because I intend for this blog to be a place where my thoughts intersect with others’ thoughts and where this medium intersects with other media, this–my first blog–concerns a book I am in the midst of reading.  How Doctors Think by Jerome Groopman explores the ways medical doctors make a diagnosis and what errors of thinking lead to a misdiagnosis. It is a great book for anyone involved with the medical system as a patient or advocate for a patient. I am fascinated as an educator who thinks meaningful parallels exist between teaching and doctoring. My first series of blogs will be devoted to reflections inspired by this book. 

Next up: teaching and emotions, inspired by Groopman’s point that emotional connections with patients help, rather than hinder, medical practice.