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an online version of the magazine Winter 2007
Learning Curve

Viva La Difference

Doctors today are specialists. Rather than criticizing colleagues for their narrow focus, why can’t we appreciate them for what they bring to the mix?


By Daniel Munoz, M.D. '04

illustration of a doctor

We in the medical profession tend to cultivate particular skill sets. I, for instance, am a resident in internal medicine, focusing on managing chronic medical conditions. My med school buddy, Alex, is training as a surgeon. He spends the bulk of his time studying techniques of operating—mastering anatomic details that are but a distant med school memory for me. Alex and I are doctors with distinct roles. What I’ve noticed, though, is a tendency among physicians to condemn colleagues for not having the same skill sets as our own. It becomes easier to criticize than to educate, to judge rather than to understand.

An example of what I’m talking about occurred at one of my department's morbidity and mortality (M&M) conferences a few months ago. These confidential meetings, held periodically in different clinical specialties, go over real cases in which human or system imperfections might have harmed the very patients we were seeking to help. By discussing the cases in safe surroundings, young physicians learn to make necessary adjustments to their clinical reasoning and to develop critical inward-thinking skills. No notes. No outside observers.

This time, the featured case was Mr. D., a patient who had needed surgery urgently but not emergently. Before he went to the operating room, his chronic medical illnesses landed him on the Medicine inpatient service for an appropriate “tuning-up.” After days of tests and adjusting medications, Mr. D. had his operation. He was then transferred to a surgical floor, where surgeons took charge of managing his postoperative care as well as his multiple chronic conditions. His surgical issues were handled without complication, but his medical conditions weren’t cared for as effectively. The patient suffered serious—but correctable—injury.

So, here’s what was a little disappointing about our M&M discussion that day. Our chance to thoughtfully dissect our own mistakes focused instead on what went wrong once the patient had left our department's care. We took a long look in the mirror—and critiqued someone else. So much for hard-hitting self-assessment.

From my internship, I recall another instance of what I’m talking about. Our team sent a complicated patient for an operation. The surgery went well, but after a few days of recovery, the patient was transferred back to our internal medicine team. Later, during rounds, the admitting intern commented on how  the surgeons had managed the chronic medical conditions. “They did nothing for this patient!”

The medical students in the group—one of whom was planning a surgical career—looked stunned. And then, our attending physician gave a response so refreshing it will stick with me permanently. “But, you know, I am a terrible surgeon.”

And therein lies the key: When it comes to the toughest challenges, specialization helps more than it hurts. Corporate executives agree that this holds true for most industries. If my transatlantic flight from New York to London encounters unexpected engine troubles as it prepares to land. I want a veteran pilot who knows every instrument panel in the cockpit like the back of his/her hand. I want an air traffic controller whose mastery of ground-based guidance systems can advise the crew about the safest approach. And perhaps most importantly, I want those people to be working seamlessly toward their common goal.

Ingredients for success in medicine are perhaps even more interdependent. If a member of my family develops jaundice with a mass at the head of the pancreas, I will do everything I can to enlist a surgeon who has done thousands of these type resections. I will hope for a savvy anesthesiologist to administer life-sustaining medicines during the procedure. And I will count on a well-trained team of ICU physicians and nurses to ensure a safe postoperative recovery.

That division of labor and skills yields unquestionable benefits for patients. But it also creates an important obligation: We as physicians owe it to ourselves to remember the lens through which our colleagues in other specialties view patients. And that recognition should foster a spirit of proactive partnership, not finger-pointing or lazy, retrospective judgments.

Certainly we can agree that we’re all here to provide the best care we can to patients. I’m convinced that one way we honor that duty is by educating our colleagues—and by being educated by them. Such partnerships make for better decision-making earlier in a patient’s clinical care. In the long run, I suspect, they might also make for fewer cases to discuss at M&M.


Dan Munoz is a second-year resident in the Department of Medicine.

 The Alfredo Story
 A Minor Balancing Act
 The Free-Radical Dilemma
 Circling the Dome
 Medical Rounds
 Annals of Hopkins
Class Notes
 The Brain Voyager
 Learning Curve
Johns Hopkins Medicine

© The Johns Hopkins University 2007