Do you remember the character Sydney Lassick played in “One Flew Over the Cuckoo’s Nest”? Yes, Charley Cheswick is correct. My “Teaching Methodology” professor at Indiana University of Pennsylvania was a man named Leonard DeFabo. In appearance the professor was a dead ringer for Cheswick. He taught in the Educational Psychology program at IUP (Indiana University of Pennsylvania in Indiana, PA.. the hometown of legendary actor, Jimmy Stewart) . This smallish man had a giant impact on my life, but I never took the time to thank him while progressing through my career. Unfortunately, he died in October of 2002. I carried his very first lesson with me to this day, forty-four years later. This is my tribute to Dr. DeFabo.
Professor DiFabo asked all of us that first day a question as he roamed about the classroom pointing his index finger from student to student; “What are you going on to teach?” “And you”? And You”? The targeted students reflexively responded ; “Math”, “English”, “Chemistry”. With great animation, a distended vein on his forehead and deep passion [some would argue craziness] in his voice, Dr. DeFabo countered; “NO!” you are not teaching Math, and you are not teaching English and you Chemistry!!!” “ ALL of you are teaching children how to learn and apply math, English and chemistry”. WOW! What an epiphany for me. Dr. DeFabo had lit a spark as I went on to score a 107/100 in his course because he found a way to reach me. This was the highest I ever scored in any course.
Herein lies the message of this blog; when the metaphorical layers of the healthcare onion are peeled away, at its core are human beings who we are attempting to influence in a specific manner. At times we inappropriately make judgements about what is right for those who are under our stewardship in given circumstances. We forget that we are dealing with people not, workers' comp, Medicare, commercial insurance. We often lose sight of the needs of diverse healthcare stakeholders whether they be; doctors, patients, employers, claims adjusters, case managers, family members or colleagues. We inadvertently apply de-personalized labels to those with whom we interact; “amputee”, “stroke”, “low back injury”, “work comp case”, "payer", "provider", “ortho”, “malingerer” or worse.
When the phrase “patient-centered care” first entered the medical lexicon, I had a moment of confusion; “that’s strange, hasn’t it always been about the patient”? Of course, that was the clinician in me and perhaps, educator revealing himself. As a physical therapist I do not view a patient as a “shoulder”, “knee”, “diabetic” or “amputee”. I view them as persons who suffer from a shoulder or knee injury, amputation or chronic disease. This personalization opens one’s mind to other issues and facilitates a “whole body” approach (e.g. psychosocial, economic) that may directly impact clinical outcomes, As technology escalates at an ever increasing pace, there is a tendency to lose sight of what we are truly attempting to accomplish. For me “high tech often means low touch” and a lack of personalization in service delivery and human interaction. Physical therapy by definition is a “high touch” profession; captured by an APTA slogan, "If its physical, its therapy". This is important because truth be told, most patients judge treatment success based upon process and structure elements not, clinical outcomes. They value personal touch, genuine interest, clear explanations, eye to eye contact, reflective listening, sincerity and warmth exuded by clinicians. Patient satisfaction surveys consistently bear this out. Eric Swirsky in a blog article entitled; “4 Reasons Why Healthcare Needs a Digital Code of Ethics” outlines a number of important considerations when attempting to balance population health with individual needs. His article should be mandatory reading in all medical & allied medical programs as well as healthcare informatics and IT programs. Swirtsky provides three statements that touched me to the core;
“Aggregated data of treatment outcomes do not necessarily reflect the needs of an individual patient and her experiences with her health or healthcare provider”
“The record is a disembodied representation of a patient, who is deconstructed byte by byte without effectively being represented as a whole person”.
“The health, well being and dignity of an individual are not found in the aggregate—they are discovered at the bedside along the course of provider-patient relationship”.
As an adjunct professor in three university-based physical therapy programs my mantra to my students was that; “ninety-percent of your clinical success will come from how you manage patients and only ten percent from yourclinical skills”. This I have believed for thirty-six years, this I will believe for another thirty-six years both as a clinician and patient myself.
Having committed many mistakes in human interactions during my career, I humbly offer these observations to others. Hopefully, they can foster a greater understanding of inter-personal relationships for you as well.
1. The vast majority of people resist not embrace change
2. Those who resist change often go through stages (e.g. denial, anger etc.) similar to what the iconic Elizabeth Kubler-Ross described in her seminal book On Death & Dying (1969).
3. The vast majority of people are driven or motivated more by fear than opportunity.
4. Common sense is uncommon.
5. Intelligence comes in many shapes, sizes and colors.
6. Change is external while transition is one’s response to it [change].
7. Encouragement is extrinsic while motivation is an intrinsic quality. We can encourage but not motivate.
8. People learn more from mistakes than from successes. Let them fail occasionally. This in my view, is especially vital for parents and supervisors to appreciate.
9. To gain optimal buy-in from a person one has to make them a stakeholder during the process not, afterwards as a passive recipient.
10. Human beings operate on the principle of least effort (based on a theory from a 1954 book about nomadic tribes, the title has escaped me for the moment).
Now back to “One Flew Over the Cuckoo’s Nest”. Think about how differently Nurse Kratched (Louise Fletcher) and Jack Nicholson (Randal “Mac” McMurphy) dealt with patient issues. How did Jack relate to Chief (Will Sampson) when compared to others? Who respected the patients more; Jack or the Nurse? Whose best interests did Mac and Kratched have in mind? Who was more patient-centric? More adaptable to change, human differences? Who developed the strongest interpersonal relationships?
Your answers to these and other questions may help you to determine if you teach math or people.
RIP Leonard DeFabo, my esteemed mentor.