Reflections on Doctoring in America and Teaching in China, (written as Comparison/Contrast class tool!)

“Dr. David, do you think my essay will make it?  What’s the prognosis?  Should we pull the plug?”  OK, so none of my students have actually said any of those things, but I could have dreamed  them the night before my first three-and-a-half-hour writing class this semester.

I have had the good fortune to experience a second career during this “gap year” in China. This semester I have become a writing teacher!  Naturally, it is fun to compare and contrast my work as a writing teacher in China with that of a primary care internal medicine doctor in America.  There are some surprising similarities, and of course there are differences.  The word “doctor” comes from Latin and means “to teach”, so both professions share some common roots.  Practicing primary care internal medicine and teaching writing both have noble aims, cover a broad range of topics, are of key importance to the networks they serve, but are both undervalued.  Finally, and most importantly, when human relationships are allowed to grow and flourish, they both can produce a wonderful feeling of satisfaction.

Both teaching writing and practicing internal medicine are noble professions.   Writing teachers have no ulterior motives.  We want our students to be able to express themselves well.   We want them to succeed in their goals, whether that is getting a good score on a writing exam, writing a paper for school or communicating with a colleague.  As an internist,  I am not out to sell people a medication or test they don’t need.  I just want them to be healthy and control their chronic health problems as much as possible.

Writing teachers and general internal medicine doctors deal with a  broad range of topics. The  students and patients often present with a collection of problems that can be difficult to prioritize.  For example, a student suffering from run-on sentences, verb tense agreement mistakes, misplaced modifiers and incorrect articles presents as much of a management puzzle as an elderly patient with congestive heart failure, renal insufficiency, chronic obstructive lung disease and mild cognitive impairment.  You need to pick, choose and prioritize to help them sort out the issues and put together a care plan to set them on the proper course to improving their situations.  It’s great fun to see both get better.

Writing teachers and general internists are known to provide valuable services to the systems they support; writers to their colleges and universities, internists to their healthcare networks.  Writing teachers are ubiquitous.   All college students need to be able to write.  Everyone recognizes the value of good, clear writing.  Writing is important not just in academia, but in the private sector as well.  General internal medicine doctors are known as “the captains of the health care ship”. A good internist guides their patients through the turbulent oceans of today’s healthcare environment.  They are there to coordinate the specialists, and to talk with the patients and their families.  They are there to listen in a world where no one seems to be listening.

Writing teachers and general internists are under-valued.  They are often the low person on the totem pole of their organizations.  Writing teachers in academia are often adjunct professors who earn very little money and often don't receive benefits like health insurance.   Primary care is under-valued in the United States.  It is not procedure-based and therefore the reimbursement is not as high as procedure-based specialties like dermatology or surgery.  There is less money in listening than operating.    

Teaching is deeply satisfying.  Whether in person or on-line, I love coming before a group of students and helping them with their writing problems.  It’s really a form of theater, something that I have always insisted is key to a good “bedside manner”.  Fundamental to teaching and doctoring are developing trust, clarifying problems and exploring solutions.  The teacher-doctor wants to instill good habits and help the learner-patient become expert at their own self-education and self-care.

It would be nice if being a doctor was that satisfying, as well.  Teaching Chinese students writing offers a real sense of joy.   I wish medicine did the same for my colleagues. My students are appreciative, engaged and really want to learn.  They trust me.  It has been easy to develop good relationships with them.  They respect education and they respect their teachers.  They want to learn.  They are a joy to teach. 

Doctoring can be satisfying, too,  but as the burnout problem rages in healthcare, that level of satisfaction seems to be falling.  I have had many wonderful patients over the years.  I have helped many of them and therefore have earned their trust and respect.  Unfortunately, the pressures of documentation, billing, time constraints and other factors have put doctors and patients at odds with each other.  We have allowed the practice of medicine to be doctored, in the bad sense of the word, by outside forces and this has removed that wonderful sense of satisfaction that real doctoring can bring to a practitioner.  In addition to considering outside forces, healthcare professionals should look inward to see if we could modify practice to restore the satisfaction in clinical work. 

Teaching writing and practicing medicine are both noble, valuable and important professions.  The practitioners of both deserve the support of the systems and people they serve.  We all should look for creative ways to make both these pursuits sustainable for those that practice them.