July 26, 2004

Distracting medical environments

On your Jul. 21 item on disabled accommodation on the medical admissions exam, let me start with Disclaimer One: Larry Paradis and the others at his law firm have done some good work for the disabled. Disclaimer Two: I am an old physician-attorney (practicing both) who is frequently appalled by the poor quality of the younger doctors he meets. Comment: The only distractions present at an MCAT exam are the other aspirants taking the test. If they can't function in that setting, what will they do with a child turning blue from asthma, a mother screaming to do something, one nurse asking for orders for treatment for the child, and another nurse asking simultaneously for instructions about the cardiac case in the next exam room? Such is a typical busy clinic or emergency department atmosphere. Multi-tasking with distractions present is ROUTINE. With regret that their aspirations do not match their capabilities, people in that situation have no business in medical school. They are in the same position as I was when my college coach told me, after he had finished laughing, that I would never be a professional-level athlete. -- Matt Howard, Law Offices of M. L. Howard, M.D., Talmage, Calif.

Posted by Walter Olson at July 26, 2004 12:25 AM

I am a female attorney with a solo divorce practice in Broward county, Florida. Affording certain classes of so-called disadvantaged test-takers, applicants and ultimately doctors, lawyers and others in which the avaerage citizen may place their reliance additional help in test taking, etc. where the "ability to perform under or in normal conditions" is pertinent to adequate job performance is creating a danger to the public at large. Shouldn't then there be an affirmative obligation on the receipients of the extra assistance to dislcose and divulge same to their future employers, patients and clients?

Posted by: Donna Goldman at August 3, 2004 07:31 PM

I certainly agree with Dr. Howard's comments that distractions are inherent in the practice environment and therefore special accomodations on the MCAT for the easily-distracted are inappropriate, but I can imagine the pro-accommodation plaintiff attorney's response: "My client was going to be a dermatologist, where distractions are not an issue. You've deprived him of his livelihood!"

An actual example may illustrate the effects of accommodations in medical training. Fifteen years ago I was Program Director of a large urban Internal Medicine training program. We recruited a 2nd year resident who had gone to a fine American medical school and did his internship year elsewhere. During recruitment in response to our inquiries we were told that he was OK and frankly we were happy to have a US graduate among our good but mostly foreign-educated house staff. Having US graduates is considered a plus for your program in the world of residency training, and the Residency Review Committee does count noses. Almost immediately, this resident impressed us as having a dangerously poor fund of knowledge, no ability to think critically, inadequate clinical and supervisory skills and an unprofessional attitude. Within a month he had badly mismanaged a fairly simple case (for a medical resident with a year of internship) of of a sick patient with cirrhosis and hepatic encephalopathy, hastening the patient's death. When we investigated, we learned that he had been brought into the medical school under an affirmative action program, where his poor college grade point average was discounted in favor of non-academic factors. In addition, his poor record in his internship had been withheld from us, presumably for civil rights reasons. We tried to assist his development, but found that he was incorrigible and eventually we terminated him. His response was bewilderment, and he actually said, "You can't fire me...you're supposed to help me." He had been carried by others throughout his education and never had to be responsible for his own development. The end product was a thoroughly dangerous individual for whom remediation was impossible. Fortunately he appears to have left medicine altogether.

As a complex profession, medicine requires certain personal skills for which accommodations during testing or training may very well be inappropriate.

Posted by: Lawrence L. Faltz, MD at August 9, 2004 11:00 AM