valued voices logo

Welcome to our new recurring column, which shares insights of UC Davis’ volunteer clinical faculty. These physicians from throughout our community contribute their expertise, experience and perspectives to educate young physicians and scientists, deliver high-quality health care to our patients, and discover new knowledge that will improve health. If you are a volunteer clinical faculty member and are interested in participating, please contact Health Sciences Development at 916-734-9400 or via email.

question icon

What has surprised you the most about practicing medicine that one doesn’t learn in school? How are you sharing that with our medical students?

Family medicine physician Tuan Doan

Tuan Doan

The practice of medicine is always a challenge for most practicing physicians let alone medical students. In school you learn about the fundamental knowledge of how to treat disease and hopefully hone skills to communicate with sick patients and their families. However, medical school did not teach students about the economics of medicine, which evolve constantly, or the business of medical practice. That aspect was left to new physicians to sink or swim in the real world of business. It would be helpful if a small portion of business/finance/law course is incorporated into the curriculum to prepare young physicians in the early stage of their career. Lastly, in California we are a multi-ethnic population. Ethnic and cultural sensitivity training was not taught in medical school. This is a flaw in our medical education for graduating residents in medicine. It impacts how we care for Californians.

Doan, formerly with Sutter Health, volunteers his time at UC Davis as a preceptor for first-year medical students in the Doctoring 1 class.

Pathologist Chris Hansen

Chris Hansen

I feel that academic/didactic teaching in medical school gives access to the “science” aspect of practicing medicine, but falls short on topics that can be as (or more) important. Skills in getting and keeping a job, understanding and negotiating an employment contract, medico-legal and malpractice issues, billing, coding, understanding insurance coverage and reimbursement, knowing how to work well with others, and supporting emotional health of others and yourself are topics I think should have greater exposure. While not an expert in these fields, I return to the UC Davis pathology residency to give the residents a view of what they need to consider learning for private practice, even if it is not covered as a standard topic in residency.

Hansen is in private practice on the Monterey Peninsula and volunteers his time on humanitarian missions through Pathologists Overseas and Partners in Health to Ghana, Malawi and Rwanda. At UC Davis, he volunteers his time lecturing to pathology residents about private practice and humanitarian work.

Oncologist Tim Grennan

Tim Grennan

In this day of evidence-based medicine, electronic health record templates, time management, and a focus on efficiency, one critical element of caring for patients that is undervalued is the importance of developing a relationship with the patient.

Having worked with residents and students at all levels in caring for cancer patients, I have found that many learners want to be thorough and complete in their initial interaction with an oncology patient and focus on data gathering, diagnosis, prognosis, and treatment. This misses the most important aspect of patient care in oncology: understanding the patient and her or his needs; becoming a physician for that one individual.

Georgetown University physician Edmund Pellegrino once wrote: “The philosophical grounding of a true profession lies in the special kind of interpersonal relationship it requires between its practitioners and those who seek their assistance...all true professions deal with humans in special existential states of vulnerability in which there is some wounding of the very humanity of the person in need.”

Caring for a cancer patient begins with a relationship, not a template found in the electronic medical record or time management or efficiency.

Grennan is an oncologist with Kaiser Permanente who oversees the UC Davis residency program at Kaiser.

Pathologist Paul Holland

Paul Holland

I have been surprised about being sued for malpractice and also being involved as an expert witness in malpractice cases. We were not taught in medical school that either of these could happen to us. Nor were we taught how to respond. Further, it was not pointed out that, despite our best efforts, patients sometimes have adverse outcomes; and they may sue their physicians.

I try to mention these two points in interactions with medical students. I recommend that they be sure to obtain full informed consent from patients before any treatment, and note especially the significant risks of the therapy. If a mistake is made, the physician should so inform the patient and apologize. If asked to be an expert witness in a malpractice case, I teach medical students that they are not on one side or another – neither the defendant nor the plaintiff. They are to inform the court of the pertinent aspects of the therapy and be objective in reviewing the case.

Holland is a pathologist in private practice in the San Francisco Bay area and has volunteered at UC Davis working with hematology/oncology and pathology residents and fellows. He also serves on the Transfusion Committee.

Pediatric surgeon Clifford Mar

Clifford Mar

With the large load of basic science and clinical material that needed to be assimilated in the past, little attention was paid during medical education to the importance of the personal interactions that need to be developed. Training is lifelong. Flexibility is critical. Adhering to tradition for its own sake is hazardous.

Administration in health care cannot solely be a role filled by non-physicians. The magnitude of administrative needs for successful delivery of health care is not apparent to the medical student. Learning that medicine is very much a business is not well known until after medical school and post-graduate training.

While the medical school curriculum has begun to address these concerns, a physician will not become facile in these areas without life’s experience following training. All of this needs to be shared with students, interns, residents, fellows and young practicing physicians as they advance in their careers. Casual discussions can have as much impact and sometimes more than formal didactic presentations.

Marr is a partner in Children’s Specialists Medical Group of Sacramento and volunteers his time with general surgery residents as well as providing care to pediatric surgery patients.