Day: November 1, 2011

An honest introspection.  NYT article follows:

Stanley Fish on education, law and society.

Last week my colleague David Brooks made a request I couldn’t refuse. He asked people over 70 to “write a brief report on your life so far, an evaluation of what you did well, of what you did not do well and what you learned along the way.” Well, here I am, reporting in.

My father was an immigrant from Poland, a taciturn, massive man who began with nothing and became a major force in the plumbing and heating industry. Once when I locked myself in the bathroom because I had done something bad — I had either set a fire under the gas tank of a car parked in a vacant lot or pushed my baby sister’s carriage off the porch with her in it, I can’t remember which — he knocked down the door with a single blow of his fist. My mother was a volatile woman with a fierce but untutored intelligence and a need to control everything. She and I were engaged in a contest of wills until the day she died after having, willfully, refused treatment for congestive heart failure.

We were far from well off — I still remember the $8 secondhand bike I got as a birthday present; I loved it — but we were, like everyone else we knew, upwardly mobile, and that meant college, even though no one in my family had ever been there. I was not bookish; I spent most of my time playing sports badly, playing cards a little better, and lusting after girls and cars. But I was lucky and that, I believe, made all the difference.

My first and decisive bit of luck (in addition to having parents who wanted their children to succeed) was to have had Sarah Flanagan as an English teacher in high school. It was the time when adults were asking me a terrifying question: “What are you going to be?” or, in another version, “What are you going to do with your life?” The implication was that I was not yet anything and that, unless something happened quickly, my life would come to naught.

What happened was that Miss Flanagan told me, not in so many words, that writing papers about poems was something I was good at, and since I was desperate to be good at something, I took what she said to heart and began to think of myself as someone who could at least do that.

My next bit of luck was to have had Maurice Johnson as an English teacher at the University of Pennsylvania (one of only two schools that admitted me). Johnson was an urbane man of dry wit who offered me a model of what the academic life might be like, if I could only learn to dress better and develop a taste for irony. (To this day I never get it.)

Luck followed me to Yale graduate school (where I was admitted, I was told, as an experiment; Penn was a bit below Yale’s standards) in the form of three of my classmates, A. Bartlett Giamatti, Richard Lanham and Michael O’Loughlin, men of enormous learning and literary sophistication who gave the gift of their friendship to a rube from Providence, R. I. Many years later, when I met another classmate at a professional meeting, she exclaimed, “Who would have thought back then that you of all people would make it?”

The crowning piece of luck — I am still speaking only of my professional life — was to enter the job market in 1962, when higher education was expanding and everyone I knew had at least three offers at good schools. (We thought this moment would go on forever, but it never came again.) I chose U. C. Berkeley, in large part because my first wife was willing to go there, and found myself in a department becoming more prominent by the day; all I had to do was go along for the ride.

So that’s what I did well. I arrived at places at the right time and had enough sense to seize the opportunities that were presented to me; and that continued to be the case in a succession of appointments, book projects, administrative positions, even the opportunity to write for this newspaper, which came about one day in 1995 when out of the blue someone from the Op-Ed page called and asked if I would write something. As usual, I didn’t have the slightest idea of what to do, but I said yes anyway to this newest piece of luck.

What I didn’t do so well, and haven’t yet done, was figure out how to be at ease in the world. I noticed something about myself when I was married to my first wife, an excellent cook and hostess who knew how to throw a party. My main job was to dole out the drinks, which I liked to do because I could stand behind the bar and never have to really talk to anyone. (“Do you want ice with that?”) My happiest moment, and the moment I was looking forward to all evening, was when the party was over and failure of any number of kinds had been avoided once again.

If you regard each human interaction as an occasion for performance, your concern and attention will be focused on how well or badly you’re doing and not on the people you’re doing it with. This turned out to be true for me in the classroom, on vacations, at conferences, in department meetings, at family gatherings, at concerts, in museums, at weddings, even at the movies. Always I have one eye on the clock and at least a part of the other on whether I’m doing my part or holding my own; and always there is a sigh of relief at the end. Whew, got through that one!

It may be unnecessary to say so, but this way of interacting or, rather, not interacting does not augur well for intimate relationships. If you characteristically withhold yourself, keep yourself in reserve, refuse to risk yourself, those you live with are not going to be getting from you what they need. So my first wife didn’t get what she needed and neither, in her early years, did my daughter. Typically, I escaped to work and a structured environment where the roles are pre-packaged and you can ride the rails of scripted routines without having to display or respond to actual feelings.

I’ve tried to do better in my second marriage, and I have done better with my daughter now that she is an adult who draws sustenance from other sources and doesn’t need everything I don’t have to give. But I’m still overscheduling myself and trying as hard as I can to make sure that I have absolutely no time for thinking seriously about life, never mind reporting on it.

And what have I learned along the way? Three things, closely related. The first is that people are often in pain; their lives are shadowed by memories and anticipations of inadequacy, and they are always afraid that the next moment will bring disaster or exposure. You can see it in their faces, and that is especially true of children who have not yet learned how to pretend that everything is all right and who are acutely aware of the precariousness of their situations.

The second thing I have learned is that the people who are most in pain are the people who act most badly; the worse people behave, the more they are in pain. They’re asking for help, although the form of the request is such that they are likely never to get it.

The third thing I have learned follows from the other two. It is the necessity of generosity. I suppose it is a form of the golden rule: if you want them to be generous to you, be generous to them. The rule acknowledges the fellowship of fragility we all share. In your worst moments — which may appear superficially to be your best moments — what you need most of all is the sympathetic recognition of someone who says, if only in a small smile or half-nod, yes, I have been there too, and I too have tried to shore up my insecurity with exhibitions of pettiness, bluster, overconfidence, petulance and impatience. It’s not, “But for the grace of God that could be me”; it’s, “Even with the grace of God, that will be, and has been, me.”

via opinionator.blogs.nytimes.com

EQ skills in Doctors?  Why, of course, but are they overrated?!  NYT Health article follows:

When I started my medical internship, my father the doctor told me that, when he was an intern, the competence of his colleagues was inversely proportional to how much their patients liked them. My heart sank. I had the likability market covered.

You wanted eye contact? I could give you eye contact. You wanted someone to nod and say, “I understand your pain”? Empathy may as well have been my middle name.

But actually tending to the acute medical issues of sick patients in the middle of the night? Interpersonal skills alone were not going to cut it.

Medicine, like education, business and fashion, is subject to fads. Hormone replacement therapy. Radical mastectomy. Bloodletting.

The latest? Breeding nice doctors. It’s all the rage.

A wealthy Chicago couple recently donated $42 million to the University of Chicago Medical Center for the creation of an institute to improve the doctor-patient relationship. Already many medical schools are changing their admissions process to weed out candidates who communicate poorly. And now, to become licensed physicians, medical students must pass a “clinical skills” exam assessing, among other proficiencies, how well they acknowledge patient concerns, ask about feelings and show empathy.

The ideal physician surely possesses both competence and compassion. But will our quest to eradicate the coldhearted physician know-it-all be another fad with consequences we may later regret?

How do we even measure these skills? Those of us who have ever fallen in love with someone we once hated know that sincere empathy can take time to discover. During one of my clinical training sessions, a patient told me no physician had ever made her feel more at ease. The next cautioned that I made too much eye contact, sat too close and “invaded” her personal space. After briefly feeling like a sex offender, I realized the process, though well intentioned, was flawed.

Proponents of weeding out students who lack interpersonal skills argue that communication errors are at the root of medical mistakes. But we have no data to suggest that medical students who sit close but not too close make any fewer mistakes than their less-communicative colleagues. That awkward medical student in the corner who obsessively follows a checklist may make fewer procedural mistakes than his charming friend who lights up the room.

In fact, qualities suggestive of extroversion do not necessarily track with leadership or altruism. Adam Grant, an organizational psychologist at the Wharton School of the University of Pennsylvania, recently led several studies suggesting that extroverts, when grouped together, competed excessively and undermined one another’s productivity. The introverts were better listeners and enhanced group performance. With the future of health care more uncertain than ever, do we want to be turning away these cooperative, albeit reticent minds?

I worry, finally, that this focus on interpersonal skills inevitably feeds our cost and quality crisis.

As a runner with serial overuse injuries, I am as guilty as anyone of conflating the most sympathetic doctor with the one who gives me what I want — for me, always an M.R.I. But in a culture that values novel technology above all else, undue emphasis on interpersonal skills may make it only more difficult for patients to discern good medicine from that which makes us feel most understood.

The beauty of clinical medicine is that we constantly question our latest wisdom. How we select and train medical students may be more difficult to evaluate than the effect of a vitamin supplement, but that does not excuse us from subjecting our novel approaches, including an emphasis on glad-handing patients, to the same investigative rigor.

I like to think my father was wrong about the relationship between clinical acumen and interpersonal skills. Regarding another piece of wisdom he shared, however, I’m certain he is right.

“Dad,” I often asked as a child, “who is smarter, you or Mom?”

“Well, Lisa,” he would answer, “there are different kinds of smart.”