A medical educator shares his love for medicine [PODCAST]

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“Each patient I have seen over these four decades has made me a better doctor. Books do not impact long term memory the way a real patient can. I once heard the chair of medicine at a teaching hospital say that the worst thing about being on call every other night as an intern is missing half the patients. I now know he was right. Each patient becomes a colored light in our sky.”

John F. McGeehan is an internal medicine physician.

He shares his story and discusses his KevinMD article, “Every patient makes me a better doctor.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard. My name is Kevin Pho, founder and editor of KevinMD. Today on the show we have John McGeehan. He’s a primary care internal medicine physician, and he’s a medical educator. He recently wrote the KevinMD article “Every patient makes me a better doctor.” John, welcome to the show.

John F. McGeehan: Thank you very much. Thanks for having me, and thanks for putting what I have to say in print.

Kevin Pho: So we’ll get to your article in a bit, but first off, tell me your story and your journey to where you are today.

John F. McGeehan: Thank you very much. Yeah, I’m very happy with my journey. I grew up in a very small ex-coal-mining town. My father was a policeman. We all lived in a place that didn’t have a lot of space, let’s put it that way, but my parents were convinced that we needed an education, and they worked hard to get us an education. So I went to a small college, and Penn Med School was gracious enough to accept me. I think I was an experiment at the time.

But I stayed and did internal medicine residency in Philadelphia, and then when I finished the residency, I loved to teach, and they were starting a primary care residency program in Scranton, Pennsylvania. So we actually left Philadelphia, my wife and I, and moved to Scranton to help get that residency program off the ground. It was there that I started working with med students and found that my greatest love is having med students around me.

Temple was sending its students up to Scranton for their internal medicine clerkships. I took that over for Temple, and then Temple asked me to start coming down to Philadelphia to start a course in the basics of medicine: the interview, the physical examination, medical ethics, compassion, and caring. And I really got into that and loved it.

A couple of years went by, and a number of doctors in Scranton came together, and we started a medical school in Scranton, at the time called The Commonwealth Medical College. I ran the clinical course there for the first two years and began to teach medical ethics, which is my real hobby. I love medical ethics. I had the great pleasure of co-authoring a textbook in medical ethics and have done a lot of lectures. I now teach medical ethics at my current med school.

And then about 10 years ago, they were starting a med school in Camden, New Jersey. It’s about two, two and a half hours from where I was living, and I was asked to come down and create the admissions process and the student affairs process, and try to get a lot of other things going there, and it was a joy. The school got fully accredited in ’16, and now I’m no longer in administration. I’m back to teaching in the classroom, in small groups, at the bedside, and quite frankly having more fun than I’ve had in a long time.

Kevin Pho: That’s a wonderful story. How have the medical students changed over the course of your career?

John F. McGeehan: Oh, that’s a really good question, and I haven’t thought about that. I guess I’d step back and say I don’t think they have. I still think the admissions processes are going well, and they’re selecting students who truly want to be doctors for the right reasons. There’s always a broad spray of individuals with different personalities, but I’m very impressed with today’s medical students, as I have been in the past. Are they smarter? No. Are they more well prepared? Absolutely.

I think one of the things that’s not a good thing, and I wrote about this in one of your articles, is it’s now very much test-related. Becoming a physician today means you have to jump through all of these hurdles, all these incredibly stressful tests. We didn’t have that. When I did the USMLE, when I was at Penn Med, it was purely pass/fail. We studied to learn, not to get a high score on a test.

And I think one of the things I found is, as a result, we’re creating young physicians who don’t have any tolerance to ambiguity. They think there’s a right answer to everything, and once you get into practice and you start seeing patients, you realize, “Oh my goodness, they are not in the books. That’s nothing I’ve ever learned before.” And it throws them off. I think in my generation, 40 years ago, the med students were much more flexible, and I think it was easier on them mentally as well.

Kevin Pho: So as medical students transition from the preclinical years to the clinical years, like you said, it’s so test-driven, especially with Step 1 now. What are the things that you do to, proverbially, deprogram them as they transition into a more clinical phase of their careers?

John F. McGeehan: Oh, that’s great. Yeah, I actually teach a brief course in medical ethics every semester, and this is an interesting course because there are no facts to it. It’s all very difficult cases that we reason through, and we argue. I love to argue. I’m Irish; I get up in the morning to argue. It just drives me. And the students start to see that the answers are not in the books. Their answers are through talking to other people and reasoning your way through it.

And I’m working on a publication now. I’ve had all the students do a test called the tolerance to ambiguity survey before the course and immediately after the course, and there is a statistically significant, major improvement in tolerance to ambiguity. So that’s something that I think is important. We have to get students to think more, memorize a little less, and realize the magic is at the bedside.

Kevin Pho: Now, I’ve been running KevinMD for almost 17, 18 years now, and I’ve gotten a lot of articles from medical students, and over that time I’ve noticed a decreasing lack of interest when it comes to students’ chosen specialty in primary care. What are you seeing on the ground? Are you seeing a decrease in primary care interest from a medical student standpoint?

John F. McGeehan: Yeah, I agree with you, Kevin. That’s a very good thing for you to point out, and this has been the case for quite a while. I know when I went down to Temple med school to start their course, what I decided to do was take the lecturers and make them all primary care physicians from the various places at Temple, and we did the same thing at Scranton, and now we’re doing the same thing at Cooper Med School of Rowan University.

I think medical students don’t see primary care physicians as role models. They see the, quote, unquote, “gods of medicine” come in on a white horse, and they want to be like that person. So that’s one thing. You have to give them role models. You have to let them see that primary care is challenging, rewarding, and fun.

The second thing you have to do, unfortunately, is financially reward them. I mean, when I went to med school, back before electricity, tuition at Penn was like less than $2,000 the first year. Now students can run up a debt in one year of $80,000 when they combine living expenses with tuition, et cetera. Multiply that times four, and our young physicians are hitting the street overburdened with debt, way overburdened with debt. So as a result, they start looking at specialties that have a higher repayment.

The fact that we are reimbursing specialties significantly more than primary care just has never made sense to me. The primary care physician is challenged to know more about more things, and it’s just as challenging and frustrating as any subspecialty. Do I think that’s going to change? No. But I think there are ways now that new graduates are being rewarded with loan payback to enter primary care. There are a lot of new programs now.

Kevin Pho: Now, I know some medical schools are even going, quote, unquote, tuition-free. You have New York University; you have Case Western in Cleveland. What are your thoughts about that?

John F. McGeehan: Personally, I think it’s a wonderful idea, but it’s just an idea. Let’s see what the experiment is. My concern is, to get into that med school, everybody in the world is going to apply, and if they take the top people, which they will, then the question is, if you get incredibly bright, driven people out of med school, are they going to then choose primary care because there’s no debt? No. I suspect they’re going to continue to go into the narrow subspecialties, the high-paying subspecialties, but we’ll have to see. I hope I’m wrong, but I don’t think it’s going to end up with a great deal of difference in specialty choice.

Kevin Pho: Now, I have a lot of medical students who listen to this podcast. So if you could share your one big tip with those medical student listeners, what would that one tip be as they progress through their journey?

John F. McGeehan: Yeah, and it’s not just for the med students; it’s for everybody. I’m now working with an incredibly gifted group of human beings at the Center for Humanism, and it’s a group of us that are looking at how we can best lay a solid foundation and build upon that in humanism, professionalism, and medical ethics. And I think if we can select students who truly care, foster that, and build upon it, those who go into practice because they care, patients feel that, medical groups feel that. It’s really the ticket to success. More importantly, it’s the ticket to being happy as a physician.

If you care, and you go into your office or wherever you go into, and you make a connection with other people, when your head hits the pillow that night, you’re going to feel really good about the day you just had. If you’re in it to make money, what I’ve seen, there’s never enough money. I’ve taken care of lots of physicians as patients. You have to go into it for the right reason, with the right expectation.

And quite frankly, I’ve been doing this now for over 40 years. I do not intend to retire because this is just too much fun. It’s too rewarding. I can’t look back at any of those 40 years and say I had a day when I wanted to hang it up, and I think the real reason for that is I taught every single day. And if you teach, you learn. You get to pass the baton to the next generation. It’s so fulfilling, and that’s what I’d like people to do: Really care, go into it for the right reason, and give back. Teach.

Kevin Pho: Well, that’s so well said. We’re talking to John McGeehan. He’s a primary care internal medicine physician and a medical educator. So I do want to touch upon your recent article on KevinMD, “Every patient makes me a better doctor,” and I want to start by reading an excerpt from that article. You write, “Each patient I have seen over these four decades has made me a better doctor. Books do not impact long-term memory the way a real patient can. I once heard the chair of medicine at a teaching hospital say that the worst thing about being on call every other night as an intern is missing half of the patients. I now know he was right. Each patient becomes a colored light in our sky.”

Now, that is very poetic and very insightful. Tell me the story behind that article and why you decided to write it.

John F. McGeehan: Yeah, it was, quite frankly, not an unusual experience. It was this lovely lady whose daughter brought her up from South America to live with her. She was in her early 70s, and the medical students had gone in to interview her and to examine her. We have the medical students go in first, and they present the case to me. Then I go in with the medical students, point out things, and direct care. They saw a lady who was depressed, unable to get out of a chair, who had been progressively more and more debilitated since she fell and hurt her back about two years earlier, and the physicians in the other country diagnosed her with spinal stenosis and depression.

So they presented the case to me, and I walked into the room, and once you’ve seen somebody with Parkinson’s disease, you recognize that face in a second. So immediately the diagnosis came to mind, and once the diagnosis comes to mind for a physician, we get to show off. So I started going through the physical exam with the students. She had the cogwheel rigidity, she had the classic gait, she couldn’t get out of the chair herself, and it was clear she had Parkinson’s disease. I was able to offer a ray of hope to the patient and to her daughter and start treatment. And I told her, “You’re going to walk again, and in fact, I think you’re going to dance again, and promise me you’ll dance with me.”

And we share patients in the clinic, and a couple of months later she came back, and she asked for me to be the attending physician with the students that day. I went in, the daughter turned music on with her cell phone, and the lady rose from the chair, reached her arms out, and we danced. That’s what the rewards of medicine are. It has nothing to do with money. It has nothing to do with stature or names. It’s being able to simply impact a life.

Kevin Pho: Well, thank you so much for sharing that story. That is tremendously poignant and powerful. My last question for you, John: What’s your take-home message for the KevinMD audience?

John F. McGeehan: Yeah, I think I made it, and the take-home message is to really care. I was very, very sick right after our medical school got accredited. I developed a problem that needed surgery, and I developed a severe infection after surgery. I was in the hospital for many weeks. I was told I would never recover. I lost my memory completely, and I went home and could barely walk stairs. Thanks to my wife, who’s been with me for over 45 years, she got me back to normal, but the one thing I couldn’t get back to normal as fast was my memory, and I’ve been gifted over time with a really good memory.

So what I did is I started to try to remember stories, and I wrote the stories down. Slowly my memory came back by remembering patients, remembering medical ethics consults, remembering times of my life. And then what I did is I tried to turn them into teaching tools, and I reflected on each of those stories and how they changed me, how they developed me, and how they impacted me and the lives of others.

And what I’d like to leave people with is, don’t wait till you get sick to do that. Everybody should write. Start writing their stories down now. Tuck them away somewhere. I think KevinMD has really enriched my life because there’s no other venue where people can share these kinds of stories, and I read them all. They’re amazing. You don’t have to get them published, but write them down now, because trust me, when you get to my stage, you’ll have wished you wrote those down, because at nighttime you can open up that pad or open up that file, read some stories from 20, 30 years ago, and you will smile and feel good, and that’s what life is about.

Kevin Pho: John, thank you so much for sharing your wisdom, and thank you for your time and for being on the show.

John F. McGeehan: Thanks for allowing me. You have a wonderful day.

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