The yearly arrival of Santa Claus was a wonderful ritual of my early childhood years and later as I became a parent and a grandparent. It was exciting and fun, and the production provided mystery and joy. The fact that millions of people look forward to giving without getting accolades for doing so symbolizes the best in human nature. We willingly give credit to a myth for bestowing on those we love things they wished for. Those wonderful mornings remain permanently engrained in my mind, not as gifts but as the looks on the faces of happy children. The day when the curtain is pulled back on the play is a sad one for children and parents alike, proving that giving anonymously is powerful in life.
I have been teaching medical students for forty-seven years now. I thank them all for making me stay on top of medical knowledge, for allowing me to see how interesting my patients are, and for the opportunity to be Santa Claus year-round. This time of year, graduation occurs, and our students leave the nest; the satisfaction of knowing we have played some small role in their future helps diminish their leaving. Every parent knows the feeling. Years from now, they are not likely to remember me, and that is fine. Teachers only want to know that they have made a difference.
What follows focuses on medicine, but I suspect most of it applies to any interaction between humans. Paying it forward is beautiful. Malcolm Gladwell, in his book Blink, wonderfully explored how we make instant decisions throughout life. He showed that actions are, in fact, very complex acts through which our mind filters many past memories and arrives at a plan of action almost instantly. Neuroscience is now growing as a field of study rapidly because there is so much we do not yet understand surrounding our brain. One day one of our students will be with a patient and know what a skin lesion is because we showed it to them years before; another will hear an S3 on cardiac exam because we took the time to show them where to put the bell of the stethoscope and how to position the patient; another will know how to assess that a patient with a variety of concerns is depressed because we covered that in a lecture two decades ago. They will not recall the lecture or the patient encounters with us, but the knowledge has been stored where it will be used in the future. Our teaching has allowed skin cancer to be discovered at an early stage, heart failure to be diagnosed and effectively treated, and a person to be able to feel joy again. Our students are not likely to recall who gave them the gift to help each patient, and that is not our goal: helping patients is. As educators, we have the opportunity to touch the lives of countless people for decades through actions that remain unheralded. We get to be Santa every day!
With the power of teaching comes the responsibility. Accepting how our impact extends beyond the student at a given moment must propel us to be our best every day. I have learned something new constantly since finishing medical school over four decades ago. The saying that knowledge not shared is knowledge lost is a wonderful driving force in life. Teaching is pure fun. Just as imparting knowledge has a lasting impact on the learner, so does the image we give them of a professional. Charles Barkley said in a famous Nike commercial years ago: “I am not a role model.” We do not choose to be role models, those who we encounter select us. It is imperative that we accept that fact and demonstrate the best of our profession every day. The hidden curriculum has shown that naïve learners often embrace behaviors that are not ideal because they saw a physician they admire act a certain way and felt that was the way to act. While knowing parts of the history and physical leads to good patient care, knowing how to be professional, ethical, and compassionate lays the way to ideal care. We must give that gift to all learners we encounter – it is what Santa does.
I have had the opportunity to see medicine evolve rapidly since I began medical school in 1973. There are now amazing tools to help diagnose and, recently, an asymptotic rise in therapies. Staying current is a daily challenge. What has not changed is the magic behind the door. When I am in the room with a patient and a student, it is a time warp. I go back to my first day as a medical teacher and can pull on those basic skills in patient interaction that have made this crazy ride possible. I suspect, and hope, the same can be said one hundred years from now. Being able to pay it forward benefits everyone. Getting credit for it pales in comparison to the inner fulfillment of knowing we may be positively impacting countless patients through how and what we give to a student at a given moment. Teaching helps everyone.
John F. McGeehan is an internal medicine physician.
