Bioethics Discussion Blog: Teaching of Medical Students to Become Physicians (3): The Middle Finger, Index Finger Trick

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Tuesday, October 18, 2005

Teaching of Medical Students to Become Physicians (3): The Middle Finger, Index Finger Trick

As the old story goes:

First-year students at Medical School were receiving their first anatomy class with a real dead human body. They all gathered around the surgery table with the body covered with a white sheet. The professor started the class by telling them, "In medicine, it is necessary to have two important qualities as a doctor: the first is that you can not be disgusted by anything involving the human body". For an example, the professor pulled back the sheet, stuck his finger in the butt of the corpse, withdrew it and stuck it in his mouth. "Go ahead and do the same thing," he told his students. The students freaked out, hesitated for several minutes, but eventually took turns sticking a finger in the butt of the dead body and sucking on it. When everyone finished, the professor looked at them and told them, "The second most important quality is observation. I stuck in my middle finger and sucked on my index finger. Now learn to pay attention."

Would you believe that I actually watched a physician, teaching 2nd year medical students the skill of observation, performing virtually the same deception? However the physician used a plastic cup filled with a yellowish liquid he identified as urine and did the same middle finger, index finger trick and actually got a student up in front of his fellow students to stick in a finger then suck. Then the physician admitted that the container was not filled with urine but actually a potable drink. Everyone laughed.

Though it was all fun and hopefully educational, I always wondered whether this act was really ethical and fair, taking advantage of a vulnerable young medical student.
Am I being overly concerned about this particular way of teaching? Or should our teaching of medical students, including those in the later years on the wards, be tempered by more concern with ethical boundaries? ..Maurice.

9 Comments:

At Wednesday, October 19, 2005 11:51:00 AM, Blogger Kenny said...

Maurice, I understand your concerns though I feel that sometimes the best way to teach someone is through these "embarassing" methods that may expose our vulnerabilities. The "butt and urine" examples both illustrate the two important qualities of becoming a doctor probably better than anything else. It's something med students will never forget and it makes for a great story. In a world where med students must know more and more than ever before, it is increasingly important that remember what we study. Teaching methods like this, in moderation, are always useful. I hope to have physicians like that teaching me when I go to medical school as opposed to the dry lectures so many conduct.

 
At Sunday, October 23, 2005 12:57:00 AM, Blogger Aftab Iqbal said...

Are you serious? This really happened? By the way have you rad Erich Segal's DOCTORS?

 
At Sunday, October 23, 2005 10:59:00 AM, Blogger Maurice Bernstein, M.D. said...

Kenny, there are so many ways to teach medical students the skill of observation that I think that a teacher need not use the "figers trick". What the trick does is cause the student unnecessary consternation at the moment since the students are unprepared for a trick. (If they knew I trick was about to occur they would be naturally more observant.) The student is then faced with the issue, while standing, embarrassed, in front of his/her fellow student and being the directed by one's superior to taste someones urine whether to follow orders based on the assumption that the superior, without hesitation, performed the same act.
The student surely is aware that to taste someones urine is not a necessary act of the 21st century and is potentially unsanitary. But in the two years of witnessing the same trick, the student went ahead and followed orders.

Can this be a beginning conditioning for the student's later experience on the wards, where the student, under the influence and pressure of superiors, are expected to follow, without resistance, their superior's ethical and other misbehavior? I hope not.

By the way, there is a tendency now in medical school education that students have found a way to avoid those "dry lectures". They just don't show up and pass their exams using the multitude of other resources available.

Aftab, if you are referring to my description, as noted above, I have witnessed this trick twice. Tell me what you took away from DOCTORS. ..Maurice.

 
At Tuesday, October 25, 2005 3:10:00 PM, Blogger Alyssa said...

I think that there is an important lesson in all of this: common sense. I don't care what kind of retribution I might get from a teacher, I'm not putting a finger covered in fecal matter or urine (whether real of not) in my mouth. If you're going to be a doctor, shouldn't you be aware that basic hygeine practices forbid such an act? Where was the student saying, "Professor, that's rediculous and everyone SHOULD be grossed out my that!" There's something to be said for observation, and another to be said for standing up for oneself instead of blindly following orders.

 
At Tuesday, October 25, 2005 5:18:00 PM, Blogger Maurice Bernstein, M.D. said...

Yea, Alyssa!!!

But note, no student in the audience of about 80 students called out "DON'T DO IT!"

And, how about me.. way in the back row. I, too, was silent. ..Maurice.

 
At Wednesday, October 26, 2005 5:38:00 AM, Anonymous Bob Koepp said...

As a teaching method, there might well be a problem here. But Alyssa might be giving too much weight to the notion of hygiene. Physicians have, throughout history, exposed themselves to all sorts of unhealthy influences, often paying for it with their lives. It was accepted as an occupational hazard of the moral practice of medicine. And though I've never heard of anybody becoming ill as a result, tasting a patient's urine used to be a standard method of "testing" for diabetic conditions.

 
At Wednesday, October 26, 2005 2:37:00 PM, Blogger Maurice Bernstein, M.D. said...

Bob, though the medical profession should accept a duty to take minimal risks or emotional burdens for a rational cause toward the benefit of the patient (such as attending an HIV patient or an influenza patient as examples) is one thing. But for a student, without explanation, to have to take whatever minimal risk is involved or whatever emotional effect might occur in tasting alleged urine for no clinical benefit, I think is no longer a professional duty.
Any risk taking by medical students should be based on informed consent.
As far as the risks involved in tasting unknown urine, though it was performed many years ago to identify diabetes and current literature suggests that HIV is not transmitted through urine, I still wonder if this action is always without any potential harm. ..Maurice.

 
At Wednesday, October 26, 2005 3:36:00 PM, Anonymous Bob Koepp said...

Maurice -
You are, of course, right that there is no strict "duty" involved in these cases. That said, I don't think we should minimize the risks accepted by physicians who exposed themselves to influenza (or even plague) when they had no effective means of protecting themselves from infection. Medicine is not nearly so "risky" a profession as it was only a few generations ago.

As for emotional burdens borne by students exposed to this sort of "gallows humor," I can't imagine that it is in the same league as the burdens arising from the "pressure cooker" environment of medical education.

 
At Thursday, October 27, 2005 8:29:00 PM, Blogger Maurice Bernstein, M.D. said...

Bob, this example of student education I presented is actually part of the entire “'pressure cooker' environment of medical education." I think it takes a special student to accept the life of a medical student and beyond. ..Maurice.

 

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