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How Good Do You Want To Be?

JeffJeff Wonoprabowo -- I've been obsessed with these Olympics. It's been so inspiring watching the athletes compete. The last event I saw was the Women's Beam Final where America, led by Shawn Johnson and Nastia Liukin, won the gold and silver medals. After Shawn Johnson won the Gold Medal, the commentator talked about her background.

Ten years ago she bounced into Chow's (her coach) gymnasium and began training at the age of six. During those years of training her coach asked her an important question: How good do you want to be?

That is a question every athlete must answer for himself or herself. The top athletes in the world only want to be the best. And they put their whole soul into achieving their goals, putting in hours and hours of training every day. The answer to that question determined what kind of training Shawn Johnson would need; it dictated the course of her childhood, finally culminating in an Olympic Gold Medal.

A couple of weeks ago I asked why we, as medical students, should bother learning something we'll eventually forget. A number of people commented and left what they felt was the reason for learning such things. And I think they are all very useful answers to this question.

For me, the answer is best phrased in the question I heard while watching the U.S. Women's Gymnastics competition -– the same question Shawn's coach asked her: How good do you want to be?

At the end of my first year I spent almost two weeks on the General Surgery service. On the last day I was there I spoke with the chief resident who was less than a week from completing his general surgery residency. He spoke about his training and how he felt it was very well rounded. Because he had to rotate through many services, he felt comfortable speaking to internists, neurosurgeons, orthopedic surgeons, radiologists, etc. Even though those areas were not his specialty, he knew enough to communicate intelligently about a patient. These days, with multiple teams caring for a single patient, effective communication between healthcare providers is crucial.

Someone commented that a doctor with a broad base of medical knowledge is a well-rounded doctor.

A well rounded doctor means better care for patients. And it's all about the patients, right?

So... How good do you want to be?

August 25, 2008 in Jeff Wonoprabowo | Permalink


What an AWESOME POST!! I am a first year medical student at GW and that is exactly what we were discussing. In our orientation, we were required to read this book called BETTER where Atul Gawande addresses this particular issue. This book is a MUST READ for medical students and those in the medical profession. of our children, we want no one to settle for average"A quote that sums this particular issue really poignantly is " If the bell curve is a fact, then so is the reality that most doctors are going to be average. There is no shame in being one of them right?
Except, of course there is. What is troubling is not just being average but settling for it. Everyone knows that averageness is, for most of us our fate. But in our surgeon, your child's pediatricians? When the stakes are our lies and the lives

Posted by: Med Student in DC | Aug 26, 2008 1:33:51 PM

Jeff, I think you have gone farther toward answering this age-old question than anyone i've heard before.
thanks for the wise insight!

Posted by: | Aug 26, 2008 1:58:53 PM

The difference between the good and THE GREAT is very small. You made an excellent point..we medical students should strive to be the best doctors there is..thats where the difference is..Thanks jeff..check this site out: http://www.212movie.com/ speaks a lot about how we shoudl aspire to be the best..I will end with my favorite quote, "Excellence I stride for, Perfection I leave for God."

Posted by: Leke Adesina | Aug 26, 2008 2:55:57 PM

Atul Gawande's "Complications" came before "Better" and as a lay person, I will more carefully choose a surgeon should the occasion arise because of reading it. I certainly want an above average doctor, nurse, hospital etc. and hope to be an above average consumer/patient.

Posted by: m.k. | Aug 26, 2008 2:59:48 PM

How would you all like to define "above-average"? USMLE scores? Clerkship or resident evals? Patient feedback? Bedside manner? Morbidity and mortality statistics? All of us would strive to be above average, but it is not as easy a position to define for a doctor as it is for a U.S. gymnast who gradually ascends through competitive levels until she reaches her pinnacle at the Olympics.

Posted by: jmd | Aug 26, 2008 6:31:27 PM

Two surgeons. One with exams that were "just average." Another with top scores in all the standardized exams.

Is it possible that the "average" doctor is a better surgeon? Absolutely.

I think being a "better" doctor has more to do with our attitude than with scores.

I'd like to think that every medical school graduate will have the necessary tools to become a fine doctor -- even the bottom of the class. But I think the attitude of a doctor will make a more significant difference than scores.

Posted by: Jeff W | Aug 26, 2008 10:25:02 PM

And then the old chestnut: "The enemy of good, is better..."

Posted by: AJW | Aug 27, 2008 3:18:09 AM

very helpful post. we just had our second block exams and i felt challenged to stop being mediocre.

i think one very important reason why we need to excel is that we are dealing with lives. we cannot fail (or do whatever God permits us to not to). :)

Posted by: ncjm | Aug 27, 2008 9:17:49 AM

Patients don't need good...patients need the best and i think that's the ideal for which every medical sudent MUST strive . Because yes, it is about the patients... and it is also about self-accomplishment, but in a job where you are working with people self-accomplishment means making those people live healthy and assuring that the quality of their life is optimal .

Posted by: Vlad | Aug 27, 2008 12:53:07 PM

Hi Jeef, I fill the same during the olympic games and thank you to encorage me to press on the same botton: getting out from the mediocre standard toward where God permits me to achieve.
medical student in Mozambique

Posted by: Bachir | Aug 27, 2008 1:03:03 PM

quoting my inspiring brother teacher.."where the stakes are so high, how can anything other than the very best be tolerated"..

whenever we undertake to do something, we should logically do it to the best of our ability as thoroughly as possible braving failures with a renewed spirit for success..

this applies to all spheres of life and if we persevere in striving for excellence, it can make all the difference we need in our life..

All the best

Posted by: jalal | Aug 27, 2008 8:38:10 PM

i am an undergraduate medical student of fourth year in Pakistan.over here a student does not have the exposure, a medical student has in America or England or elsewhere but i have to say this that in spite of few facilities students here do become a good doctor, i mean they do receive patient,s satisfaction after providing them standard treatment.a good doctor receives satisfaction of patient wherever he works in the whole world.

Posted by: rafia ayaz | Aug 27, 2008 10:08:48 PM

thanks a lot for your article coz it was encourage me
to work hard to achieve my dream...

Posted by: biena | Aug 27, 2008 11:39:31 PM

Perhaps, but never underestimate the ability of med students to over exhaggerate that particular aspect as a pivot to showing off as opposed to actually using their knowledge to help people. The "I know more than thou" and "god" complexes can drive people to dig into knowledge that they necessarily don't need and because they were simply scratching at the surface they can presume a certain degree of info that is actually not warranted. I'd recommend that knowledge and actual application be schized so that the folly of "it sounded so good in book A and book B" be avoided.

Posted by: John McStern | Aug 28, 2008 1:30:39 AM

Some people are in medicine not willingly but may be due to parental pressure, imitating friends or to even have the title, DR, added to their names etc. If one decides to do it, regardless of the hurdles one will endure, put in the best you can. I can add that it depends on the individual's attitude towards the course. Thanks

Posted by: MOSES | Aug 28, 2008 4:12:44 AM

It's been quite sometime since i last logged into this differential blog due to time constraints. However, today as i was browsing through my emails, the title 'How good do you want to be' literally jumped out at me! So i clicked on the link and here i am! Honestly, I must say that after reading this article, i just sat staring at my laptop screen for a while. In retrospect, i always wanted to be an excellent doctor, i used to study so much in my first few semesters...somewhere along the line, my zeal for excellence dwindled to mediocre. If u ask me how, i seriously don't know how it happened. Well, perhaps i could blame it on medical school pressure or simply being satisfied that i managed to clear my semester? Reading all your comments up there has jolted me out of my slumberland, that i should strive to achieve excellence and not happily settle for mediocre. I'm seriously gonna begin my journey to excellence and i wish u all my fellow comrades all the best!

Posted by: Anna | Aug 28, 2008 6:50:38 AM

The quest for perfection is something that every doctor, and every aspiring doctor, should strive towards. However, when speaking to a cardiology fellow during my Internal Med rotation, we both agreed that the only person who can judge how good a doctor is, is the patient.

However, the EXPECTATION for perfection from the patients is something that is unrealistic and unfair. For example, a neonatologist I know very well, who runs a Level III NICU, was relating to me an affidavit he was involved in where a rural doctor was being sued for not providing the same level of care as a "typical" NICU. Is it really the doctor's fault that he didn't know as much as a subspecialist? Or that a 27-weeker wasn't able to be sustained until the NICU transport team arrived?

How good do you want to be?

Posted by: Ephraim | Aug 28, 2008 8:37:15 AM

Thanks for this inspiring post Jeff.. was having a hard time meeting deadlines for dissertation work; my work is getting interrupted by frequent power-cuts due to shortage of electricity in India !!!When I was feeling like am up against an obstacle course,your post strenghthened my resolve to be the best I can be, against all odds!

Posted by: karuna | Aug 28, 2008 12:52:10 PM

hi everybody! I am a 4th year medical student of Lima, Peru. Jeff, what you are saying is so important for us that sometimes we don't realize about how quick the years in the medical school pass! For example, I study anatomy 2 years ago I think, and at the moment I can't remember all the complicate names of lots of structures of the body, and I thought it was not important if I want to be an internist, but some things make us better than other ones, and one of those things could be easily these kind of knowledge. I do want to be good. Now I know a way to do it. Greetings from Peru!

Posted by: Renato | Aug 28, 2008 7:07:22 PM

Your post really shows up one reason to 'strive', but I don't feel that it only works this way: I spent most of my youth training gymnastics every day because I loved the feeling of control and of flying through the air. I still miss that 25 years later. Now as a med syudent, I just want to know! Perhaps another reason to study is just for the joy of knowledge.

Posted by: julie Mclean | Aug 29, 2008 3:23:00 AM

I love all your posts!

Posted by: Pamela Franco | Aug 29, 2008 4:25:31 PM

Is medicine really about bell curves? This comment adds to the comparison of earning gold medals to being a great physician.

Unlike most games, medicine is not a competition amongst the players, but rather a challenge within oneself. As an Olympian, the beloved Phelps does more than to aim to defeat his colleagues- he aims to reach his personal best. Similarly, a physician's answer to "How good do you want to be" ought to have a response more congruent with the Army slogan "be all that you can be," i.e. reaching one's personal best.

One may argue that this fosters mediocrity, satisfaction with being average. I believe it challenges physicians to arise about competing with peers and to devote themselves wholly to serving the patient, to learning, and to humility.

Posted by: Rohini Khatri | Aug 31, 2008 8:05:09 AM

this is an excellent question
my answer is i want to be the best, i go to the hard road and i dream at certain time in my life to be the owner of Nobel Price . i know this is a huge hope but i think it is accessble if any one wants to be a special

Posted by: mona | Aug 31, 2008 9:46:50 AM

Very encouraging! Thanks.

Posted by: Yvonne | Sep 2, 2008 3:58:38 PM

I'm in my second last year of med school in Australia. I had a lot of the same thoughts watching the Olympics as what Jeff is saying here.
But the next question I must ask is "How good do you want to be... at what?"
Surely I am not only measured by my success as a doctor. I am a mother, a wife, part of a community. Am I "the best" if I become a brilliant physician but an absent mother? If my kids look back on their childhood and say "Mum was always to busy for me, I never came first" ?
Certainly I feel the same urge I'm sure you all feel to strive to be the best doctor I can, to give my patients the best of care. But I would also like to be the best overall human being that I can be, someone who knows which responsibilities take priority at any given time. It may not win me any gold medals, but it might keep me sane.

Posted by: Claudia | Sep 3, 2008 7:33:40 PM

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