'Bad patients, son, bad patients. There's nothing a good doctor can do about bad patients. '
8:59 PM


Picture this scene: Dr Gillupsie has grouped around him several of the young resident surgeons at Blear General Hospital. They are about to begin their weekly analysis of the various operations they have performed in the preceding four days. Gillupsie nods in the direction of Jim Kildear, indicating that Kildear's cases will be discussed first:

GILLUPSIE: Well, Jim, what have you been up to this week?

KILDEAR: Only one operation. I removed the gall bladder of the patient in Room 421.

GILLUPSIE: What was his trouble?

KILDEAR: Trouble? No trouble. I believe it's just inherently good to remove gall bladders.

GILLUPSIE: Inherently good?

KILDEAR: I mean good in itself. I'm talking about removing gall bladders qua removing gall bladders.

GILLUPSIE: Oh, you mean removing gall bladders per se.

KILDEAR: Precisely, Chief. Removing his gall bladder had intrinsic merit. It was, as we say, good for its own sake.

GILLUPSIE: Splendid, Jim. If there's one thing I won't tolerate at Blear, it's a surgeon who is merely practical. What's in store next week?

KILDEAR: Two frontal lobotomies.

GILLUPSIE: Frontal lobotomies qua frontal lobotomies, I hope?

KILDEAR: What else?

GILLUPSIE: How about you, young Dr Fuddy? What have you done this week?

PUDDY: Busy. Performed four pilonidal-cyst excisions.

GILLUPSIE: Didn't know we had that many cases.

PUDDY: We didn't, but you know how fond I am of pilonidal-cyst excisions. That was my major in medical school, you know.

GILLUPSIE: Of course, I’d forgotten. As I remember it now, the prospect of doing pilonidal-cyst excisions brought you into medicine, didn't it?

PUDDY: That's right, Chief. I was always interested in that. Frankly, I never cared much for appendectomies.

GILLUPSIE: Appendectomies?

PUDDY: Well, that seemed to be the trouble with the patient in 397.

GILLUPSIE: But you stayed with the old pilonldal-cyst excision, eh?

PUDDY: Right, Chief.

GILLUPSIE: Good work Fuddy. I know just how you feel. When I was a young man, I was keenly fond of hysterectomies.

PUDDY: (giggling) Little tough on the man, eh chief?

GILLUPSIE: Well, yes (snickering). But you'd be surprised at how much a resourceful surgeon can do. (Then, solemnly) Well, Carstairs, how have things been going?

CARSTAIRS: I'm afraid I've had some bad luck, Dr Gillupsie. No operations this week, but three of my patients died.

GILLUPSIE: Well, we'll have to do something about this, won’t we? What did they die of?

CARSTAIRS: I’m not sure, Dr Gillupsie, but I did give each one of them plenty of penicillin.

GILLUPSIE: Ah! The traditional 'good for its own sake' approach, eh, Carstairs?

CARSTAIRS: Well, not exactly, Chief. I just thought that penicillin would help them get better.

GILLUPSIE: What were you treating them for?

CARSTAIRS: Well, each one was awful sick Chief, and I know that penicillin helps sick people get better.

GILLUPSIE: It certainly does, Carstairs. I think you acted wisely.

CARSTAIRS: And the deaths, Chief?

GILLUPSIE: Bad patients, son, bad patients. There's nothing a good doctor can do about bad patients. And there's nothing a good medicine can do for bad patients, either.

CARSTAIRS: But still, I have a nagging feeing that perhaps they didn't need penicillin, that they might have needed something else.

GILLUPSIE: Nonsense! Penicillin never fails to work on good patients. We all know that. I wouldn't worry too much about it, Carstairs.

Perhaps our playlet needs no further elaboration, but we want to underscore some of its points. First, had we continued the conversation between Dr Gillupsie and his young surgeons, we could easily have included a half dozen other 'reasons' for inflicting upon children the kinds of irrelevant curricula that comprise most of conventional schooling. For example, we could have had one doctor still practicing 'bleeding' his patients because he had not yet discovered that such practices do no good. Another doctor could have insisted that he has 'cured' his patients in spite of the fact that they have all died ('Oh, I taught them that, but they didn't learn it'). Still another doctor might have defended some practice by reasoning that, although his operation didn't do much for the patient now, in later life the patient might have need for exactly this operation, and if he did, voila!, it will already have been done.

The second point we would like to make is that we have not made up these 'reasons'. Our playlet is a parody only in the sense that it is inconceivable for doctors to have such conversations. Had we, instead, used a principal and his teachers, and if they discussed what was taught during the week, and why, our playlet would have been a documentary, and not a heavy-handed one, either. There are thousands of teachers who believe that there are certain subjects that are 'inherently good', that are 'good in themselves', that are 'good for their own sake'. When you ask 'Good for whom?' or 'Good for what purpose?' you will be dismissed as being 'merely practical' and told that what they are talking about is literature qua literature, grammar qua grammar, and mathematics per se. Such people are commonly called 'humanists'.

There are thousands of teachers who teach 'subjects' such as Shakespeare, or the Industrial Revolution, or Geometry because they, are inclined to enjoy talking about such matters. In fact, that is why they became teachers. It is also why their students fail to become competent learners. There are thousands of teachers who define a 'bad' student as any student who doesn't respond to what has been prescribed for him. There are still thousands more who teach one thing or another under the supposition that the 'subject' will do something for their students which, in fact, it does not do, and never did, and, indeed, which most evidence indicates, does just the opposite. And so on.

The third point we would like to make about our analogy is that the 'trouble' with all these 'reasons' is that they leave out the (patient) learner, which is really another way of saying that they leave out reality. With full awareness of the limitations of our patient-learner metaphor, we would assert that it is insane (literally or metaphorically, take your pick) to perform a pilonidal-cyst excision unless your patient requires it to maintain his comfort and health; and it is also insane (again, take your pick as to how) for a teacher to 'teach' something unless his students require it for some identifiable and important purpose, which is to say, for some purpose that is related to the life of the learner. The survival of the learner’s skill and interest in learning is at stake. And we feel that, in saying this, we are not being melodramatic.

 from 'Teaching As A Subversive Activity' by Neil Postman & Charles Weingartner

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