If You Don't Teach Well, At Least No One Dies

We at Tenured Radical are sorry to hear that Zenith alum and historian of Africa Tim Burke, over at Easily Distracted, was temporarily sidelined by a bout of diverticulitis. For the non-cognoscenti, this is a manageable, chronic condition that tends to introduce itself with excruciating pain. From here on out, it's Fiber City, Tim. Get well soon, you hear?

As anyone in our tribe might have done, Tim used this small emergency and its resolution as an opportunity to blog. In a meditation on the state of two large, amorphous industries, higher education and health care, he writes:

Academia’s issues I see from the professional’s side, medicine’s problems from the perspective of the clientele. The first perspective tends to put me in the position of an apologist, the second as accuser. Maybe between the two some kind of insight is possible, though when I add it all up, I’m left with the sense that many modern professions are simultaneously indispensable, a high water mark of social progress and hopelessly screwed up in ways that can’t really be fixed by outsiders or insiders.

In the absence of any systematic fix, as Tim notes, we are all left to meander our way through the maze of what the insurance industry and the government call our "health care options," feeling lucky if we make a good connection with a physician and get decent care, or fighting grimly to hang on when we can't seem to make sense of why we are being treated with what appears to be diffidence. Like patients in our polyglot health care system, students at university are told in many ways that they get the education they deserve: if said student goes to a large, anonymous diploma factory, s/he must not have exhibited the virtues or intelligence necessary at precisely the right moment to have been admitted to a prestigious SLAC, Ivy or flagship public U. If s/he goes to a prestigious school, and can't seem to navigate it, pick the right courses or succeed in class, s/he is told that s/he is under prepared, irresponsible, immature, lazy and failing to take advantage of the cornucopia of opportunities just beyond hir grasp.

Think about it: as teachers, do we sometimes mistake the romance of what we do for its reality, and judge students accordingly when they don't perform? How many of us watch Gray's Anatomy because the idea of being able to get our health care at "Seattle Grace" hospital (despite the occasional psychotic shooter as in last night's season finale) is so seductive? Everything at Seattle Grace is handled by a skilled, empathetic and highly trained surgeon. People are reproached for their failings, and grow as a result of it; residents who make mistakes apologize for them. Patients get the outcomes they need, not the ones that happen to be available at the moment. (And by the way? I know this is totally irrelevant, but Cristina Yang is my idol: last night I was sucking back the tears as she found the courage to take charge of McDreamy's surgery.)

What Tim Burke points out in his post is that becoming a client can provide useful perspective on how we, as professionals, treat others to whom we are responsible. I found this extremely provocative. Long-time readers may remember that last fall I fired my primary care physician in a rage because the practice wouldn't refill my asthma meds when I was in the middle of an attack. But the larger issue was that actually making an appointment with any doctor in that practice -- much less my own -- had become a gargantuan, alienating chore. My doctor didn't think I needed an annual check-up; she preferred to phone in prescriptions without seeing me; and in the incident that resulted in the firing, refused to prescribe because I had not had an office visit in over two years and left a time for me to visit the office for my asthma on my office answering machine. I didn't get the message, of course, being sick and at home, and when I called to check about the appointment I had already missed it, and there wasn't another one for five hours. Meanwhile, I was sucking wind big time. They suggested I go to the emergency room. Practiced wheezers know that asthmatics are the last people treated in an urban ER (although at my age, murmuring "chest pains" can get me ahead of the bluish seven year-old from public housing.) Instead, I fired their asses and called my gynecologist. She fixed me up with the prescriptions I needed to help me breathe and the name of a new PCP.

Who, by the way, I love. She is funny and nice. She is younger than me (this is key, by the way, when you are in your fifties.) She does medical histories herself. She delivers all instructions in writing. She explains things. She says, "Call when you need us and we'll get you in." She watches all the same TV shows I do. If she were a cardio-thoracic surgeon, she would be Cristina Yang.

There's a lot in the story about the tortuous path by which I have found my dream doctor that hints at common frustrations about the medical system as it exists, even for those of us who have what passes for really good insurance. Doctors who are too busy and discourage their patients from coming in; staff sending patients for an expensive, time-consuming ER visit rather than taking a little extra time and care to talk to them directly and/or see them regularly; blaming the patient for not having overcome the barriers put in the way of care; the failure to make relationships that convey an ethic of care to the patient; and "managing" patients rather than establishing a set of cooperative practices between patient and physician that enhance wellness.

But Tim is right: the parallels to similar failures of professionalism in the academy are intriguing. My guess is that many undergraduates experience college with the same sense of powerlessness and frustration that I experienced in the failed relationship with my first PCP. How many of you have colleagues who have no scheduled office hours? Who are abrupt and peremptory with students in a way that discourages them from seeking help, or even making contact? Who then blame students for not having come to office hours? Who are often unavailable even if they have posted office hours? Who give assignments without saying what they are for or what the student is supposed to learn from them? Who give grades without any comment or instruction about what is right or wrong with the paper? Who deal with students who are not learning -- not by teaching them -- but by sending them to the writing workshop, the learning center or for tutoring by another undergraduate?

And the question is: how might one act on what might be conceived as a professional obligation to point these systemic flaws out and offer some comprehensive solution to them? I agree with Burke: it's hard to imagine. But perhaps not impossible. What I do know is that the testing structure, and demands by people who are not educators for what is now called "accountability" do not add up to the kind of close work and critical thought that would be necessary to re-invigorate the teacher-student relationship. The result is that some of us do what we are paid to do in generous and caring ways and others do not, and with the exception of the occasional teaching prize here and there, teaching is a set of professional obligations that one either takes personal responsibility for -- or not.

Readers?