From the Dean: Asking Critical Questions

The New England Journal of Medicine arguably is the most prestigious medical journal in the world. Many seminal medical discoveries are first reported in the Journal. One of the features of the publication that I and others especially enjoy is the weekly Case Records of the Massachusetts General Hospital, wherein a medical expert discusses a challenging patient case history, reaches a diagnosis, and then learns if the diagnosis is correct. Last week’s case involved a man with depressed mood, unsteady gait, and urinary incontinence. The case history documented his slow and then more rapid decline that culminated in not one but two hospitalizations within a month’s time. Despite extensive evaluation and expectant treatment, the patient’s status continued to deteriorate. As the discussant said, “Something was not making sense; why was this patient’s gait getting worse, with no clear precipitant?”

Then something special happened: “The residents and medical student on the team proposed the diagnosis of normal pressure hydrocephalus.” To make a long story short, the patient did indeed have NPH, was treated, and had a miraculous recovery: “He practically leapt from the bed and raced across the room, hardly in need of the walker he had been dependent on for months.” Why such a dramatic turnaround? Because of the questions of the medical residents and medical student! As a former medical student who many years ago took care of patients in the very same Massachusetts General Hospital, I continue to be amazed by the dedication, thoughtfulness, intellectual curiosity, and altruism of the School’s trainees, be they medical students, health sciences students, or residents (post-MD graduates who are getting additional training in a medical specialty area). Although in this case they didn’t have all the answers, they asked the critical question that led to the patient’s rapid and dramatic turnaround. To be sure, this is an especially poignant example of the contributions that trainees can make to patient care, but that questioning attitude they demonstrated is so critical to the life-long learning that all good doctors demonstrate. As someone who has been practicing cardiology for a good number of decades, the case history was a wonderful reminder to ask questions, seek input from others, and be humble in patient-care matters.

The past year has been especially challenging for our trainees as their training routines were disrupted, they helped care for very sick patients, they were separated from classmates, and all struggled with the uncertainties of COVID-19. But just look at what students and residents can do to help patients! This parable is a good reminder of the many wonderful contributions of our students. Thank you!

Joshua Wynne, MD, MBA, MPH
Vice President for Health Affairs, UND
Dean, UND School of Medicine & Health Sciences