Gunners.
(aired on All Things Considered August 6, 2004)

A few of our classmates seem to simply know more than the rest of us. Some of those people we admire. Some of them we despise. The students we admire are the ones who we say know their stuff. Then there are the gunners. If you ask most medical students to name their most infuriating classmates, it would be the gunners.

A gunner uses knowledge to put everyone else down. If a teacher is asking a question, and one of us is stumbling and fumbling, a gunner will jump in with the answer. Gunners value certainty. They hoard facts like ammunition. They think medicine is a competition and that they are winning.

We gossip mercilessly about gunners. Recently, I heard a story fourth hand about one alleged gunner who said that he hated small-group discussions because "All I do is teach everyone else what I already know." I'm sure his fellow students are charmed.

I've heard lots of folks compare medical education to drinking water from a fire hose. You have to get enough to become a good doctor, but there's no way you can drink it all. Gunners act as if they get it all and that's part of why we hate them. After all, even though I've learned a huge amount since I've started, medicine remains an ever-widening horizon of things I don't know and ways I might screw up. The farther I go in medicine, the more terrifying my ignorance becomes.

Most of us are spending much of our medical school careers asking ourselves `What kind of idiot am I?' The gunner emanates the question: `What kind of idiot are you?' To which we think `We were doing fine with that question without your help.' But in my calmer moments, I know it doesn't matter what some 23-year-old thinks of my intellectual abilities. What does matter is what he thinks of his own abilities. And very often gunners are correct in the details of what they say with such arrogance and disdain. I'm sure they do better than I do on exams.

But gunners will become doctors, and that presents two problems. First, sometimes I'll witness a gunner saying something blatantly false with all of his usual confidence and contempt. That's no big deal on an exam, but it'll be terrible for patients. Worse yet, medicine is full of risky surgeries, drugs with dangerous side effects, clinical trials of experimental treatments, situations full of dilemmas and doubts. At such times, certainty is a form of ignorance. At such times, the most terribly wrong answer is to think that there is a right answer.

copyright 2004 joe wright