my pride and ask the stupid questions that came to my mind during lectures, and I did so often. Dr. Brinckerhoff not only enthusiastically embraced my hand-raising and questioning, she even praised it—telling the class she thought I was smart and asked great questions.
I can't put into words how empowering that was—how it helped me to keep asking questions and asking people to explain things again, maybe in a different way, until I understood them. Dr. Brinckerhoff was a great teacher for many other reasons, including that she always seemed to enjoy what she was doing, was always curious about students, and laughed a lot.
But I would like to take this opportunity to thank her profusely for what she did for me. I'm now a psychiatrist in a community mental health center in Salt Lake City and have two children—so I have little time or energy left over for angst or self-doubt. I'm more interested in having fun with my kids, having a glass of wine with my husband and friends, and, of course, trying to be a better doctor!
Katherine L. Carlson, M.D.
Salt Lake City, Utah
A birthday thank-you
My son, Alex, was one of the first preemies in DHMC's new Neonatal Intensive Care Unit (NICU) in 1991. Alex was rushed there after his unexpected birth seven weeks early. Since I'd had an emergency c-section in Brattleboro, Vt., and my husband was in Maryland, it took us a while to join Alex. The building wasn't even fully furnished during his two-week stay at DHMC, but it still seemed beautiful. Most importantly, it symbolized hope to us. As traumatic as the experience was, the care that Alex (and we parents) received was truly amazing.
Alex turned 17 on October 10, 2008, and, as I have every year, I sent his caregivers at DHMC a silent thank-you. Then it dawned on me that Alex's success story might give a boost to the wonderful, dedicated staff in the NICU. I'm enclosing Alex's birthday photo from this year to show what a happy, normal kid he is, and a photo from1991 to show how far he's come. I want to thank the NICU doctors and nurses, without whom our lives—and those of thousands of other families—would be radically different.
A round of snaps
I thought the Grand Rounds essay in the Fall issue, by Dr. Joe O'Donnell, was a great piece. I was fortunate to be able to spend quite a large amount of time with him throughout my first two years as a student at DMS, so I can attest to the truth of everything he said in his essay.
He loves the "informal curriculum," and I think Dartmouth really is different in its emphasis on that aspect of the student experience. I think it's one of the reasons that medical students from Dartmouth do so well once they're out in residency and practice, because this informal curriculum keeps us well-rounded and helps us learn to balance medicine and real life.
In addition, these extracurricular experiences really do help us learn the parts of medicine that simply can't be taught in a classroom or an exam room. Dr. O'Donnell truly is the dean of this informal curriculum; it is well known among first- and second-year students that if you need money or support for a program or idea, go to Dr. O'Donnell, and he will make it happen to the best of his ability.
I am very glad this topic was addressed in the magazine, because the idea of the informal curriculum is fairly new. Most doctors, especially more senior ones, did not have access to such experiences when they were students. But it is a hugely important part of medical
education now and of becoming a "good doctor"—something that, ironically, you can't teach.
No "slow" in today's system
My husband was one of the first doctors, in the 1950s and '60s, to focus on the care of chronically ill patients, many of whom were elderly. The efficacy of acute care having been exhausted, the goal was to enhance their quality of life—an early version of "slow medicine," described in your Fall issue.
As my husband was either a professor at a medical school or a salaried staff doctor at a hospital, he was able to spend the time needed to listen to his patients' concerns and evaluate the best course of treatment, especially if they were near the end of life. But the doctor in private practice faces obstacles in attempting to provide this type of care.
First, the time needed for a thorough understanding of the patient and family—formerly achieved by primary-care physicians through long association—is no longer available. In the 15-minute office visits now mandated by insurance companies, immediate problems are all that can be dealt with.
Second, the high compensation for high-tech, subspecialty interventions—in contrast with relatively no compensation for time spent listening to a patient—is a disincentive.
Third, the institution of the hospitalist—a model of care now prevalent in the U.S.—means that at their sickest and most vulnerable, patients are signed over, by the doctor they have learned to trust to understand their wishes, to a total stranger. This stranger not only knows nothing about them but will cease to have contact with them if, and when, they leave the hospital—advance directives and chart notes by the referring doctor notwithstanding.
Our health system is not designed to provide "slow medicine" for most patients.
I recently saw a painting made from a photograph of the nation's first clinical x-ray, performed at Dartmouth in 1896. It reminded me that I saw the photo in your