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1_Exploiting a Research Underclass

1_Exploiting a Research Underclass - P ERSPE C T I V E T he...

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PERSPECTIVE n engl j med 358;22 www.nejm.org may 29 , 2008 2316 sion about a child who doesn’t seem critically ill. You can’t let all the what-ifs terrorize you, or you would do a lumbar puncture on every young child with a high fever and do a CT scan for even the most minor bump on the head. So you just go on practicing, haunted by stories — stories you’re a part of, stories that happen to people you love or know well or take care of, stories you hear from your teachers and colleagues, and the occasional well-told story that en- ters your brain and lives there . . . all those ghosts that hover at your shoulder or in the dark places of your mind. I had a peculiar sense of multiple levels of precepting — of me standing over the in- tern, and my preceptor standing over me, and of the ways that your medical education comes down to you partly from people you will never meet. I’d like to think of it, in part, as a collective medical memory. And also as a way of honoring the pa- tients who have suffered “bad outcomes” — and their physicians, too, the ones who are grieving still, who have told and retold these difficult stories. Bad things can be only a step away, and we need to absorb that knowledge and yet still do our job. It seems to me right and proper that even
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  • Spring '10
  • McGrand
  • Clinical trial, Eli Lilly, Massachusetts Medical Society, Contract research organization, occasional well-told story, collective medical memory

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