As I mentioned in yesterday's post I have been reminiscing over my academic career ... both as a student [undergraduate and graduate] as well as faculty for the past nearly fifteen years. And it is from this context that I'd like to approach the above subject. We've all met these people ... both the cows and the bulls.
But I remember one such "bull" especially well. He was my first medical student reporting for Doctoring I practicum in my office in August 2001. His name was not Rick [but I will call him that just to be nice]. Not Rick had a lot going for him back in those days [he still does from what I understand]. Not Rick had been accepted into the inaugural medical school class at Florida State University's brand new College of Medicine the preceding spring and had just finished the Summer Semester mastering Gross Anatomy a week or two before and been cloaked in his short white lab coat common to most medical students.
Now at that time the FSU College of Medicine was quite the talk of both the City of Tallahassee as well as the State of Florida and was basically the brainchild of a powerful state senator, John Thrasher, who just so happens to now be President of the University. It was born with a rather unique mission among medical colleges ... one that would not be a clone of so many other medical colleges across the country ... which produce sub-specialists in droves. No, it would be a "community-based" medical school ... one which would start with 30 students in its charter class but quickly build to 120 students per year. It would not be centered in a large university teaching hospital but students in their third and fourth years would be divided among regional campuses scattered across the state of Florida [in Orlando, Pensacola, Sarasota, Daytona Beach, Fort Pierce, Tallahassee and even more rural places like Marianna and Thomasville, GA]. It's mission was to produce primary care physicians and geriatric physicians to care for those in Florida who seemed have the hardest time finding a physician.
So how exactly did Not Rick get accepted into the FSU College of Medicine Charter Class? I was all too eager to hear his story. It turns out that Not Rick had no desire to ever become a primary care physician nor a geriatrician either. His life's goal was to become a medical researcher at the National Institutes of Health in Bethesda, MD. A worthy goal I'm sure, but one that in no way fit the mission of the school. So now I become very much intrigued as to how he was able to hide this career aspiration from the Admissions Committee of the FSU COM. It turns out that he wasn't at all. In fact, just the opposite occurred, as he told them straightaway at his interview of his exact career plans. And he was still accepted anyway. At this point, I seriously wondered just what kind of medical school faculty I had agreed to join in the first place. Were we really just going to be spinning our wheels? After all, there had not been a new medical school opened in the United States for just over twenty years at that point in time, and now I was wondering if the FSU College was really going to be any different from all the other cookie cutter schools out there.
And that is when I soon came face to face with Not Rick's gift of bull. Now it is not expected that a first year medical student would have much game clinically. Heck, I didn't even see my very first patient in medical school until I was nearly a month into my second year. So the bar to meet was pretty low, but Not Rick always had to try to clear the bar by several hundred feet it would seem. Week after week he came to clinic on Wednesday afternoon and saw patients first with me and then on his own, but I don't think I ever heard him say "I don't know" for nearly a semester before we had our first "Come to Jesus" meeting. Mostly I was just incredulous at the beginning because he could talk a very good game and he often even fooled my nurses at that time with his imagined competence but what he didn't know was that I knew he almost never knew what he was talking about. For awhile I wondered how long he would try to play the ruse and bluff his way by. After two to three months I began to realize that he would never know what he didn't know if I didn't step in and burst his bubble. So much for my hope to be basically a cheerleader for my first medial student. And he kept reminding me of an essay I had heard about during my English Composition 1013 class at Oklahoma State University back in the Spring of 1979.
Written by a Harvard teaching assistant, it told the story of an undergraduate student with too much time on his hands who followed one of his friends into an exam and took the test just for fun. On the essay portion, the test crasher got an A; his friend, who was actually enrolled in the course and had done all the reading, got a C.
The difference was that the friend, who had all the facts, didn't do much with them. Whereas the test crasher, who had no facts other than the few suggested in the way the question was posed, spun out an amazing exploration of what he assumed the issues to be.
The teaching assistant telling the story came up with two verbs to identify the different approaches. The first was "to cow," which boiled down to presenting facts as a substitute for understanding. The second was "to bull," which is to present evidence of an understanding of form, context, and frames of reference in order to suggest a nonexistent familiarity with the facts. Cow is data without a model, theory or connections. Bull is a model with no data to support it.
You cannot bull your way through life, and you certainly cannot bull your way through the medical sciences, engineering or any of the other hard sciences ... maybe that works in philosophy and the social sciences, but I doubt it works even there. But the converse is true as well ... you cannot cow through it either. Essentially the "cows" are the facts that link us to the observable universe and the "bulls" are the connections between the facts, the causal relationships between the observations. The bulls are our models of the universe -- they are what we use to predict as-yet-unobserved cows.
I have come realize that, in the business of restoring and preserving the health of humanity, most of our problems arise from a lack of bull. Rarely do we lose people because we lack facts or because a specific fact was wrong. We lose people because we did not appreciate the links or connections between the facts.
Constantly striving to find and understand those connections is the prime motive for science, but it is also critical for any other practical enterprise, including any business. It is not enough to log and tabulate the observables; it is essential to develop an actionable understanding of the underlying causes of the observables.
All of which somehow brings us back to Not Rick. I did have to confront him on not having to "know it all" and especially not in his first year. In fact, I let him know that it is actually much more important to "know what it is that he doesn't know" than it is to "know what it is that he knows." I wish I could say that was the only conversation like that I had to have with him that year, but it wasn't. It kept coming back up. Bulls are like that I think. But they also are the ones who ultimately shape our world ... if they can find the right balance. As for Not Rick, I think he turned out okay. He graduated with that Charter Class on time in May 2005 and ended up with a fellowship at the NIH where I believe he still works to this day.
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