One-on-One

Being particularly fond of the game, Charlie took up my offer to play. It was a ridiculous idea. I am a balding, thirty-something Internist whose basketball career had come to an unceremonious end in the sixth grade. Charlie, my third year medical student, had mastered his three-pointer and foul shot in junior high. As soon as he realized he could dunk the ball, Charlie had dreamt of becoming a professional basketball player. Only a fractured tibia derailed his basketball plans, leading him to pursue medicine and eventually to my clinic. In clinic, Charlie was just beginning to learn to care for patients. His interviews and physical exams were extensive and meticulous. However, despite my encouragement to share his thinking with me, he froze before developing his own assessment and waited for me to suggest a reasonable diagnosis and treatment. Later, he would send me his progress note, with a textbook-style differential diagnosis including multiple common and rare disorders. These extensive notes, written after he had read about the topic, would arrive at the same conclusions I had suggested and shed no light on his thinking. I wanted him to share his clinical reasoning with me, no matter how naive or uninformed it was. Without understanding his thinking, I did not know what Charlie needed most to learn. He might have not wanted to share his ideas with me for fear of embarrassing himself or harming a patient. I wanted him to jump into clinical medicine, make mistakes, and allow me to coach him. Despite my best attempts to understand Charlie’s reasoning, he remained guarded, and my teaching remained ineffective. I thought a game of one-one-one might help. To outfit myself, I purchased a pair of Nike Flight© sneakers with patented Shox© (for added bounce) and a pair of gray, knee-length Champion© basketball shorts with distinctive white-and-black stripes. Charlie arrived on the court wearing baggy sweatpants, a faded T-shirt, and worn flat-tops. Playing Charlie proved to be even more of a challenge than I had anticipated. Within a few minutes, I had missed two jumpers, and Charlie had expertly recovered the rebounds. He blocked my third shot, and I found myself quickly behind 3–0. Gasping for breath, I asked Charlie for some pointers. He suggested I loosen up and enjoy myself. However, this did not help much as he proceeded to sink the next basket from 3-point territory, and I missed again. By the time the score was 7–0, I had only one goal in mind—not to be shut out. Desperately, I chased after the ball. On one rebound, the ball flew well over my head, and as I reached for it, I felt my shoulder tear. Having dislocated this shoulder before, I knew the game was over. Lightheaded from the pain, I sat down. I explained what happened to Charlie (and reviewed how to relocate a shoulder dislocation if necessary) then I suggested he play a game of pick-up while I stay to watch. Charlie found three other students to join him, and I admired his skill on the court as he set up a block for his teammate to break free and then hustled under the basket for the rebound. He sunk a 10-footer then repositioned himself to block his opponent’s layup. As he made another successful drive to the basket, I felt like a proud parent. I wondered if I could help him develop this same confidence caring for patients. Soon, Charlie was back by my side offering me a glass of cold water and a hand to help me up. As we walked together into the evening air, I looked down at my Nike Flights©. “I’m sorry. Playing with me wasn’t much fun,” I said. He gave me a reassuring pat on the back. “I look forward to seeing you in clinic,” he said. Later in clinic, Charlie meticulously described his patient’s story, a young man with abdominal pain and a normal physical exam. An awkward silence followed, but eventually, he explained that despite the many possible reasons for his patient’s pain, from peptic ulcers to porphyria, he thought reflux was the most likely diagnosis. Somewhat sheepishly, Charlie added that he did not have any idea which antacid to prescribe. If it had not been for my sore shoulder, I would have danced the funky chicken.