The smartest doctors aren't necessarily the best ones.
She says it, putting on her coat after a long day in the office. We've gone through papers together and sorted all of her inbox into the out. She narrates patients to me one at a time as she scribbles initials on lab results, consult notes, calls from parents. We discuss what to do about the little girl with an incidental white cell count of 2.1 (Don't treat a lab. Treat a child. Redraw tomorrow and see if it's still low before worrying.) All the patients have gone home and it is well past office hours. We're in her office because of the chart at the bottom of the inbox: a little boy born with a case of FLK - one of those doctor acronyms that means "funny-looking kid". When we're being professional, we tell our colleagues that the child is "syndromic" or "dysmorphic" - and what it means is that the baby's features don't look right. The jaw is too small, the nose too flat, the eyes bulging or missing or too-widely set; fingers are disproportionate or widely spatulate, legs or arms aren't the right length, the chest is spade-shaped or concave or there is some other change that causes the mind of the healthcare professional to raise an alarm bell: there is something about this child that requires further examination. Funny-looking kid. In this case, baby had bulging eyes, a concave facial profile, a too-small jaw, an odd nose, and spatulate fingers. Workup was not initiated shortly after birth, as his parents insisted that his father had looked funny as an infant too. But not, she says, this funny. And now he is getting seen by the geneticists down at the children's hospital to determine what sort of syndrome he has - which determines what sorts of problems he's likely to encounter in the future - so that they can answer the questions that any parent might have.
This leads to a discussion about her experiences at $childrens_hospital, as we both took pediatric surgery there. And when discussing pediatric surgery it comes up to discuss the mannerisms of various attending doctors, and the way of things with staff. And she said it first. Some doctors are smart, book-smart. Some doctors are good doctors. Some doctors can teach. Some doctors are all three, but not all doctors are any of them. And such is the way of things. I think all of my med student colleagues know it.