Ágoston Kecskés

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January 16, 2012

Blog Entry #10: Illness scripts

            I first heard about illness scripts[1] two weeks ago. I'm glad I did because although I knew about them before, I now have a name for them. Over the course of the daily morning reports during my first exposure to the clinical teaching units at Mount Sinai Hospital I was convinced that my junior and senior residents were geniuses. They seemed to have the answers before the question was even posed! They also seemed to have an "approach" to everything and they hammered that home time and again. I didn't realize it at the time but that was my first exposure to the illness script.

Of course, scripts are not specific to medicine. I have used scripts for all sorts of learning tasks at school, work, and even at home. These scripts speak directly to the notion that George E. P. Box's phrase that "all models are wrong, but some are useful." It's awfully tempting, however, to be lured in to think that models are reality. On serially busy days on the clinical teaching unit as a clerk, I have often been tempted to put off seeing some of my less acutely ill patients until the end of the day. I would think back on their illness script and try to convince myself that as long as the patient stuck with the script we would be fine. But patients don't stick to their illness scripts. In fact, they seem to waver from them exactly when you least expect it - or at least when you need them most to remain steadfast.

Despite that illness scripts serve as the basis for much of our learning in clerkship, they are not explicitly taught. It would also be nice to know how to optimize my illness scripts. Should I take an expert nap? Should I whip out my smartphone during bedside rounds to visually connect my textbook learning to my patients? I suspect the answers to most of these questions are not fully understood, but at the very least I would have liked an introduction into how physicians think before they asked me to try to be a physician.

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[1] Henk G. Schmidt and Remy M. J. P. Rikers, “How expertise develops in medicine: knowledge encapsulation and illness script formation,” Medical Education, http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2923.2007.02915.x/full; accessed 16 January 2012.