Distractible doctors

People who read slowly and are easily distracted don’t seem like great candidates for medical school. After all, med students must be quick learners and doctors have to work quickly under pressure. The San Francisco Chronicle reports:

Would-be California medical students with learning disabilities filed a discrimination suit Monday saying their prospects of becoming doctors are being thwarted because they aren’t given enough time on the medical school entrance exam.

The proposed class-action suit was filed in Alameda County Superior Court by four students and two advocacy groups. It argues that students who have trouble reading are capable of learning and practicing medicine, provided they’re given enough time to complete the Medical College Admission Test in a distraction-free setting.

“Without accommodations, I really can’t show what abilities I have,” said Brendan Pierce, 28, of Oakland, who has dyslexia and attention deficit disorder. He said he’s been given extra time on his exams since junior high and has done well in school.

The Association of American Medical Colleges, which runs the exam, accommodates severely disabled applicants but says these students weren’t disabled enough since they’d done well in college. That does seem like a Catch-22. Are medical schools admitting students who did badly in college?

Maybe there are specialities for dyslexic, distractible doctors. But I have a feeling some disabilities are very relevant to the ability to succeed in medical school and medical practice.

About Joanne


  1. That’s just what I need next time I am rushed into the emergency room – a doctor that requires a “distraction-free setting.”

  2. Steve LaBonne says:

    You just couldn’t make this stuff up, could you?

  3. Why is it people feel so much entitlement? They aren’t qualified to be doctors – get over it! Lots of people aren’t qualified for things based on natural inability (you should see me try to do basic arithmetic). So pick something you are good at (under typical conditions, not fabricated ones), and stop your belly-aching.

  4. I don’t know about requiring extra time for the MCATs, but there are surgeons with Tourette’s around.

    And of course someone who needs a distraction free setting on an exam might (a) choose to practice somewhere other than an ER or (b) be less distractable when they’re actually doing things.

  5. When my health, bodily integrity and possibly even my life are the subject of the doctor’s focus, I am not taking any chances. Call me crazy and insensitive, but there it is. And M.D.’s have to learn everything before they can specialize in anything. And Tourettes can be treated into remission. However, I highly doubt that any hospital will allow an individual whose tourettes is not in remission, who therefore displays random, uncontrollable, spastic motions, to perform surgery in their O.R. Seriously, think about that for a minute – medical malpractice lawsuit much?!?

  6. I know an emergency room doctor who was a terrible studnet because he couldn’t sit still in hi chair and because he has dyslexia, which cases one to see things in a different way, with a sort of “bouncy vision”. He considers both of these “school weaknesses” to be great strengths as a doctor–his bouncy vision takes in all kinds of information that other “school suited” folks have to study in a more linear fashion. His ability to accomplish things while he on the move is critical to success in an emergency room.

    He had to work like the devil in school–but he did. The MCAT as a measure of knowledge might be of value but the *process* of displaying the knowledge is a one-off, contrived, situation that could exclude very good people for no good reason.

    I am reminded here of the reserarch that has shown that the skill sets that make for good teachers are almost the opposite of the skill sets that make for good administrators in schools–but to get to be a good administrator in a school, you have to be a teacher first; likewise, the promotion path for a teacher is into administration. Doesn’t that seem like a path that could be modified so we get to have and keep good teachers and have and keep good administrators without requiring them to go outside their skill sets?

    “That’s the way we do it here” for its own sake just never seemed to be a reliable guide to increased quality or opportunity.

  7. Great. This should raise the cost of malpractice premiums, which will raise the cost of medical care for all of us.

    These people need to be smacked upside the head and told to pursue a career they are capable of pursuing without “accommodations.”

  8. Tell you what… let’s pass the increase cost of medical malpractice premiums and health care insurance premiums onto the malpractice premiums of the lawyers that make these would-be doctors their clients and sue the MCAT testing folks for discrimination or whatever other cause of action they chalk up. (And in the interest of complete disclosure, I am a lawyer. Just not of the sue-happy variety).

  9. there are applications for medical training which do not involve ER or even patient settings e.g. design of medical devices. That being said, internships and residencies *will* be a distraction0driven environment

  10. I agree with Chris that there will distraction-driven environments in residency–and if a person can’t *work* in a distraction-driven environment, then this is not the job for them. But to cut them out by a one-ff setting that will likely not happen again might be throwing a lot of people out of a professions where they could contribute mightily. I am actually not a big fan of the victim or entitlement mentality…but neither am I willing to say that a one-off process used to address the masses is a gate that should stand like iron.

    (looking at my typing, you might assume I have dyslexia. I don’t. I need trifocals–can’t see what I am writing here.)

  11. Andy Freeman says:

    > I am reminded here of the reserarch that has shown that the skill sets that make for good teachers are almost the opposite of the skill sets that make for good administrators in schools–but to get to be a good administrator in a school, you have to be a teacher first;

    Careful – Mike disagrees. He thinks that only teachers should have any say wrt public education. However, the rest of us do get all the blame.

  12. Richard Nieporent says:

    plaintiffs’ lawyers wanted a statewide order requiring accommodations on the exam but would first seek an immediate injunction — perhaps by today — that would let the four plaintiffs take the next scheduled test, on Aug. 14, with extra time to complete it.

    And when they become doctors they will be allowed 6 minutes instead of the normal 4 minutes to revive a person who has stopped breathing.

  13. Cardinal Fang says:

    Actually, oddly enough, people with ADD do extremely well in some kinds of jobs that are chaotic. For example, emergency dispatcher is a classic perfect fit of a job for a person with ADD. Quite likely if he could make it through med school a person with ADD would make a great ER doctor. Probably he’d be better off working in the ER than as, say, a dermatologist.

    The question is, how well does the MCAT test a person’s true ability to learn to be a doctor and to practice medicine?

  14. or example, emergency dispatcher is a classic perfect fit of a job for a person with ADD.

    … but perhaps a person with ADD who is not so stricken as to bomb on an MCAT taken under the normal parameters. The whole ‘eep! there’s been a small change at the periphary! let me devote some attention to it’ aspect of ADD can bloody well cut the other direction. As does the difficulty that ADD folks can have with routine (did I forget to wash my hands?) or holding thoughts in their heads (‘the spleen is on my left the spleen is on my left wow my scalpel is shiny, must be one of the new ones they just ordered… wait, what was I doing? something about a spleen? oops’) If you don’t have the ability to focus for long enough to do well enough on the MCAT under normal circumstances, I don’t want you messing with my innards.

    Unfortunatly, the case law surrounding the Americans with Disabilities Act is pretty clear. The students will win their lawsuit with breathtaking ease. I just hope that I’m not one of the patients whose breath will be taken.

    Sincerely yours,
    Jeffrey Boulier

  15. Mike in Texas says:

    Ahh, this is the way to start a morning.

    A warm cup of coffee and a post from Andy that once again I can laugh at.

    I never said teachers should have ALL the say in education. I said politicians should have NO say and teachers should have more.

  16. z1975ss says:

    I work in a field that requires exams and licensing. I could imagine that during one of these 3-hour gems that a person with ADD would be going out of their skull. However; if you want something bad enough, you will do what it takes to make it happen. Tests like MCATs and LSATs are more of a weeding-out process than anything. Just because they succeed in doing this doesn’t give you the right to play the victim. When will the day come that stupid people sue because they are competence-challenged?

  17. [snip!]

    Nurse! Uh . . . what operation is this again?

    Oh! Right, thanks . . .


    Uh, I’m not sure if I was supposed to snip that.

    What operation is this again? I’ve snipped off one too many things? Sorry! Just spaced out for a sec.

    Now if you could just hand me another scalpel . . .


    Hm. That tray’s getting awfully loaded with body parts. What operation is this?

    Oh! Crap! Sorry!


    Aw, cripes! Somebody stop me!


    That should do it.

    I think.

    What operation is this again?

    Aw, man! Honestly, it’s like I have ADD or some . . .


    That oughta do it. What operation is this again?


    That oughta do it. What operation is this again?


    That oughta do it. What operation is this again?

    repeat ad infinitum.

  18. Hyperbole and maybe a tad offensive? Yes.

    But funny as hell? absolutely!

    Thanks ccwbass

  19. [blushes]


  20. “there are applications for medical training which do not involve ER or even patient settings e.g. design of medical devices. That being said, internships and residencies *will* be a distraction0driven environment”

    You have to have a medical license to design medical devices? Say it ain’t so!

    If so, no wonder it takes so long for us to get new ones.

  21. It’s probably more likely that manufacturers of medical devises consult licensed medical professionals.

  22. Joanne, since your regular commentators seem to equate dyslexia with stupidity and laziness, I’d like to introduce them to:

    Delos “Toby” Cosgrove was born in 1940, well before we had a good handle on dyslexia and how to treat it. None the less, he became a renowned cardiac surgeon. In June, 2004, he started a new career: at the age of 64, he is starting on another career: the leader of the Cleveland Clinic.

    From C’s and D’s to Clinic’s helm Wednesday, June 09, 2004 Diane Solov Plain Dealer Reporter
    (dyslexia topics mostly)

    “I’ve thought for a long time that there was another thing for me to do in my life, something important, but I didn’t know what it was,” Cosgrove said. “I’ve been searching for it for a while.”

    Cosgrove is a cardiac surgeon of international renown. He has pioneered such procedures as mitral valve repairs. He is an accomplished inventor, with 18 patents, and a relentless workhorse, counting 700 surgeries last year an average of more than 13 a week.

    Cosgrove’s resolve is typical of his life story, which took him from a student who struggled for C’s and D’s to the top of the most prestigious rung in medicine. He credits his innovative bent to dyslexia, a reading disorder that he has come to regard as a gift.

    “We’re not very good at the scholastic stuff, but we see other things that are different,” he said. “And that’s a big advantage.”

    Cosgrove’s story is featured in Shaywitz’s book, “Overcoming Dyslexia,” which was published last year. In a telephone interview, Shaywitz said keen intelligence is often a hallmark of dyslexia and predicted Cosgrove’s qualities will set his leadership at the Clinic apart.

    “There’s a great deal to suggest that people who are dyslexic are not going to be your rote learners or bean counters,” Shaywitz said. “They are going to be the people to think outside of the box, to have vision, to move things forward. His vision, imagination and fortitude are going to move the Cleveland Clinic to an even higher level than anyone can imagine.”

    At the Clinic, Cosgrove’s inventiveness so far has manifested itself in myriad innovations for surgical procedures. His unique view of the work allowed him to spy a solution for a flexible clamp in a bicycle gear and to see an embroidery hoop as inspiration for a ring used to repair heart valves. In surgery, he said, dyslexia is an advantage because it favors spatial relationships.

    Cosgrove didn’t know he was dyslexic until he was 32, when he read the New York Times aloud to a teacher he was dating. As he struggled to pronounce some of the words, she put a name to the learning difficulties he had faced since he was a young boy.

    These days, Cosgrove can rely on his assistants for help with spelling and sentence structure. But in his youth, a mix of serendipity, moxie and determination helped him jump one hurdle to the next

    Cosgrove struggled in public schools in his hometown of Watertown, N.Y., and studied hard for D’s in college French at Williams College in Williamstown, Mass., his father’s alma mater. He did so poorly on the standardized tests required for medical admission that he credits special circumstances for getting into the University of Virginia’s medical school, the only one of 13 schools that accepted his application.

    At medical school, he was no academic performer, but he thrived in the clinical work.

    In his senior year, during a clinical rotation at Boston Children’s Hospital, a legendary surgeon there took a shine to Cosgrove when he learned that he spent two summers in the early 1960s on the crew of the Nefertiti, a Boston-based yacht in the America’s Cup races, starting in the bowels of the boat and becoming known as the “sewer man” a name that stuck for those in subsequent America’s Cup races.

    He landed an internship at the University of Rochester and a year of residency training before he was shipped off to a hospital in Da Nang, Vietnam. There, he earned his stripes as a surgeon and a soldier winning a Bronze Star for his medical work, a medal from the Vietnam government for a weekly clinic he ran on the side, and an air medal for flying combat missions to keep busy.

    Cosgrove returned stateside with a newfound confidence that provoked him to apply to top residency programs to finish his training, including Massachusetts General. He was rejected, but wouldn’t take “no” for an answer and pestered the department chairman’s secretary. His persistence and a brief phone call from the legendary surgeon he had met in medical school got him in. When he finished his training there, he was told he was No. 13 in a residency group of 13.

    In the end, as he decided on heart surgery, he became chief resident at Boston Children’s Hospital. Then he spent six months unemployed, writing a book on heart surgery before a letter from Loop arrived in 1975 offering him a job. He went to the Clinic and opted to stay, despite an open offer from Harvard.
    © 2004 The Plain Dealer. Used with permission.

  23. Joanne, since your regular commentators seem to equate dyslexia with stupidity and laziness,

    Who was doing that? I missed those post entirely.

    Dyslexia (or ADD) makes things *difficult* If you are dyslexic, you need to be work harder and be smarter than a normal person to match his performance. In the opinion of the medical schools, you have to study extra and be more brilliant in order to pass an MCAT under the same circumstances that everyone else does.

    In medicine, transposing numbers kills people. I, and presumably the medical colleges, want to weed out people who either have too severe a case or don’t have something really special that allows them to compensate.

    But as I said before, these arguments mean nothing before the ADA. The students will win.

  24. For those of you who are practicing professionals in fields for which the LSAT, MCAT or other similar exams I challenge you to go back and take those tests and see if you would today, with the current competition, be accepted to the professional school from which you recieved your degree. For all you JDs try the to complete all 4 of the logic games on the LSAT within the time alotted. Then explain to me how you think this particular section relates to the practice of law. Now do you still feel the LSAT is the all mighty predictor for who will be a good lawyer? I have yet to find a lawyer who, has not taken the exam within the last 10 years, who could out of the blue accomplish this challenge. Yet, I have asked some very successful lawyers.

    As a student with a learning disability which causes me to process visual information, like words on a page, at a rate slower than 95 percent of the population achieving a score which, reflects my skills under normal testing comditions, on a timed test, such as the LSAT, is impossible. Yet, without accomodation in school I graduated with honnors. The LSAT and the MCAT are one time situtations which have little relevance to the applicants future performance as a doctor or a lawyer. On these exams the amount of extra time given to applicants to complete the exam is so little that in every day tasks you probly would not notice the delay. However, in the tightly timed exams, this extra time makes or breaks a persons score. In summation, I am trying to make you understand because, in reading the above posts the phrase “F YOU” has come to my mind quite often, that these exams are so tightly timed that delays which, are not even evident to the untrained person, and which have very little affect upon a persons’ “real life” ability to perform tasks within time limits for normal people, will kill a standardized test score. So show a little more understanding the next time you are faced with a subject about which you know little.

  25. Steve LaBonne says:

    “these exams are so tightly timed that delays which, are not even evident to the untrained person, and which have very little affect upon a persons’ “real life” ability to perform tasks within time limits for normal people, will kill a standardized test score.” How about some non-anecdotal evidence fof this claim?

  26. Fundamentally, the assumption is that the time pressure corresponds with some ability that in turn corresponds to success in school. It’s hard not to believe that someone who can read and process information at five hundred words per minute is going to have a pretty big advantage over someone who can only handle fifty.

    The trouble is, of course, that colleges are not allowed to access this information from the SAT and (with history a guide) will not be able to get this information from the MCAT before they make admissions decisions. I’m not even sure it’s possible now to research what adjustmants to make to a predictive model built around untimed scores vis-a-vis timed ones.

    From my personal perspective, I know enough about myself to suspect that I am the sort of person who would have been allowed to take the SAT untimed. My bete noir was the math section; untimed I’m pretty sure I could have gotten a perfect score. This would have gotten me into Princeton University. There I would have probably flunked out, or (even worse!) wound up an English major, because there is no way I would be able to compete surrounded by people who can race through calculations that fast.

    I’ve got to head back to work, but will try address your points about the LSATs later. The pressure of time impedes how well I can make my arguments.

    Sincerely yours,
    Jeffrey Boulier

  27. I think the LSAT is a very good indicator, and there is statistical proof of the direct correlation between LSAT scores and G.P.A. in law school.

    It boils down to whether you possess the natural skill set for a given profession. Like Jeffrey said, if had I been given enough time on every math exam I ever took, including the SAT, I would have done well enough. But the truth is that I just plain SUCK at math, in all its incarnations. I lack the skill set to ever fully comprehend it. I can’t focus on it and it literally frustrates me (learning disorder perhaps?). But given enough time, I would have done well enough on an SAT or MCAT to get a false result, admission to a medical school and then would have been a lousy doctor.

    I ignored my poor math score on the SAT and tried my hand at biology (pre-veternary) in college. I was horrible. For two years I struggled to prove I could do it, but I just could not hack it. It seems the SAT was a really good predictor.

    I switched majors in a desperate attempt to salvage my G.P.A., and then I excelled. I then took the LSAT. I scored very well, it came naturally to me. I did very well in law school and now I am an very good attorney (hopefully you will all forgive my hubris in the name of anectdotal evidence). As a litigator, I have to think on my feet. In argument before the Judge, I am peppered with questions that I have an average of 15 minutes to answer, and my answers have to be better than the other guy’s. I have to bill the amount of time it takes me to write a brief, and of course the client will not pay for my “extra time” to research and write it. Time constraints are built into my job, and if you can’t handle it, then the job is not for you. But the time constraints on the LSAT seemed a pretty good indicator to me.

    Very long story short, I recognized my inability to do a certain job. It’s exactly what they say: you have to play with the hand you are dealt.

  28. Anonymous says:

    I would like to adress 2 points mentioned above-
    A) There is a statistical correlation between LSAT/standardized test scores and GPA.

    There is but it is small less than 10 percent. Past GPA is a better predictor for future GPA than the standardized test. However, standardized tests are necessary due to the huge discrepancies in grading. Ivy league schools I think do disservice to their students by inflating grades giving up to 45% As. Large public schools are more likey to stay to the strict curve of 15-20% As. So the GPAs between students from these different system is not so easliy compaired and therefore you need the standardized test. Same for SATs in high school only it comes down to highly competitive school district vs barely academic school districts. A student at a barely academic school might yet all As and yet earn an 800 combined on the SAT vs a student at a competative school could have a 3.3 nad a 1300. I have seen this happen many times.

    B) that people who request extended time are requesting unlimited time.

    we are not. The deal is if you sit a normal person down to take the LSAT with double time once and normal time once you are not likely to see more than a 5 point increase in this person’s score. The extended times allows him to do a little better but not much because with normal time he is pretty much able to work to his ability and the questions he misses he would miss regardless of time. he simply does not know teh answers. If you repeat this with an LD student you will see a drastic difference in the normal vs extended time scores. However the higher score is not as accurate a prediction of how the LD student will do as the normal time score of the normal test takers score is for the normal test taker. But by the same token the LD’s student’s score under normal conditions is equally unable to predict his future academic success. So you need a compromise.

  29. Judging by the credentials of the plaintiffs, they are far from dumb. One of them is a graduate of Univ. of California-Berkeley and currently doing brain research, while one of the other plaintiffs seeking accommodations is a Stanford graduate and is doing research at UCLA. Keep in mind that these distractability issues only manifest themselves in a classroom environment, not a clinical environment. In fact I’ve met many capable and excellent physicians who have ADHD. The ones who should be criticized are the ones at the AAMC for breaking federal law and trying to pretend like these students have no justification

  30. Strangely you develop an incredible level of intollerance to peoples rights and aspirations when your life is in danger and you have to trust someone with a very sharp knife and a sewing kit

  31. What people seem to forget is the fact that, medical schools turn away thousands of perfectly qualified applicats each year. In order to ensure that anyone they accept will graduate they use the MCAT, GPA, volunteer work, and general character as indicators of who will graduate from medical school. However, it is important to note that, the MCAT is only one part of an overall package, NOT the sole criteria. By the way, Dr. Roger Mee is the head of Cardiac Surgery at the Cleveland Clinic. Read the book “Walk on Water,” by Michael Ruhlman.
    In my opinion, the students that are filing the lawsuit are just looking for a way to get in, even though, they have crappy test scores. Rarely does the MCAT, taken under normal conditions, fail too predict ability. Furthermore, it’s people like these nitwits who keep good and qualified people from gaining acceptance, because they abuse the system, as oppossed to embracing it.

  32. There are some compelling points on both sides here, but I think what some people may be missing is that “learning disability” is really a misnomer in many cases. What it often means is that people learn in a different way, or have exceptional intelligence in atypical areas. To be exceptional at certain types of surgery and medical reasoning may require unusual skills or unusual modes of thinking. You don’t want the average Joe on the street cutting you open. And there’s a pretty good case to be made that passing a rote written exam really doesn’t cut it for performing specialized surgery. Some people can pass a written test but can’t handle the on-the-fly hands-on activity or certain spatial reasoning required to be great at surgery. We have WAY too much faith in written tests, and I say this as someone who doesn’t have any “learning disability” as far as I know, but also knows that some of the smartest, most capable people out there are people with so-called “learning disabilities.” And there are plenty of these guys I would trust to cut me open, and plenty of guys without so-called “learning disabilities” who I wouldn’t trust to give me a ride around the block.

    The point is that there are many different kinds of intelligence, and written tests really aren’t ideal for measuring some of the more important ones. For skills so specialized, it’s just very difficult to learn what you need to know about a person from a test score. We rely on these things because in many cases they’re all we’ve got, but we place WAY too much faith in them sometimes.

  33. Clearly, this is a difficult area for those with these disabilities and those without that must compete for spaces in medical school. See “Comparison of Ease of Falsification of Attention Defficit Hyperactivity Disorder Diagnosis Using Standard Behavioral Rating Scales”, in _Cognitive Science Online_, Vol 2, pp 6-20, 2004, to see how very easy it is to fake the diagnosis.
    The acccomodations are bound to make it easier for students and to improve their performance. What can be done?