Diagnosis for Democracy
Insights into the State of Our Union
A Blog by Rob Tenery, MD


April 10, 2012: The Three Little 'Doctors'

By Rob Tenery, MD on April 10, 2012

Nursery rhymes often evolve from real life situations. Frequently, their purpose is not just to entertain, but point out truisms in the abstract.  We all grew up hearing about the ‘Three Little Pigs.’ The first pig built his house out of straw. The second used sticks, and the third built his home with bricks. Not worrying that their shoddy construction might bring future adverse consequences, the first two pigs had other priorities in mind when they were constructing their houses. They just wanted to get done, so that they could go out to frolic in the fields around their homes.

The third pig had much more foresight. While his two brothers were already out playing, and with trowel in hand, he methodically shaped each layer of mortar as he laid one brick on top of the other.  His progress was slow. His sweaty clothes hung heavy across his shoulders, but he persevered.  The elements were against him. The overhead sun beat down parching his skin. Sometimes the intermittent rains washed away that day’s work as he dashed for cover. But when the storm cleared, he was back. Finally, one day, as the last ray of sunlight dipped below the horizon, the third pig laid down his tools and pulled the heavy door to his completed house closed behind him.

Completing his task, the third pig was now able to join his brothers to frolic in the fields around their homes. That was until the big, bad wolf appeared on the scene.

Physicians can learn from the symbolism hidden in this often-told fable. It starts with the goals of each of the three little pigs and how much they were or were not willing to sacrifice to attain their goals. Sacrifice not only in how they built their houses, but also in the amount of effort they were willing to put forth in order to reach them.

Like the pigs, those deciding which career to pursue must make sacrifices in order to achieve their goals. Those sacrifices can be equated to building their structure on a sound foundation. For physicians, the years spent in medical school, internship and residency is their foundation. The tale of the three little pigs doesn’t delve into the pigs’ skills as builders, only their goals.

Although the first pig built that his house out of straw could have been the best carpenter of the three, he was obviously more concerned about getting into the fields to play rather than preparing for any future uncertainties. There is nothing that leads us to believe he was stupid, just naïve and short sighted. His rewards were his immediate goals, not building for the future. In the original version by James Orchard Halliwell-Phillipps, this pig was eaten by the wolf after his straw house was destroyed. In a more modern rendition, he flees to the house of the other foolish brother, the one who constructed his home out of sticks.

We all know physicians that fall into this first category. They worked hard and sacrificed to earn their degree. But now, it’s pay back time. That time is now. They often abandon the conventional methods of building their practices, incorporating methods used in the business community to fill their waiting rooms. Their goals are often the trappings that come with their diploma. Taking care of the patients is frequently just a means to an end--- their end. Their patients are just the vehicle to get them there. Preserving the profession is not on their agenda. Medicine is thought of as their job and not their calling.

Then there is the second pig whose house was built out of sticks. His investment in materials was more carefully thought out. Except for the extreme, the elements would not be a problem. He probably was the frugal one because he knew his first brother’s house of straw would not last. Eager to join his playful brother, we can only assume, like many doctors, he thought that unforeseen tragedy was for the ‘other guy.’ His choice to cut corners came back to him when the wolf arrived at his door. Like his naïve brother, he paid the price for his shortcomings.

Examples are many practitioners in the non-physician community whose credentials are bestowed on them by the state legislatures based more on campaign contributions than on qualifications. Or even doctors who claim expertise in areas for which they are not adequately trained. They learned the basics, but just enough to call themselves an expert. The fellowship they should have taken, but didn’t. The three-day course in Las Vegas over the weekend that made them a Monday morning expert in their new endeavor. Where is their foundation? As long as the unforeseen doesn’t occur, they muddle along. When it doesn’t, tragedy steps in. That is unless they have an arrangement with the expert in the ‘house made of bricks.’ Unfortunately, often that can be too late.

Then there is the third pig. The one who built his house out of bricks. We don’t know if he was a better builder than his other brothers. We can conclude, however, that he had the foresight to plan for the future by erecting a structure that would resist the elements. The big, bad wolf would not have him for dinner.

In the most recent version of this fable, the third pig also showed compassion toward his ill-prepared brothers by allowing them a place of refuge, even potentially putting himself in peril when he let them in.

Following this analogy, this would be the doctors who ‘stick to what they know.’ Their fortress is their knowledge base. That is not to imply that the less informed can’t expand their areas of expertise. They should. Only to point out that their foundation of knowledge must be able to support this additional responsibility.

As physicians, we learn from this nursery rhyme the importance of three virtues: sacrifice, foresight and compassion. We can see that it is not always about the doctor that knows the most. Often it is about the doctor who looks above their own needs and cares the most.




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