Surgeon Relies on his Track Record as True Test of Skill

General Surgeon Ferdinand Louis Rios, M.D. thinks that the fact that he has a learning disability makes him a better doctor, although it took him a little time to see what having a disability could give to him.

He grew up in a non-English speaking household. His parents immigrated to the Bronx, New York from Puerto Rico and had to learn English along with the children as they grew up. Rios's mother never did pick up English well, and although it was important to his father that his ten children learn English, he was not around very much to practice with. Rios ended up having his troubles in school blamed on his lack of good English skills. However, Rios felt that there was something else wrong, especially since his brothers and sisters did not have the same difficulties. He told his teachers that he was just stupid, that words didn't make sense to him, and that he could only learn by doing. But teachers still attributed his problems to the fact that he learned English as a second language.

Rios started to get a feeling that he wasn't really stupid, that he just learned differently, when he was given a small tape recorder as a Christmas gift. He found that if he read a passage aloud into the tape recorder and then played it back, he could understand what he had read, and correct his own pronunciation. His teachers, however, did not allow him to use it at school. They felt it gave him an unfair advantage and that he got out of doing his work the way they wanted him to. "[They would] teach you how to find a word in the dictionary that you didn't understand and couldn't spell to begin with. And trying to read a book and stop and look up everything you didn't understand and trying to get through one paragraph was almost impossible because there were so many words that you didn't know the meaning of. And at times the definition in the dictionary really didn't fit the context of the paragraph and that didn't make sense," Rios explained. "This made reading excruciating and debilitating," he remembered.

He was able to use his tape recorder in college and managed to do well, especially in Social Science and Humanities classes. He had more trouble in Science classes. He would do very well in classes where he was tested using essay style exams and graded mostly on the content of what he wrote. He had significant problems with the reading comprehension on multiple-choice tests, even if he felt he knew the material. He started out at a junior college and then transferred to the University of California Berkeley campus.

Sometimes he would try to get help from his professors when he was struggling. He still didn't realize that he had a learning disability, but he would explain the trouble he was having with reading comprehension and ability to focus with his professors. "Most were unsympathetic and really didn't listen," said Rios, "but I did have one who really cared and listened, who really didn't know what to do but was willing to just work with me and told me, 'I really want you to pass this class.'" This professor allowed Rios to take his tests home to be completed over the weekend. "It was the type of test where your book wasn't going to help you work out the problems correctly. Besides, looking up stuff in a book was a nightmare for me anyway. So I didn't really consider it cheating. I was able to take the test with no distractions and without a time limit," Rios explained. Finally, he felt like he could prove what he actually knew.

The stress of college eventually caused Rios to develop a bleeding ulcer. He underwent surgery and spent several weeks in the hospital and then landed a job as an orderly when he recovered. Despite his troubles in science classes, he started having his first inclinations to become a doctor. As a child, he had visited his father at work at Albert Einstein Medical School (where he worked as a maintenance man) and had always admired the doctors in white coats. His mother had inspired him to go into a caring profession, but he never imagined that might be medicine until his experience as a patient. "I found the doctors not to be very caring at all. They spent two minutes with you and didn't want to answer questions or listen to your concerns. I thought that it should be a caring profession, and that I could do better."

It took Rios a couple of years to be accepted into medical school. He applied to several until he ran out of money to pay the application fees. A professor at Berkeley who believed in his ability to be a doctor gave him the money to put towards 25 additional applications. Finally, he was accepted to Rutgers Medical School's entry level Master's of Science in Public Health Program, with the intention of going on for his last two years of medical school after that. Although, again he struggled through reading and multiple choice tests (he spent many hours re-writing textbook paragraphs verbatim to improve his comprehension), he did well enough at Rutgers to be accepted to medical school at the University of California at Irvine.

His years at UC-Irvine were somewhat easier for him because they were almost entirely clinical. He did fine when he could be shown how something was done and could then do it himself. He also started developing memorization skills using mnemonics and other strategies to tie information together in a meaningful way.

After getting his Medical degree, Rios originally went into a family practice residency. However, during his surgical rotation, he found that he had a gift for it, and that when performing a surgery, his problems with distractions and comprehensions vanished. He changed residency and started working as a surgical resident at San Francisco Public Health Hospital. "I got as focused performing surgery as I did when I would work on a drawing or painting. Everything else disappeared and my brain and my hands naturally did what they were supposed to do."

Rios thinks that his learning disability has helped him be a more creative surgeon and a more caring doctor. Rios believes that people are taught to much about what other people have done and are discouraged from coming up with their own solutions. "When they teach kids to play the piano, they just have them memorize songs that others have already written. Why not teach them the basics: scales, teach them proper fingering and see what they come up with for music," Rios explains. "Medicine is the same way, everyone must follow a specific standard of care and when a patient is presented, they must regurgitate exactly what this standard of care is. There is no room for new ideas." Because of his struggles with reading comprehension, Rios feels that he was more able to fill in the blanks by coming up with his own solutions. Also, because he has struggled in his life, he does not see himself as perfect or as a doctor on a pedestal. Rios says this makes for better communication and compassion with patients. Rios gives an example of this in how he handles patient charts. "I always take an extended time with my patients and go through their chart with them to make sure that I am getting the important information. This also gives the patient more time to think of any important information or concerns they might need to talk to me about. I draw a lot of pictures in charts as well. This helps me plan a surgery much easier than writing out what I'm going to do. And then I also can show the patient what I'm doing in pictures." Rios thinks that this extra time spent communicating a teaching patients through the use of pictures and diagrams increases his overall effectiveness as a surgeon.

After completing his residency and practicing as a general surgeon, Rios faced another challenge: board exams. Practicing surgeons can take the exam offered by the American Board of Surgery (ABS) once a year and up to five times. If they don't pass it after five years, they are required to do another residency in order to re-qualify. For Rios, even though he was doing successful surgeries every day, the multiple-choice format was a challenge. "In the beginning, they started their club (the ABS), and they would go around and actually watch you perform surgery to credential you. When the logistics of that got impossible, they put together a multiple choice test," explains Rios. After taking it for four years and failing, Rios's wife suggested he get tested for a learning disability and ask for reasonable accommodations. After a lifetime of struggling through reading tasks, a neuropsychiatrist finally diagnosed Rios with a learning disability. When he took his documentation and requested a reader and extra time on the exam, he was denied. He spent thousands of dollars taking preparation courses anyway, but failed it again. He could no longer ever pass the board exam unless he quit his job and went back to a low paying residency for a year. Rios remembers that he was "quite surprised. I had drove my family crazy with my hours of studying with books on tape and reading notes aloud to myself. I knew I knew the material, and I knew that I had surgical skills, because I did it every day. The language of multiple choice, with its double negatives and trick choices, I just can't do it. I didn't feel like I failed as a surgeon, I felt like I was tested on my skill at taking a multiple choice test, and that is the thing I can't do well."

For the most part, Rios's lack of board certification has not been a problem. "The ABS is a private organization, a club that decided to make an exam to get in. Hospitals cannot legally bar you from employment because you have not joined a private organization," says Rios. He is honest with people when they ask why he is not board certified; he says that he did not pass the test because he has a learning disability and was not accommodated. Although he has lost a few patients because of this, most patients, as well as his colleagues are satisfied with his track record and skill as a surgeon. Rios now has over 23 years experience in successful private practice and is currently doing locums throughout the state of Oregon, where he relieves other surgeons during vacations or sabbaticals. Rios believes that his experiences as a person with a learning disability make him a better surgeon and person. Rios says, "I don't know if I would have even been able to be a doctor without those experiences."