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."