A deep-throated growl dripping with fear and venom escaped the dog’s mouth as the man loosened the muzzle.  Just as quickly, the man backhanded the dog, tightened the muzzle and swore.  Trying once more, the man began loosening the muzzle.  Again, a rumbling growl escaped the dog’s clenched teeth.  Swearing again, the heel of the man’s boot sunk deep into the dog’s ribs and the muzzle was retightened.

Wondering why the dog wouldn’t learn, the man tried once again.  Forcibly grabbing the muzzle, he loosened it a notch.  The dog stood still.  Another notch, and still no reaction.  Another notch and still not even a whisper of a growl.  Removing the muzzle completely, the man felt that hint of satisfaction from exerting his control and authority over another.

And so it came quickly without any warning.  Freed from the muzzle, the dog’s bite crushed through the man’s arm, cracking bone, tearing muscle, and ripping tendons.  For the dog had learned not to growl.

Throughout my years of teaching, the thought of a “hidden curriculum” was a recurring theme.  The idea is that there’s the intended lesson, and then there’s the unintended lesson, often more powerful than the original.   An educational spin on the adage that actions speak louder than words.  The patient demands an early narcotic refill.  Did they learn their provider was compassionate and understanding, or did they learn that they could get inappropriate refills?  Staff that reach out with concerns that are met with animosity or silence.  They may have just learned not to speak up.  So let’s be aware of not just what we’re teaching but what we’re promoting, and hopefully not get bit by an unintended lesson.

Dr. Troy Phillips, DO FAAFP
Support Services Physician
Teleios Care Network

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An organizational model that allows nonprofit hospices (Members) to leverage best practices, achieve economies of scale and collaborate
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