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Based on the events of July 28th, 2014

When I came home today, my sister asked me whether I had done any work at medical school. Over the past few days, she had been disappointed to stay home and finish calculus and physics homework while I was solving logic puzzles and escaping from tsunamis.

Today I answered, “I played with Legos.”

My sister scowled. “This is medical school? Are you sure it’s not kindergarten?”

“No, seriously,” I said. “I have a picture to prove it.”


The essence of the first-year curriculum at Hogwarts College of Medicine. At least, for one hour on Monday.

In this scenario, there were 7 people in our team: 1 builder, 1 guide, 1 Game Master, and 4 observers. The Game Master placed a pre-made Lego sculpture (such as the one pictured above) in front of the guide, in an open shoebox set up much like the workstations in Battleship. The guide was not allowed to touch or reposition the sculpture to observe it from a better angle; additionally, the shoebox concealed the sculpture from the builder’s view.


The Game Master then gave the builder the unassembled pieces of the same sculpture that the guide had been given. It was the builder’s job to recreate the structure with the help of the guide; the guide could look at the builder’s pieces, but the builder was not allowed to look at the guide’s sculpture. The four observers monitored the “game”.

There was just one caveat to the activity.

ROUND 1: The guide was not allowed to say anything except for “yes,” “no,” and “I don’t know.”

“Chaos” was the only word for this round. Our builder had to initiate all instruction from the guide with yes-or-no questions, and he was nowhere near completing the sculpture within the five minutes allotted. In a neighboring group, the guide accidentally answered “no” to the builder’s question when she actually meant “yes”, but she was not allowed to convey in plain English that she had made a mistake. The result was a disaster.

ROUND 2: The guide was allowed to say anything to describe the sculpture to the builder.

This round was much less difficult. Being the guide, I was able to take the lead in instructing the builder, instead of the other way around, as it had been in Round 1.

Nonetheless, both rounds were exceedingly frustrating. The game master did nothing for most of the game – but the position of the sculpture inside the guide’s box was critical, since the guide was not allowed to pick up and reposition the sculpture to examine it from a more favorable angle. For example, glancing at the picture I took of the sculpture above, wouldn’t you feel an urge to turn around the sculpture, and see how it was built from the other side?

Now, consider this analogy:

  • Builder = physician
  • Guide = patient
  • Game Master = healthcare bureaucrats who enforce the rules of the system but don’t have to live with its impracticalities on a day-to-day basis
  • Professor Haidet, designer of the simulation = healthcare policy-makers on a national level; Supreme Game Master

Imagine how frustrating it is for the patient to explain their case to the physician, when the healthcare system doesn’t allot enough time, or foster a conducive environment for telling their story in their own words, instead of answering close-ended “yes-or-no” questions for the entire visit. Imagine how much more efficient the visit becomes if the physician is willing and able to listen to the patient’s story, and does not interrupt the patient in the interests of time after only 14 seconds, as is the national average…

As we were about to conclude our discussion about the parallels between The Lego Game and real life, Dr. Haidet said:

“Did any one of you think of just tossing out my rules?”

The class was silent.

Dr. Haidet continued, “Why didn’t anyone say, ‘To h*** with Haidet’s rules!’ and take the sculpture out of the shoebox to show the builder so he or she could build it properly?”

No one in the class had considered that idea. No one had even thought of it. Disobeying The Rule of All Rules – the tried-and-true dictum that you must obey the rules of the game – was not on the radar for law-abiding first-year medical students.

“You are not the future of the healthcare system. You are part of the healthcare system, right now. Recognize that rules don’t have to be followed, that they can be changed. The current healthcare system needs to be changed. All of you can be a part of that.”

To reinforce his own call to action, Dr. Haidet presented the following clip from The Matrix (end at 3:12), where the kung-fu master fights Neo (the guy in the white gi) in a virtual-reality dojo. I have not watched The Matrix, nor do I plan to, but this video clearly summarized the essence of Dr. Haidet’s speech.

I finished explaining The Lego Game to my sister at home after class and concluded with, “See, Nashat? We did work today.”