Nihar Rama, a medical student, responds to Lisa Rosenbaum's New England Journal essay: On Being Well While Doing Well — Distinguishing Necessary from Unnecessary Discomfort in Training.
Interesting perspective though I wish that mispronouncing names and having the curiosity and interest to ask about something like where you’re from could be seen as that and an opportunity. I often ask people of all races where they grew up. Unfortunately, I have to admit that sometimes I hesitate or forgo this curiosity and interest due to the concern that someone will take offense. More the pity. It’s been shown that getting to know others often requires sharing personal information about yourself and safe and sometimes interesting things such as where you’re from is a common and used to be anyway safe conversation starter. And obtw my last name is two syllables and English origin and mispronounced frequently for reasons unknown and I’m sure unremarkable
Thank you, Nihar, for exposing yourself so well. I am a retired pediatric specialist and was an iconoclast within my Department and the medical school. I am appalled at the way most physicians accommodated to the bad practices of Covid and the existence of gender-affirming care in Departments of Pediatrics around the country. We have awesome responsibilities. The idea of a medical school faculty being a community of conscience is sadly out of date. Most of the clinical faculty at medical school faculties have no idea what med students are taught at their own medical schools. They sign annual onerous conflict of interest statements while overlooking the obvious and clearly unethical conflict of interest violations by Anthony Fauci which have been out in the open for three years. I hope that Med students of today are educated about the pollitical aspects of medicine and the good, bad, and the ugly within the pharmaceutical industry. I, for one, believe that there is far more good than bad and ugly.
I'm sure it's a calling, it's a grind and (hopefully) rewarding. The financial benefits can be argued given that an undergrad who goes into IB can make soooo much money out of the gate with 1/50th of effort/work and 1/20th of school loan. And to be honest, Covid debacle has taken a LOT of shine off of being a doctor. The AAP has taken a lot of shine off of being a doctor. Almost every prof org in medicine (and faculty) has lost a lot of luster, or so it seems to me.
Everything is relative. I learned this as a young Infantry officer. I moaned about something and my friends father overheard me. He said "Hansang, at your age, I was wading across rivers with pushing away the dead bodies to try to find food for the family" Yeah, like most Koreans of that generate, they lived through a war. Lesson two. A general officer was talking about his experience in Vietnam and every time it got horrible, he cheered himself up by saying "well, at least I'm not in Ranger school"
But I want people who have to treat people in the most intense situations to have experienced major stress. Just like I want the guy stacked with me, about to pull a trigger next to my head, has experienced stress of having to make split second decisions of life and death.
I'm mid to late career but am fortunate to be in a specialty in which most of my colleagues are millennials and Gen Z'ers. What i have noticed consistently is the judgement of those who may be 3-5 years out of training is as harsh, or harsher, than mine as it relates to those who are still in it. What that tells me is the real world toughens souls. Suddenly, when you have no cap, need to cross-cover a bigger census, get stuck with a difficulty family--there is no one behind to step in and rescue you. The real world is a kick in the ass when you are responsible. Mileage will vary, humans are funny that way, but I am more hopeful than others. "Snowflakes" thaw when exposed to heat.
We ideally become doctors because patients need us. If we become doctors because we think we're special, we've misunderstood the requirements of being a good and caring physician. Quit focusing on how you feel, spend more time thinking about how the patients feel and learn how to respond to their needs. If you do that you will discover the magic of being a physician.
And, being triggered because someone asks you how to pronounce your name? There are many forms of disrespect in the world, that is not one of them
I’ve just crossed the mid-career to late-career threshold. I fear that when I get old, I will be cared for by a generation of weak-kneed, brittle, useful idiots who don’t know how to function when tired/stressed/ poop hits fan, cuz they’ve insulated themselves from it their entire lives. Perhaps I should seek out Dr. Rama who may be a rare exception amongst this generational scourge.
Apparently the predictable drop in competence is already being seen. My surgical colleagues tell me that night-time surgical mistakes are on the rise with young surgeons who are not used to operating and making decisions while tired. Cuz guess what trainees…after the program comes real life. And you don’t get to design real life to coddle you.
Comfortable, uncomfortable, acknowledged, disrespected, happy, angry, the list goes on. Yes all people should have manners and respect for others if not even empathy, concern, connection.
But it's not about you. Cutting in line at cafeteria - you chose to feel angry and insulted. You could've thought, "what an a$$^le", and let it go.
Many careers, academic communities have hierarchies, stressful periods. You're learning something outside your comfort area, you're going to feel stress, inferior, etc. But if you're in the right field of learning and looking forward to a career in what you're learning then take the bad with the good and move on.
There will always be bad and good, choose how you want to respond to outside influences. Training in medicine is not like training in computer science. The required skills are markedly different.
Interesting read. But discomfort around one’s name being mispronounced, and chatter about “microaggressions”? Those types of things, unsurprisingly, got millennials branded as snowflakes. Be grateful that macroaggressions are now so rare that the grievance-Left turned to manufacturing micros. Still, the author seems very bright, and those are the people I want when my health or life is on the line, not some diversity hire.
Medicine is a field to avoid if you are focused on the microaggressions or have difficulty working through small, unintended mistakes like a mispronounced name or assumption about your background. Undoubtedly, your patients will be dealing with real discomfort and trauma and their needs are far more real and important than these small distractions. Resiliency and perspective are key traits required in this field, and I fear many in this generation lack both.
I get all I need to know about medicine from watching "The Resident". Over 107 shows, the entire gamut of possibilities are covered concerning the interaction of patients with the medical community and within the medical community by the actual staff. I wonder how much is close to the truth?
I think it’s sad that the culture that is supposed to promote “healing” is often a culture of abuse. Self-abuse. Stay up all night—-get yelled at by mentors—-be bullied intellectually? As a student I’ve found that getting yelled at does nothing to increase my ability to retain information or increase my capacity for compassion. In fact it —sort of shuts down the nervous system.
I’m not sure people who are training or practicing in such a high stakes profession should be in a constant state of fight, flight or freeze accompanied by exhaustion.
My opinion-is that teaching doctors and to some extent nurses -that they are above having normal physiological responses to stress leads to many mistakes/errors…and that actually owning our vulnerability and fallibility increases our ability for clear and lucid decision making/judgement.
None of us are super heroes or robots, as much as we’d like to think that we are.
The American Psychological Association defines trauma this way: "Any disturbing experience that results in significant fear, helplessness, dissociation, confusion, or other disruptive feelings intense enough to have a long-lasting negative effect on a person’s attitudes, behavior, and other aspects of functioning. Traumatic events include those caused by human behavior (e.g., rape, war, industrial accidents) as well as by nature (e.g., earthquakes) and often challenge an individual’s view of the world as a just, safe, and predictable place." While I don't think ANYBODY should be intentionally treated disrespectfully or disdainfully, and I also think residents should be given sufficient time to sleep, to use the word trauma to describe situations that simply make one "uncomfortable" minimizes the experience of true trauma victims. A certain level of discomfort in life is normal and what teaches us lessons and helps us become resilient. Hopefully people such as you can help return the tide back to a reasonable level of discourse.
Think that they don’t have to develop the necessary social skills to “deal” with being uncomfortable. This gentleman seems to think that learning basic social skills and interacting with people is too low for his eventual pay grade or somehow makes him special.
I—-I’ve met very few doctors who seem capable of communicating—and some of you —don’t even bother to learn intelligible English and put the responsibility for communicating on everyone else on your team.
That was one of the things about Stanford that seemed different than any hospital —it seemed like they were training people to communicate. One of my family me members had a surgery there and I was just observing.
And honestly if you are smart enough to do all of that work—you are smart enough to develop communication skills.
And also medicine is about patients not the doctors and their discomfort with actual humans, including the rest of the members of their team.
But that’s what people do right. Why on earth would academics think that because they went to school for 8 years that they have no responsibility to communicate with other people. Honestly what I observed in nursing clinicals was that doctors set bad examples for the people they were mentoring by acting unkindly to pretty much everybody.
Like why is it any different. It seems like communicating should just be part of the curriculum? Or how about work experience outside of medicine?
I think too—some people dedicate their lives to studying and end up with the emotional range of two/three year olds.
Or like the medical student from Brown who cut in front of me in line for burritos in Whole Foods and told me “I should get used to it..” because he was a about the be a DOCTOR…..you guys teach THAT. And that is unacceptable behavior for basically every person and in every profession…. Except medicine…..
Beautifully said, I would be honored to have you care for me or my family. Good luck on your journey, medicine is better having you there.
Interesting perspective though I wish that mispronouncing names and having the curiosity and interest to ask about something like where you’re from could be seen as that and an opportunity. I often ask people of all races where they grew up. Unfortunately, I have to admit that sometimes I hesitate or forgo this curiosity and interest due to the concern that someone will take offense. More the pity. It’s been shown that getting to know others often requires sharing personal information about yourself and safe and sometimes interesting things such as where you’re from is a common and used to be anyway safe conversation starter. And obtw my last name is two syllables and English origin and mispronounced frequently for reasons unknown and I’m sure unremarkable
Thank you, Nihar, for exposing yourself so well. I am a retired pediatric specialist and was an iconoclast within my Department and the medical school. I am appalled at the way most physicians accommodated to the bad practices of Covid and the existence of gender-affirming care in Departments of Pediatrics around the country. We have awesome responsibilities. The idea of a medical school faculty being a community of conscience is sadly out of date. Most of the clinical faculty at medical school faculties have no idea what med students are taught at their own medical schools. They sign annual onerous conflict of interest statements while overlooking the obvious and clearly unethical conflict of interest violations by Anthony Fauci which have been out in the open for three years. I hope that Med students of today are educated about the pollitical aspects of medicine and the good, bad, and the ugly within the pharmaceutical industry. I, for one, believe that there is far more good than bad and ugly.
I'm sure it's a calling, it's a grind and (hopefully) rewarding. The financial benefits can be argued given that an undergrad who goes into IB can make soooo much money out of the gate with 1/50th of effort/work and 1/20th of school loan. And to be honest, Covid debacle has taken a LOT of shine off of being a doctor. The AAP has taken a lot of shine off of being a doctor. Almost every prof org in medicine (and faculty) has lost a lot of luster, or so it seems to me.
Everything is relative. I learned this as a young Infantry officer. I moaned about something and my friends father overheard me. He said "Hansang, at your age, I was wading across rivers with pushing away the dead bodies to try to find food for the family" Yeah, like most Koreans of that generate, they lived through a war. Lesson two. A general officer was talking about his experience in Vietnam and every time it got horrible, he cheered himself up by saying "well, at least I'm not in Ranger school"
But I want people who have to treat people in the most intense situations to have experienced major stress. Just like I want the guy stacked with me, about to pull a trigger next to my head, has experienced stress of having to make split second decisions of life and death.
I'm mid to late career but am fortunate to be in a specialty in which most of my colleagues are millennials and Gen Z'ers. What i have noticed consistently is the judgement of those who may be 3-5 years out of training is as harsh, or harsher, than mine as it relates to those who are still in it. What that tells me is the real world toughens souls. Suddenly, when you have no cap, need to cross-cover a bigger census, get stuck with a difficulty family--there is no one behind to step in and rescue you. The real world is a kick in the ass when you are responsible. Mileage will vary, humans are funny that way, but I am more hopeful than others. "Snowflakes" thaw when exposed to heat.
We ideally become doctors because patients need us. If we become doctors because we think we're special, we've misunderstood the requirements of being a good and caring physician. Quit focusing on how you feel, spend more time thinking about how the patients feel and learn how to respond to their needs. If you do that you will discover the magic of being a physician.
And, being triggered because someone asks you how to pronounce your name? There are many forms of disrespect in the world, that is not one of them
I’ve just crossed the mid-career to late-career threshold. I fear that when I get old, I will be cared for by a generation of weak-kneed, brittle, useful idiots who don’t know how to function when tired/stressed/ poop hits fan, cuz they’ve insulated themselves from it their entire lives. Perhaps I should seek out Dr. Rama who may be a rare exception amongst this generational scourge.
Apparently the predictable drop in competence is already being seen. My surgical colleagues tell me that night-time surgical mistakes are on the rise with young surgeons who are not used to operating and making decisions while tired. Cuz guess what trainees…after the program comes real life. And you don’t get to design real life to coddle you.
Comfortable, uncomfortable, acknowledged, disrespected, happy, angry, the list goes on. Yes all people should have manners and respect for others if not even empathy, concern, connection.
But it's not about you. Cutting in line at cafeteria - you chose to feel angry and insulted. You could've thought, "what an a$$^le", and let it go.
Many careers, academic communities have hierarchies, stressful periods. You're learning something outside your comfort area, you're going to feel stress, inferior, etc. But if you're in the right field of learning and looking forward to a career in what you're learning then take the bad with the good and move on.
There will always be bad and good, choose how you want to respond to outside influences. Training in medicine is not like training in computer science. The required skills are markedly different.
Jesus protect me from young physicians who haven’t discovered that it is a vocation.
Interesting read. But discomfort around one’s name being mispronounced, and chatter about “microaggressions”? Those types of things, unsurprisingly, got millennials branded as snowflakes. Be grateful that macroaggressions are now so rare that the grievance-Left turned to manufacturing micros. Still, the author seems very bright, and those are the people I want when my health or life is on the line, not some diversity hire.
Medicine is a field to avoid if you are focused on the microaggressions or have difficulty working through small, unintended mistakes like a mispronounced name or assumption about your background. Undoubtedly, your patients will be dealing with real discomfort and trauma and their needs are far more real and important than these small distractions. Resiliency and perspective are key traits required in this field, and I fear many in this generation lack both.
Amazing work. Would have loved to have been a colleague of yours during medical school.
I get all I need to know about medicine from watching "The Resident". Over 107 shows, the entire gamut of possibilities are covered concerning the interaction of patients with the medical community and within the medical community by the actual staff. I wonder how much is close to the truth?
I think it’s sad that the culture that is supposed to promote “healing” is often a culture of abuse. Self-abuse. Stay up all night—-get yelled at by mentors—-be bullied intellectually? As a student I’ve found that getting yelled at does nothing to increase my ability to retain information or increase my capacity for compassion. In fact it —sort of shuts down the nervous system.
I’m not sure people who are training or practicing in such a high stakes profession should be in a constant state of fight, flight or freeze accompanied by exhaustion.
My opinion-is that teaching doctors and to some extent nurses -that they are above having normal physiological responses to stress leads to many mistakes/errors…and that actually owning our vulnerability and fallibility increases our ability for clear and lucid decision making/judgement.
None of us are super heroes or robots, as much as we’d like to think that we are.
Much love…🤗
The American Psychological Association defines trauma this way: "Any disturbing experience that results in significant fear, helplessness, dissociation, confusion, or other disruptive feelings intense enough to have a long-lasting negative effect on a person’s attitudes, behavior, and other aspects of functioning. Traumatic events include those caused by human behavior (e.g., rape, war, industrial accidents) as well as by nature (e.g., earthquakes) and often challenge an individual’s view of the world as a just, safe, and predictable place." While I don't think ANYBODY should be intentionally treated disrespectfully or disdainfully, and I also think residents should be given sufficient time to sleep, to use the word trauma to describe situations that simply make one "uncomfortable" minimizes the experience of true trauma victims. A certain level of discomfort in life is normal and what teaches us lessons and helps us become resilient. Hopefully people such as you can help return the tide back to a reasonable level of discourse.
A lot of doctors
Think that they don’t have to develop the necessary social skills to “deal” with being uncomfortable. This gentleman seems to think that learning basic social skills and interacting with people is too low for his eventual pay grade or somehow makes him special.
I—-I’ve met very few doctors who seem capable of communicating—and some of you —don’t even bother to learn intelligible English and put the responsibility for communicating on everyone else on your team.
That was one of the things about Stanford that seemed different than any hospital —it seemed like they were training people to communicate. One of my family me members had a surgery there and I was just observing.
And honestly if you are smart enough to do all of that work—you are smart enough to develop communication skills.
And also medicine is about patients not the doctors and their discomfort with actual humans, including the rest of the members of their team.
But that’s what people do right. Why on earth would academics think that because they went to school for 8 years that they have no responsibility to communicate with other people. Honestly what I observed in nursing clinicals was that doctors set bad examples for the people they were mentoring by acting unkindly to pretty much everybody.
Like why is it any different. It seems like communicating should just be part of the curriculum? Or how about work experience outside of medicine?
I think too—some people dedicate their lives to studying and end up with the emotional range of two/three year olds.
Or like the medical student from Brown who cut in front of me in line for burritos in Whole Foods and told me “I should get used to it..” because he was a about the be a DOCTOR…..you guys teach THAT. And that is unacceptable behavior for basically every person and in every profession…. Except medicine…..
From a nurse….
Who got a free burrito….