There is something about the twitter responses that remind me of a punchline from Dave Chappelle's Jan 2025 SNL monologue at about the 3:05 mark (monologue here - https://www.youtube.com/watch?v=57pGarTBJrU). Chappelle's final remarks at the end of the 17 minutes tie this whole monologue together beautifully, but the first 3 minutes will get you the main bit that came to mind as I read the reactions and your reaction to those reactions.
We all draw insights from others' appearances. A doctor who dresses meticulously may be more meticulous about rendering care. A slovenly doctor, well, the opposite. Very expensive clothes and jewelry may give the impression the doctor is too materialistic, which may color his/her judgement. How clean is the exam room? The patient appropriately integrates this info into their assessment of the doctor.
This goes both ways. I had a Renal Attending who based his decision re a patient's ability to handle CAPD on the condition of their bedside table: a messy table meant recurrent peritonitis.
The real lesson here, though, is that X continues to be a cesspool of vile and inappropriate comments made by people who hide their identities.
“The site also gave me a place to share pithy observations — thus sparing my colleagues and family from my incessant, self-important, observations. Twitter also helped my career. It got my work read by people and made me more widely known than you average clinically active, pseudo-academic, bad-at-networking, general internist.”
Don’t judge the patient? No one was judging the patient. They were judging the tweet, which was dumb and petty.
The patient was judging (or “considering” as Cifu puts it) the doctor in that scenario. There’s no evidence that the doctor in the suit judged the patient.
Patient’s who badmouth their doctors on twitter are fair game.
I liked the first doc's comment. What does this have to do with medical care?
I moved from San Francisco where I did my residency and then worked in a county clinic for 10 years back home to PA in 1979. I wore a suit and tie every day, for a few years, then dressed down to a sport coat and tie for a bunch of years, then started to skip the tie, then finally ended up with a long white coat and no tie. It was all based on, in the beginning, the image I felt I had to present, social custom through the years and in the end my comfort and convenience.
I gave the same level of medical care throughout. I hardly ever got any comments about my appearance. I'm sure some may have had some opinions about it but after getting established I always had as many patients as I could handle.
Doctors wear their particular garb for different reasons. I tell my patients and family I went into emergency medicine so I could wear my pajamas to work. I have never been impressed by suits and ties. In fact, studies have shown that ties are a major vector of disease. But we should never put down a colleague who wants to show up in a suit. Who cares? I'm not impressed. I have never been criticized for wearing scrubs to work, treating over 130,000 emergency patients. "Doc! I dont thinks you should be treating me because you came to work in your pajamas"
wish i could comment. i would say that i am either a doctor's worst nightmare or someone that they very much look forward to seeing. I need to know things and if they ask, I will tell them anything they want to know about procedures I get from other specialists. I'm advocating and getting them to work together. It IS happening!
I believe it all comes down to respect, rightly so, wrongfully so, or indifferent. If we don't respect who we are, where we are, and what we want to accomplish, why should anyone else?
How hard is it to distance yourself in this new wave of disrespect? The 'people' who arrive in the ER with a gun and begin showering bullets everywhere. The 'people' who are in for a psych eval and get up pummeling an ED staff member causing lifelong debilities. What about healthcare workers who are so tired because of long shifts, no help, and innocently make a medication error to then bed stripped of their uniform, license, dreams, livelihood?
Fragile egos. I'm all that and a bag of chips. I'll just get my lawyer, HR, DOL, you'll see.
Mandatories: M&M, Peer Reviews, Quality Improvement, the organ recipient discussions, ....
How about - How to act in conflict situation? How to de escalate a violent person's rage? How to be a mirror for frustrated, angry, hurting patients? And so on....
Things have become homogeneous. All staff on each hospital floor wears navy blue. Who do I ask? Who do I listen to? Ok, the guy in scrubs must be a nurse. The gal with a scrub hat must be an anesthesiologist. The guy in a white coat is surely a doctor. Why are some why coats short, medium and long? Being here, sick as I am, I wish I had a game roster.
We, the healthcare workers who are in the trenches with a good bit of knowledge of what's happening in the world, the country, the city, the hospital can barely contain our frustrations and disappointments in healthcare. How in the world are we to expect patient 11085-9 female room 210, cholecystitis, patient 44239-0 male room 111, HIV & AIDS, cachectic and dying, and finally the 98 people in the ER waiting room because they have no insurance because they work 80 hours per week at minimum wage and have nowhere else to go for help understand the fragility of our healthcare system and the doctor in a Brioni $22,000 suit and the $12,000 Tom Ford Custom Oxfords and the $345 Jose Balli gilded pocket square?
For me, it was such a privilege to engage patients and parents (I was a pediatric specialist) for nearly 50 years. When I taught medical students how to take histories and physical exams, I tried to alert them to the mere fact that they were playing the role of a physician, an actual caregiver, patients and mothers on the in-patient service naturally exposed themselves willingly for the sake of their education. They sometimes shared nuggets of information and actual secrets that they had not told anyone else. Amazing! I wonder how many of them appreciated the awesome magic and privilege of the role that they were preparing to take full-time.
As a med student, part of my disillusionment with medicine is the disrespectful attitude to patients... They're not in bed for ward rounds? Discharge them... That cholecystitis can't be that bad if they've gone out for a smoke... And it's hard to see that I can have any impact as a junior given my senior's attitudes
I am a retired pediatric pulmonologist and my mother died of COPD. Thus, I naturally became a strong critic of the tobacco industry and tended to look down on smokers. However, Heather, you have much to learn. Tobacco addiction is a real medical disorder and requires understanding and sympathy as essential aspects of the treatment. I wish that I had a chance to share with you my sense of privilege for being a physician.
I am shocked by those comments. Wow. As humans, we all struggle with self awareness. But to see it so transparently like that... sometimes I am reminded of how so much progress has yet to be made with such existing attitudes.
Lisa Rosenbaum once wrote a piece that was powerful to me about tweets of gratitude.... Back in the Twitter days. She was reflecting on a tweet by an OHSU EM doctor, Esther Choo, who noted that a patient, whose life she saved, contacted her every year to thank her. Esther encouraged others to tweet gratitude, too and some beautiful tweets emerged.
Love this article.
There is something about the twitter responses that remind me of a punchline from Dave Chappelle's Jan 2025 SNL monologue at about the 3:05 mark (monologue here - https://www.youtube.com/watch?v=57pGarTBJrU). Chappelle's final remarks at the end of the 17 minutes tie this whole monologue together beautifully, but the first 3 minutes will get you the main bit that came to mind as I read the reactions and your reaction to those reactions.
We all draw insights from others' appearances. A doctor who dresses meticulously may be more meticulous about rendering care. A slovenly doctor, well, the opposite. Very expensive clothes and jewelry may give the impression the doctor is too materialistic, which may color his/her judgement. How clean is the exam room? The patient appropriately integrates this info into their assessment of the doctor.
This goes both ways. I had a Renal Attending who based his decision re a patient's ability to handle CAPD on the condition of their bedside table: a messy table meant recurrent peritonitis.
The real lesson here, though, is that X continues to be a cesspool of vile and inappropriate comments made by people who hide their identities.
“The site also gave me a place to share pithy observations — thus sparing my colleagues and family from my incessant, self-important, observations. Twitter also helped my career. It got my work read by people and made me more widely known than you average clinically active, pseudo-academic, bad-at-networking, general internist.”
I love this passage. Thank you for the piece.
Hey Cifu, I hope that patient shit-talked you to another doc. This is a petty, mean-spirited critique.
What if that suit had sentimental value to that doc? He’s just trying to look his best and be his best.
Validating this behavior online is just you signaling “i’m one of the good ones, patients confide in me when they don’t like other doctors”.
It also encourages patients to be as shitty as they want, dehumanizing doctors into commodities.
Fucking lame dude.
Don’t judge the patient? No one was judging the patient. They were judging the tweet, which was dumb and petty.
The patient was judging (or “considering” as Cifu puts it) the doctor in that scenario. There’s no evidence that the doctor in the suit judged the patient.
Patient’s who badmouth their doctors on twitter are fair game.
Thank you for all your thought-provoking posts, Dr. Cifu. Always appreciated. 🙏
I liked the first doc's comment. What does this have to do with medical care?
I moved from San Francisco where I did my residency and then worked in a county clinic for 10 years back home to PA in 1979. I wore a suit and tie every day, for a few years, then dressed down to a sport coat and tie for a bunch of years, then started to skip the tie, then finally ended up with a long white coat and no tie. It was all based on, in the beginning, the image I felt I had to present, social custom through the years and in the end my comfort and convenience.
I gave the same level of medical care throughout. I hardly ever got any comments about my appearance. I'm sure some may have had some opinions about it but after getting established I always had as many patients as I could handle.
Doctors wear their particular garb for different reasons. I tell my patients and family I went into emergency medicine so I could wear my pajamas to work. I have never been impressed by suits and ties. In fact, studies have shown that ties are a major vector of disease. But we should never put down a colleague who wants to show up in a suit. Who cares? I'm not impressed. I have never been criticized for wearing scrubs to work, treating over 130,000 emergency patients. "Doc! I dont thinks you should be treating me because you came to work in your pajamas"
wish i could comment. i would say that i am either a doctor's worst nightmare or someone that they very much look forward to seeing. I need to know things and if they ask, I will tell them anything they want to know about procedures I get from other specialists. I'm advocating and getting them to work together. It IS happening!
I believe it all comes down to respect, rightly so, wrongfully so, or indifferent. If we don't respect who we are, where we are, and what we want to accomplish, why should anyone else?
How hard is it to distance yourself in this new wave of disrespect? The 'people' who arrive in the ER with a gun and begin showering bullets everywhere. The 'people' who are in for a psych eval and get up pummeling an ED staff member causing lifelong debilities. What about healthcare workers who are so tired because of long shifts, no help, and innocently make a medication error to then bed stripped of their uniform, license, dreams, livelihood?
Fragile egos. I'm all that and a bag of chips. I'll just get my lawyer, HR, DOL, you'll see.
Mandatories: M&M, Peer Reviews, Quality Improvement, the organ recipient discussions, ....
How about - How to act in conflict situation? How to de escalate a violent person's rage? How to be a mirror for frustrated, angry, hurting patients? And so on....
Things have become homogeneous. All staff on each hospital floor wears navy blue. Who do I ask? Who do I listen to? Ok, the guy in scrubs must be a nurse. The gal with a scrub hat must be an anesthesiologist. The guy in a white coat is surely a doctor. Why are some why coats short, medium and long? Being here, sick as I am, I wish I had a game roster.
We, the healthcare workers who are in the trenches with a good bit of knowledge of what's happening in the world, the country, the city, the hospital can barely contain our frustrations and disappointments in healthcare. How in the world are we to expect patient 11085-9 female room 210, cholecystitis, patient 44239-0 male room 111, HIV & AIDS, cachectic and dying, and finally the 98 people in the ER waiting room because they have no insurance because they work 80 hours per week at minimum wage and have nowhere else to go for help understand the fragility of our healthcare system and the doctor in a Brioni $22,000 suit and the $12,000 Tom Ford Custom Oxfords and the $345 Jose Balli gilded pocket square?
For me, it was such a privilege to engage patients and parents (I was a pediatric specialist) for nearly 50 years. When I taught medical students how to take histories and physical exams, I tried to alert them to the mere fact that they were playing the role of a physician, an actual caregiver, patients and mothers on the in-patient service naturally exposed themselves willingly for the sake of their education. They sometimes shared nuggets of information and actual secrets that they had not told anyone else. Amazing! I wonder how many of them appreciated the awesome magic and privilege of the role that they were preparing to take full-time.
Interesting; the only thing I wondered was if the person was at Mayo, where that is a dress code (or used to be).
As a med student, part of my disillusionment with medicine is the disrespectful attitude to patients... They're not in bed for ward rounds? Discharge them... That cholecystitis can't be that bad if they've gone out for a smoke... And it's hard to see that I can have any impact as a junior given my senior's attitudes
I am a retired pediatric pulmonologist and my mother died of COPD. Thus, I naturally became a strong critic of the tobacco industry and tended to look down on smokers. However, Heather, you have much to learn. Tobacco addiction is a real medical disorder and requires understanding and sympathy as essential aspects of the treatment. I wish that I had a chance to share with you my sense of privilege for being a physician.
I am shocked by those comments. Wow. As humans, we all struggle with self awareness. But to see it so transparently like that... sometimes I am reminded of how so much progress has yet to be made with such existing attitudes.
Lisa Rosenbaum once wrote a piece that was powerful to me about tweets of gratitude.... Back in the Twitter days. She was reflecting on a tweet by an OHSU EM doctor, Esther Choo, who noted that a patient, whose life she saved, contacted her every year to thank her. Esther encouraged others to tweet gratitude, too and some beautiful tweets emerged.