If you’re in anesthesia, someone should’ve told you on day 1 that dosing matters. You need to know dosages cold, especially of important, relevant drugs before a case.
Some people are just assholes though. But if you weren’t prepared or didn’t know and felt uncomfortable, then that’s a you problem.
Sensitivity has its place, but NOT when someone is learning about patient care. As an RN, I had to be thick skinned when in school and during preceptorship. I became a nurse in my 40’s and was often surprised at how “delicate” other students could be. We are dealing with people’s LIVES and frankly I think that firmly emphasizing mistakes and poor planning is essential. She/he says Ativan he/she says Versed? There is a big problem right THERE. “Nice” has nothing to do with it. LEARN it.
Absolutely. The focus today on making sure nobody feels discomfort is not realistic. You cannot control how other people act. As VP points out, we each interpret things that are said to us very differently. Medical professors and attendings go out of their way to consider how to best interact with "learners' (new term for students and interns/residents). Resiliency must be encouraged. This all improves over time. That's part of being a professional. Deal with the discomfort of the training process.
Whatever the intent behind the question running to social media and posting about it suggests poor coping mechanisms. In that situation you have to ask yourself two questions:
- “have I prepared inadequately?”. Only preparing on a case by case basis seems like doing the bare minimum, so what are the priorities for learning in advance. The kind of question you can ask an attending. Be open to the possibility that you should have known the answer.
- “why do I care if I was made to look ignorant?” You’re there to learn. If the attending is just a jerk then all the permanent staff already know that about him. Maybe it’s his way to motivate you. Shouldn’t you expect challenges in learning a high pressure job where ignorance and mistakes have real consequences.
I went to medical school 50 years ago. Some attendings showed the same kind of behavior. It was almost considered compulsory in surgery rotations to pimp and bully your underlings. Another reason I didn't go into surgery. There were always kind attendings who could let you know when you fell short without puffing themselves up or yelling at you. Those were the ones we fondly remember rather than the dicks.
Maybe this is the origin of the other problems that we've been discussing here - rude doctors who ignore their patients' wishes and feelings and sit in front of computers without making eye contact.
"Treat others as you would have them treat you" and "Professional behavior" should be the rules of any workplace. "The customer is always right" may not be true, but is a reminder of the direction our politeness should flow. The resident is also the customer - getting an education - and that resident will eventually be the business who needs to treat the true customer - the patient - with politeness too.
I grew up with parents who spanked me (I usually had it coming), I went to college and had to make grades to get to medical school, we had competition in medical school to show that we were capable. We competed for rank in class, we competed for medical honor societies. And in neurosurgery we endured a memorable verbal punishment for any lack of requisite knowledge, by a master of analogy calling us ignorant. We all knew we were smart and capable, we tried harder to stay ahead of the game, we learned everything possible despite grueling schedule and finished, proud of our accomplishment. I'm at the end of my career now and in part time faculty position and do not like what I see. I have heard the comment that we could do better with off-shore medical trainees, because of the rigor of the schooling. I hardly see medical students in the hospital, and if on the service only from 7-4 or 5. Most "educators" now think that students need to decompress at least one day a week, in addition to their weekend off! Students cannot present a patient because they don't know how to write prose, they can only type and mostly cut and paste or auto fill meaningless lines of computer screen. What future doctors will do is use the internet to look up the most likely Diagnosis and treat you with a possibly misguided protocol, because experience is so limited in the clinical realm. Because what they don't know is the great variation of the human condition, and they will have no way to look that up on-line. The education of social science is only learned at the bedside, totally deficient in our training now. As Sir Wm. Osler said, "It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has. The good physician treats the disease; the great physician treats the patient who has the disease."
Times have changed. When I was a 3rd year medical student (1988) the joke (which I'm sure what not new) was, "What's the difference between a 3rd year medical student and a piece of shit? Nobody goes out of their way to step on a piece of shit." Our expectations were set accordingly. Nobody felt outraged by an attending's question; nobody called HR because somebody asked them a tough question. It was a challenging environment, in many ways, and we wanted to see if we were up to the challenge. We weren't focused on our fragile egos, and, perhaps as a result, we learned a lot.
Another true story: Giving out grades in 3rd year medicine at a major urban teaching hospital. I've been grading Medicine for 16 years at this point. Student X gets a high pass (this school used honors, high pass, pass, low pass for A/B/C/D).
The dean calls: "We have to meet about this student, and why they didn't get Honors". OK
Meet with Dean, student, Mom and Dad. Long discussion around two points: 1) I have given lots of honors grades in 16 years, those students display effort, interest, and reasoning that the student in question did not quite match. 2) Getting what amounts to a B in medicine means "no Dermatology for you". So, the Dean asks me to change it. I asked the Dean to do it herself if she thought her contact with this student justified the change. She did.
Resident (NOT a student) calls 9:30PM, "Just a question, not a consult. What should I give for UTI with [this organism]?"
Me: (asking THE essential question for a case discussion) "How do you know the patient has a UTI?"
Resident: "He has a fever and a positive culture"
Me: "OK, let me look it up" - 2 minutes later - Me: "Uh, the culture was seven months ago, and there's no u/a"
Resident: Slams down the phone and storms out of the hospital.
- 30 minutes later - Page from resident service attending: "WHAT DID YOU SAY TO MY RESIDENT? SHE JUST WANTED AN ANSWER TO A SIMPLE QUESTION, NOW WE HAVE TO GET HER BACK"
If the many hundreds of questions I answered from my residency attendings from 1976-1979, or from my fellowship attendings afterwards, were "toxic", I would have been dead a long time ago.
Astonishing that a country with such desperate problems has nothing better to discuss than this, with respect to medical education/training. I do agree with Dr. Prasad's point that administrators rush to judgement and blame, rather than considering all facts. But if every such complaint were "investigated", little if any real work would get done. Patients are likely to suffer, either way.
My late father said that when a Harvard Medical School surgeon stamped on his foot under the table in the 1930's, he stamped back. Even if apocryphal, that may have been a rapid, self-limited response to untoward aggression that established a relationship of mutual respect, if not love.
One could ask whether the surgeon or anaesthesiologist referenced in this column may have been great physicians for their patients. If so, does a little bee sting or mosquito bite really matter - in the great scheme of things?
But I have an alternative solution. Dr. Prasad's fable of the "small molecule" reminds me of many lectures in which clinicians appear erudite, even when they are not. Students and residents can easily learn to read clues:
- the "science" discussed by the lecturer/teacher is sufficiently complicated and the teacher sufficiently old (dated) that it's unlikely (s)he/they really know what they're talking about;
- the use of brand names only suggests cultural enslavement to commercial influences, whereas use of generic names (e.g. midazolam, lorazepam, trastuzumab) suggests resistance and maintenance of intellectual independence;
- when one recognizes that the teacher is out of her/his/their depth on one subject, it's a reason to be appropriately cautious about other "facts," "factoids," or especially of interpretations of complex and controversial issues;
- one of the best indicators of the above is the use of hortatory language: if a teacher (live, or in consultations) repeatedly writes "this patient should do ...", or "this patient will benefit from ..." or "this patient needs ...," BEWARE ... instead of copying that non-scientific parlance, think of the probabilities that this could be true, or think throught the simple logic of whether a diagnostic test or procedure will change treatment in the interest of the patient.
Once a health professional embarks on the trajectory of hortatory language, it's almost impossible to expunge. I've been trying for > 20 years, and still catch myself saying "needs," "should," etc.
Another useful tool to deal with the situation described and referenced from comments on "X" is to apply the Golden Rule. I've found it extremely useful over many years in eliminating pointless or even harmful medical recommendations or actions. "Would I accept this, myself?" ... it's remarkably powerful, which may be why early philosophers or humane religious preachers proposed it.
One hopes that at least those who complain vociferously, or need emotional support to deal with "microagressions," will become model paragons of medical virtue: first for their patients and society, then for their students, and of course also to their families and friends. Then they can teach the rest of us how to be perfect! And perhaps help repair the general f-up that Earth is living through now.
I think by posting on social media this person needed to use a coping mechanism to deal with the challenging situation. It is part of coping and dealing as well as learning and growing. I can understand that. However, reading this article was a waste of time, mainly because all the middle part was a fabricated construct of someone else who wasn't there and didn't experience it and yet appears to have so much to say on the subject.
It's societal and parental failure. It's the result of "everyone is great", "everyone gets a trophy" attitude that taught the next generation that HE or SHE is special and can do no wrong. If you want to know who's responsible; parents, look in the mirror. I did my best to try to toughen up my boys to face the real world. But even, I, fell victim to wanting to do everything for my boys.
Even in the military they mandated no yelling at the recruits. I don't mean for type clerks, I mean for Infantrymen learning to kill the enemy. Some training requires harsh training. Air Traffic controllers, airline pilots, infantryman, and yes...doctors.
We really are going to die by sensitive but incompetent doctors. Unless, of course, we first get overrun by Vonuatu's military because our sensitive infantrymen started crying when the enemy yelled at them. /* hey, it was the most ridiculous example I could think of */
If you’re in anesthesia, someone should’ve told you on day 1 that dosing matters. You need to know dosages cold, especially of important, relevant drugs before a case.
Some people are just assholes though. But if you weren’t prepared or didn’t know and felt uncomfortable, then that’s a you problem.
"Pimpin' ain't easy, but it's necessary." Toughen up, kiddos.
Sensitivity has its place, but NOT when someone is learning about patient care. As an RN, I had to be thick skinned when in school and during preceptorship. I became a nurse in my 40’s and was often surprised at how “delicate” other students could be. We are dealing with people’s LIVES and frankly I think that firmly emphasizing mistakes and poor planning is essential. She/he says Ativan he/she says Versed? There is a big problem right THERE. “Nice” has nothing to do with it. LEARN it.
I don’t even work in the medical field. I read this blog for the science, data analysis tips, experimental design tips. Yet, I have an opinion here!
Part of becoming a professional is to learn to not take negative feedback personally. Part of being a leader and a teacher is to motivate.
I have room to grow in both skills and suspect that I am not alone.
If a hospital administrator, I’d put more emphasis on student learning to avoid taking negative feedback personally.
Absolutely. The focus today on making sure nobody feels discomfort is not realistic. You cannot control how other people act. As VP points out, we each interpret things that are said to us very differently. Medical professors and attendings go out of their way to consider how to best interact with "learners' (new term for students and interns/residents). Resiliency must be encouraged. This all improves over time. That's part of being a professional. Deal with the discomfort of the training process.
Being embarrassed for not knowing something is actually a great way to remember it.
The pain and humility of feeling inadequate is a daily occurrence in medicine. It’s what drives one to be slightly less inadequate every day.
Striving to avoid that feeling or lashing out at anyone who elicits that feeling is completely and utterly stupid.
Whatever the intent behind the question running to social media and posting about it suggests poor coping mechanisms. In that situation you have to ask yourself two questions:
- “have I prepared inadequately?”. Only preparing on a case by case basis seems like doing the bare minimum, so what are the priorities for learning in advance. The kind of question you can ask an attending. Be open to the possibility that you should have known the answer.
- “why do I care if I was made to look ignorant?” You’re there to learn. If the attending is just a jerk then all the permanent staff already know that about him. Maybe it’s his way to motivate you. Shouldn’t you expect challenges in learning a high pressure job where ignorance and mistakes have real consequences.
I went to medical school 50 years ago. Some attendings showed the same kind of behavior. It was almost considered compulsory in surgery rotations to pimp and bully your underlings. Another reason I didn't go into surgery. There were always kind attendings who could let you know when you fell short without puffing themselves up or yelling at you. Those were the ones we fondly remember rather than the dicks.
lol reminds me of Patch Adams
https://youtu.be/vUOJi3HvdwU?si=LslTMD-7VO0QiPm4
Maybe this is the origin of the other problems that we've been discussing here - rude doctors who ignore their patients' wishes and feelings and sit in front of computers without making eye contact.
"Treat others as you would have them treat you" and "Professional behavior" should be the rules of any workplace. "The customer is always right" may not be true, but is a reminder of the direction our politeness should flow. The resident is also the customer - getting an education - and that resident will eventually be the business who needs to treat the true customer - the patient - with politeness too.
I grew up with parents who spanked me (I usually had it coming), I went to college and had to make grades to get to medical school, we had competition in medical school to show that we were capable. We competed for rank in class, we competed for medical honor societies. And in neurosurgery we endured a memorable verbal punishment for any lack of requisite knowledge, by a master of analogy calling us ignorant. We all knew we were smart and capable, we tried harder to stay ahead of the game, we learned everything possible despite grueling schedule and finished, proud of our accomplishment. I'm at the end of my career now and in part time faculty position and do not like what I see. I have heard the comment that we could do better with off-shore medical trainees, because of the rigor of the schooling. I hardly see medical students in the hospital, and if on the service only from 7-4 or 5. Most "educators" now think that students need to decompress at least one day a week, in addition to their weekend off! Students cannot present a patient because they don't know how to write prose, they can only type and mostly cut and paste or auto fill meaningless lines of computer screen. What future doctors will do is use the internet to look up the most likely Diagnosis and treat you with a possibly misguided protocol, because experience is so limited in the clinical realm. Because what they don't know is the great variation of the human condition, and they will have no way to look that up on-line. The education of social science is only learned at the bedside, totally deficient in our training now. As Sir Wm. Osler said, "It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has. The good physician treats the disease; the great physician treats the patient who has the disease."
Times have changed. When I was a 3rd year medical student (1988) the joke (which I'm sure what not new) was, "What's the difference between a 3rd year medical student and a piece of shit? Nobody goes out of their way to step on a piece of shit." Our expectations were set accordingly. Nobody felt outraged by an attending's question; nobody called HR because somebody asked them a tough question. It was a challenging environment, in many ways, and we wanted to see if we were up to the challenge. We weren't focused on our fragile egos, and, perhaps as a result, we learned a lot.
Another true story: Giving out grades in 3rd year medicine at a major urban teaching hospital. I've been grading Medicine for 16 years at this point. Student X gets a high pass (this school used honors, high pass, pass, low pass for A/B/C/D).
The dean calls: "We have to meet about this student, and why they didn't get Honors". OK
Meet with Dean, student, Mom and Dad. Long discussion around two points: 1) I have given lots of honors grades in 16 years, those students display effort, interest, and reasoning that the student in question did not quite match. 2) Getting what amounts to a B in medicine means "no Dermatology for you". So, the Dean asks me to change it. I asked the Dean to do it herself if she thought her contact with this student justified the change. She did.
"No Dermatology for you" is how we grade now?
Times have changed.
True story:
Resident (NOT a student) calls 9:30PM, "Just a question, not a consult. What should I give for UTI with [this organism]?"
Me: (asking THE essential question for a case discussion) "How do you know the patient has a UTI?"
Resident: "He has a fever and a positive culture"
Me: "OK, let me look it up" - 2 minutes later - Me: "Uh, the culture was seven months ago, and there's no u/a"
Resident: Slams down the phone and storms out of the hospital.
- 30 minutes later - Page from resident service attending: "WHAT DID YOU SAY TO MY RESIDENT? SHE JUST WANTED AN ANSWER TO A SIMPLE QUESTION, NOW WE HAVE TO GET HER BACK"
If the many hundreds of questions I answered from my residency attendings from 1976-1979, or from my fellowship attendings afterwards, were "toxic", I would have been dead a long time ago.
Times have changed.
Astonishing that a country with such desperate problems has nothing better to discuss than this, with respect to medical education/training. I do agree with Dr. Prasad's point that administrators rush to judgement and blame, rather than considering all facts. But if every such complaint were "investigated", little if any real work would get done. Patients are likely to suffer, either way.
My late father said that when a Harvard Medical School surgeon stamped on his foot under the table in the 1930's, he stamped back. Even if apocryphal, that may have been a rapid, self-limited response to untoward aggression that established a relationship of mutual respect, if not love.
One could ask whether the surgeon or anaesthesiologist referenced in this column may have been great physicians for their patients. If so, does a little bee sting or mosquito bite really matter - in the great scheme of things?
But I have an alternative solution. Dr. Prasad's fable of the "small molecule" reminds me of many lectures in which clinicians appear erudite, even when they are not. Students and residents can easily learn to read clues:
- the "science" discussed by the lecturer/teacher is sufficiently complicated and the teacher sufficiently old (dated) that it's unlikely (s)he/they really know what they're talking about;
- the use of brand names only suggests cultural enslavement to commercial influences, whereas use of generic names (e.g. midazolam, lorazepam, trastuzumab) suggests resistance and maintenance of intellectual independence;
- when one recognizes that the teacher is out of her/his/their depth on one subject, it's a reason to be appropriately cautious about other "facts," "factoids," or especially of interpretations of complex and controversial issues;
- one of the best indicators of the above is the use of hortatory language: if a teacher (live, or in consultations) repeatedly writes "this patient should do ...", or "this patient will benefit from ..." or "this patient needs ...," BEWARE ... instead of copying that non-scientific parlance, think of the probabilities that this could be true, or think throught the simple logic of whether a diagnostic test or procedure will change treatment in the interest of the patient.
Once a health professional embarks on the trajectory of hortatory language, it's almost impossible to expunge. I've been trying for > 20 years, and still catch myself saying "needs," "should," etc.
Another useful tool to deal with the situation described and referenced from comments on "X" is to apply the Golden Rule. I've found it extremely useful over many years in eliminating pointless or even harmful medical recommendations or actions. "Would I accept this, myself?" ... it's remarkably powerful, which may be why early philosophers or humane religious preachers proposed it.
One hopes that at least those who complain vociferously, or need emotional support to deal with "microagressions," will become model paragons of medical virtue: first for their patients and society, then for their students, and of course also to their families and friends. Then they can teach the rest of us how to be perfect! And perhaps help repair the general f-up that Earth is living through now.
I think by posting on social media this person needed to use a coping mechanism to deal with the challenging situation. It is part of coping and dealing as well as learning and growing. I can understand that. However, reading this article was a waste of time, mainly because all the middle part was a fabricated construct of someone else who wasn't there and didn't experience it and yet appears to have so much to say on the subject.
It's societal and parental failure. It's the result of "everyone is great", "everyone gets a trophy" attitude that taught the next generation that HE or SHE is special and can do no wrong. If you want to know who's responsible; parents, look in the mirror. I did my best to try to toughen up my boys to face the real world. But even, I, fell victim to wanting to do everything for my boys.
Even in the military they mandated no yelling at the recruits. I don't mean for type clerks, I mean for Infantrymen learning to kill the enemy. Some training requires harsh training. Air Traffic controllers, airline pilots, infantryman, and yes...doctors.
We really are going to die by sensitive but incompetent doctors. Unless, of course, we first get overrun by Vonuatu's military because our sensitive infantrymen started crying when the enemy yelled at them. /* hey, it was the most ridiculous example I could think of */