Tuesday, January 11, 2005

Why doctors suck.

I have two lives. One of them is at work. The other is at home. At work, I have to be hard and sharp, pretend to be kind, and never, ever say what I think. At home I have to be softer, actually kind, and I ought to say what I think except when it would harm my marriage.

Here is a story from work.

Last month I had to interview med students for residency slots. I've done it before, I'll do it again. They schedule about three interviews in a morning, 50 minutes each, but you can compact them into 40 because no-one really cares. The med students want it to over and I want to do something more useful with the time, like jab myself with something sharp. The first person was a girl who was clearly anorexic, her silly man-dress-suit hung over her narrow shoulders while her toothpick legs made a brief stockinged appearence before terminating into sensible closed toe pumps. As soon as I saw her I thought she would do better in law school. Or in real estate. Some field where people wouldn't vomit and bleed on her.

She had all the answers down. Wanted to go into our field because her early experiences in research and with a certain patient made her think that it was interesting. Her prepared speech was like the old Japenese cars: ran well, but sounded tinny. OK, I hear you: fake fake fake, blah blah blah. Also, it could go on forever. Looking at her, you knew she got very good mileage, she could go all day on one carrot.

But I have to pretend to be kind, so I asked her about an interesting patient she saw as a med student. Her case was a woman with a hypertensive crisis. It was actually pretty interesting.

She asked me what I thought of the ACGME stuff, which, if you don't know, is some residency review board that limited the hours that a resident can work.

Now, I don't really give a shit. Residency is shit. After the first few months you stop learning and it all becomes work, something to get through and to never think about again. My answer was much like hers. Shadows on walls: movement without substance. Fake fake fake, blah blah blah. I told her that it's very important, that things have to change, that residency has to be more humane, and that it has become more humane.

But that's a lie. The residents seem to hate the work even more now if you catch them in an honest moment, and they have to work harder than ever while they're actually at work. As a whole, they look more miserable and beat up now than they did 3 years ago. Maybe that's just the residents we have, but I don't think so.

I think medicine is getting worse. Residents don't get respect from patients, med students, attendings, or each other. Who can blame them for hating it? Also, one of the reasons they really hate it is because they came into medicine, these days at least, with the idea that it was going to be a normal job. Like one in which you can hope to do well, get enjoyment from, and work hard at, but one that will not take over your life, leave you a depressed and emotional cripple, and have an occasional weekend off. When they realize that being a resident is not normal, that's when the real depression sets in.

I also think it's better to work long hours than work shitty pressured hours. But that's just me.

6 Comments:

Anonymous Anonymous said...

Dear Dr. Nos,

Sounds like you're being sand-paperred under the grinding pressures of residency. My humblest sympathies to you. Have you ever asked your predecessors how they lived in that period as well as lived through that period? Perhaps they could offer some practical and spiritual tips.

Is it prohibited to be honest with patients in the US? Perhaps loosening up the fear of becoming attached to your patients in caring for them a bit is possible and harmless. Reach out for just a few seconds longer, a bit more sincere (which takes less effort than masking insincerity), it could make the patient feel more satisfied and understanding of your difficulties as well as making you feel fulfilled in having successfully cared in ways other than procedural under GA. That's my humble suggestion anyway, give it a try for a few days, see if it works.

Did you ever hear of the Italian saying "Hasten slowly"? Every thirsty sponge of a human being that we are can absorb more life out of life just by doing that.

Never forget that you're a DOCTOR. From time to time you'd probably find that meaningless or insignificant, but it is a special role. You're a healer when no-one else has the expertise to heal, and even when you can't heal you can comfort, and failing that you are in the least the only person that could have done the best for that person in need (you gave them what they needed) - best efforts that no-one else could give. That's not really empty hero-making when you think of it is it? It is the truth.

You are a doctor, a man in a post in a wall of defence in an army of builders and healers. That makes you indispensible because if you're knocked out - either by you losing the passion for your work, stopping to care, destroying your personal and family life through too much stress and poor coping, destroy your own person through turning into emotional and cognitive stone or through the many quick-fix drugs of life - that wall will be weakened. No-one wants that to happen.

By that very reason, there are people who care for you too, doctors to the doctor. Let them know what goes on in your mind. They could be your fellow "soldiers", your patients, your family, your friends, your mentors, strangers that you decide to open up to within reason and allow to have open up to you. The act of opening up is as much a release as the physical opening up of the jail cell one finds oneself become locked in at the end of a stressful time. Free yourself often.

Anyway, that's my two cents worth. I see things simply because I think life is simple no matter how much we try to complicate things. After all, none of this would exist for you (no stress, no joy, no satisfaction, no wife, no love, no appreciation, no money, no being called "Doctor" and people trusting your non-existent ability, no med students to vent their annoyance at you, no superiors to breathe down your neck, no patients to look to you out of hope or dissatisfaction, NOTHING FOR YOU oh simple non-existent person who's not on the important wall of defence) - IF....if you didn't have that beautiful thing that is the one breath that keeps being given to you again and again. With each one is another chance to live and make all the above happen. Think about that breath. And then decide what you're going to do with it. (Not really giving you charlottan spiritual crap here, if you stop breathing you die right?) Every breath is an opportunity, and every difficulty is an opportunity to overcome and improve existing circumstances. Difficulty will make you powerful not powerless. Take difficulty on not with the sole aim to surviving it with as little injury as possible, but to conquer it and show by example that a better way is possible. That's the way you can change the world, your kindergarten dream remember?

Typhon :D

7:52 PM  
Anonymous Anonymous said...

Dear Dr. Nos,

Sounds like you're being sand-paperred under the grinding pressures of residency. My humblest sympathies to you. Have you ever asked your predecessors how they lived in that period as well as lived through that period? Perhaps they could offer some practical and spiritual tips.

Is it prohibited to be honest with patients in the US? Perhaps loosening up the fear of becoming attached to your patients in caring for them a bit is possible and harmless. Reach out for just a few seconds longer, a bit more sincere (which takes less effort than masking insincerity), it could make the patient feel more satisfied and understanding of your difficulties as well as making you feel fulfilled in having successfully cared in ways other than procedural under GA. That's my humble suggestion anyway, give it a try for a few days, see if it works.

Did you ever hear of the Italian saying "Hasten slowly"? Every thirsty sponge of a human being that we are can absorb more life out of life just by doing that.

Never forget that you're a DOCTOR. From time to time you'd probably find that meaningless or insignificant, but it is a special role. You're a healer when no-one else has the expertise to heal, and even when you can't heal you can comfort, and failing that you are in the least the only person that could have done the best for that person in need (you gave them what they needed) - best efforts that no-one else could give. That's not really empty hero-making when you think of it is it? It is the truth.

You are a doctor, a man in a post in a wall of defence in an army of builders and healers. That makes you indispensible because if you're knocked out - either by you losing the passion for your work, stopping to care, destroying your personal and family life through too much stress and poor coping, destroy your own person through turning into emotional and cognitive stone or through the many quick-fix drugs of life - that wall will be weakened. No-one wants that to happen.

By that very reason, there are people who care for you too, doctors to the doctor. Let them know what goes on in your mind. They could be your fellow "soldiers", your patients, your family, your friends, your mentors, strangers that you decide to open up to within reason and allow to have open up to you. The act of opening up is as much a release as the physical opening up of the jail cell one finds oneself become locked in at the end of a stressful time. Free yourself often.

Anyway, that's my two cents worth. I see things simply because I think life is simple no matter how much we try to complicate things. After all, none of this would exist for you (no stress, no joy, no satisfaction, no wife, no love, no appreciation, no money, no being called "Doctor" and people trusting your non-existent ability, no med students to vent their annoyance at you, no superiors to breathe down your neck, no patients to look to you out of hope or dissatisfaction, NOTHING FOR YOU oh simple non-existent person who's not on the important wall of defence) - IF....if you didn't have that beautiful thing that is the one breath that keeps being given to you again and again. With each one is another chance to live and make all the above happen. Think about that breath. And then decide what you're going to do with it. (Not really giving you charlottan spiritual crap here, if you stop breathing you die right?) Every breath is an opportunity, and every difficulty is an opportunity to overcome and improve existing circumstances. Difficulty will make you powerful not powerless. Take difficulty on not with the sole aim to surviving it with as little injury as possible, but to conquer it and show by example that a better way is possible. That's the way you can change the world, your kindergarten dream remember?

Typhon :D

7:57 PM  
Blogger Doc NOS said...

Thanks for your comment. I really appreciate any that I get. I've finished residency btw.

Let me tell you what happens when you're honest with patients: bad shit. Patients like being told white lies, not the bald and painful truth. When you have to give bad news - that's about as honest as doctors get. Actually, it's a topic for another day - when I was honest and why I'm not anymore.

Non-doctors tend to think that being a doctor is full of healing people. Most doctors with IQs over 100 make the fast realization that the difference between a good doctor and no doctor is very little - other than easily correctable things: abx for infections and surgery for gall bladders.

8:52 PM  
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