Tuesday, July 20, 2004
Back on the Hospital Floors -- the patients are happy, but the docs seem divided
Yes, I'm back, in full force, in my last year (11 months and counting) of medical school, after a year away from patient care (working as a fellow for the American Medical Student Association). I'm doing my 3rd year surgery rotation in my 4th year of medical school because I postponed it to start my AMSA job in time. I've gained so much respect for the work of surgeons in my first 3 weeks here (at a community hospital in New Jersey), and I'm really digging in and enjoying the experience, even though I'm sure I'm not going to pursue it career-wise (actually because i'm not pursuing it -- I won't have another chance to see all these operations and all the other amazing work that surgeons do).
As I talk to resident physicians in the hospitals, whether surgery residents or internal medicine residents or ob/gyn residents I know from my 3rd year clinical rotations, I'm finding the inter-disciplinary generalizations, ignorant comments, and disparaging comments increasingly intolerable. To illustrate what I mean, here are some examples of statements that have come up in conversation:
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Surgery Resident: "Ah, you're interested in family medicine -- isn't that field going to become obsolete real soon?"
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Gastroenterologist: "You know, you've gotta start thinking realistically. When you have kids of your own, you're going to want to have the best for them. And pursuing general internal medicine or family medicine won't earn you enough income to provide for them."
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Insecure Surgery Resident: "Many people think surgeons are idiotic people who just want to cut things out of people, and don't know how to think things through. Well, we're not really like that. We're.... smarter than other doctors."
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Pediatric Neurologist: "I'd die before I'd send my son to a family physician. They don't know anything." (this after hearing of my passionate interest in family medicine and my vision for the future of community health. i mean, that's just mean).
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Department head of Surgery: (paraphrased from what I remember from two weeks ago) -- Surgery is very different from internal medicine, expect this difference when you do your rotations as medical students. Surgeons don't think things over and over and over, we don't round on patients for hours on end and waste the day. Our situations are more often emergencies. We do things.
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My medical student colleague: "Anesthesiology could be done by a robot. Only people who are lazy and want to make tons of money go into it."
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Surgeon: "Ah, you're interested in family medicine. Do you really just want to see runny noses and sports physicals?"
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Surgery resident: "Emergency Medicine doctors are just triage nurses. They see the patient and hand him or her off to us or to internal medicine."
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Internal Medicine resident: "You're too smart for family medicine. Don't waste your education on it."
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Surgery resident: "Man, those medicine residents, they're no good. They dont' treat anything. They create surgery patients for us."
Anjali in response (couldn't hold back): "No, they treat non-surgical patients" (patients not needing surgery, electively or acutely)
Surgery resident: "No, they create surgery patients for us."
Anjali (raising voice a bit): "No, they treat non-surgical patients."
Surgery resident (raising voice a bit): "No, they create surgery patients for us."
Then he got paged and we had to continue the puerile back and forth later. Reminded me of the whole "I know you are but what am I?" back and forth that 8 year olds engage in. I had to remind myself that I'm a (relatively) mature medical student, and he's a (relatively mature) 3rd year surgical resident, in order to calm down a bit.
---------- The fact that so many physicians "hate" on other physicians' fields really gets to me. Why can't we all just get along? But I find myself doing it -- jumping to judgments and generalizations of people in various fields of medicine. Oftentimes it's a knee-jerk reaction to what other docs say of the field I'm interested in pursuing, and other times it's just plain old judgments. This growing process is very interesting -- as I become more aware of my own judgments of other fields of medicine, I become less judgmental of them. (but I reserve my right to look critically at the individual or collective actions of physicians "pan-field" -- I just made up that word).
I was discussing this with a friend the other day, and we brainstormed a few ideas about why doctors may disparage other physicians' fields: 1. The desire for acceptance within your field and ownership of what you do can drive you to talk disparagingly about other fields. In order to be in the "in" group, you've gotta create an "out" group. A basic sociological and time-tested concept. This can get to the point where you start thinking your field is really the only important field in medicine (very dangerous).
2. Insecurity about the field you've chosen causes you to complain about others.
3. The result of imprinting that occured during medical school or previously. As you're first exposed to the attitudes of physicians in various different professions, you start to stereotype the whole profession from the few "characters."
4. It's a status/hierarchy thing, and with status comes arrogance (the culture of medicine places specialists higher up in conventional status, while generalists are generally lower in status -- among physicians).
I'll keep pondering this one. Add to the list if you'd like, in the "thoughts" section below. But now, back to being on call overnight at the hospital (and working with some of the most kickass surgery residents this side of the Mississippi River).
posted by Unknown |
7/20/2004 05:06:00 PM |
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| cure this! |
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We've MOVED! and grown!
Join us at Cure This!...
...where we invite you to create a user account, read, comment, write your own posts. Let's discuss health in its broadest sense, share personal stories, creatively make positive change, and build an online community along the way...
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| what's "to the teeth"? |
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To the Teeth is a weblog discussing issues of health justice, medicine, race in America,
public health in its broadest sense, healthcare at a local clinic level, and honest discussions around strategies in advocacy. Ok, so it's not so focused, but it's all connected. The regulars who post to this site are:
Anjali Taneja, a resident physician in Family Medicine at Harbor-UCLA in Los Angeles,
California (a recent transplant from the east coast). She also blogs at Los Anjalis and the
Harbor-UCLA Family Medicine Residency blog. She's on the national leadership of the National Physicians Alliance and previously worked as the Jack Rutledge Fellow for Universal Health Care
& Eliminating Health Disparities at AMSA. She dj'ed for several years with the
M U T I N Y dj crew and currently DJs and produces electronic music. (email: movement-at-gmail-dot-com)
and Andru Ziwasimon, a family medicine physician in Albuquerque, New Mexico, and a lead member of the Community Coalition for
Healthcare Access, a diverse group of providers/patients/advocates addressing access issues with the state hospital system, translation and interpretation issues, billing for under and uninsured patients, and other disparities locally.
He created and runs a sustainable and innovative clinic that serves
uninsured patients with quality care and fair prices. He also serves on the leadership of the National Physicians Alliance. (email: aziwa-at-null-dot-net)
and Sri Shamasunder, a resident physician in Internal Medicine at Harbor-UCLA in Los Angeles, CA. He's passionate
about health justice, good music, and spoken word/poetry. (email: elsrizee-at-yahoo-dot-com)
"to the teeth" (idiom):
-> in opposition; directly to one's face
-> completely, fully
-> title of a song by Ani Difranco
-> alotta alliteration
For them RSS lovers (more about rss here), here's the atom site feed for To the Teeth.
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| hot links |
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Inspiring spoken word from Poetic License
Conversation: Growing up in the Shadow of Chemical Pollution - Michigan and Bhopal
Missing: Minorities in the Health Professions
Angell: The Truth about Drug Companies
Wonderful animation on procrastination!
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| dope orgs/sites |
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National Physicians Alliance
American Medical Student Association
The Peoples' Institute
Alternet
The Policy Action Network
The Principles Project
Common Dreams
No Free Lunch campaign
Kaiser Family Foundation
Families USA
Consumer Project on Technology
Campaign for a National Health Progam NOW
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| to the teeth archives |
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12/01/2002 - 01/01/2003
01/01/2003 - 02/01/2003
02/01/2003 - 03/01/2003
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| poem: history |
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They caught the peasant walking home from the field.
On the dark road they gagged him and cut off his nose.
This they took to the museum and stuck to the king's noseless statue.
Thus was born the history that is taught in schools.
- Amitava Kumar, "History"
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| Willing to Fight |
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From Ani Difranco's "Willing to Fight":
"'cause i know the biggest crime
is just to throw up your hands
say
this has nothing to do with me
i just want to live as comfortably as i can
you got to look outside your eyes
you got to think outside your brain
you got to walk outside you life
to where the neighborhood changes"
Excerpts of lyrics to Ani Difranco's poem "Self-evident" (hear her recite this poem on her official website:
yes,
us people are just poems
we're 90% metaphor
with a leanness of meaning
approaching hyper-distillation...
here's a toast to the folks living on the pine ridge reservation
under the stone cold gaze of mt. rushmore
here's a toast to all those nurses and doctors
who daily provide women with a choice
who stand down a threat the size of oklahoma city
just to listen to a young woman's voice
here's a toast to all the folks on death row right now
awaiting the executioner's guillotine
who are shackled there with dread and can only escape into their heads
to find peace in the form of a dream
cuz take away our playstations
and we are a third world nation
under the thumb of some blue blood royal son
who stole the oval office and that phony election
i mean
it don't take a weatherman
to look around and see the weather
jeb said he'd deliver florida, folks
and boy did he ever
and we hold these truths to be self evident:
#1 george w. bush is not president
#2 america is not a true democracy
#3 the media is not fooling me
cuz i am a poem heeding hyper-distillation
i've got no room for a lie so verbose
i'm looking out over my whole human family
and i'm raising my glass in a toast
here's to our last drink of fossil fuels
let us vow to get off of this sauce
shoo away the swarms of commuter planes
and find that train ticket we lost
cuz once upon a time the line followed the river
and peeked into all the backyards
and the laundry was waving
the graffiti was teasing us
from brick walls and bridges
we were rolling over ridges
through valleys
under stars
i dream of touring like duke ellington
in my own railroad car
i dream of waiting on the tall blonde wooden benches
in a grand station aglow with grace
and then standing out on the platform
and feeling the air on my face
give back the night its distant whistle
give the darkness back its soul
give the big oil companies the finger finally
and relearn how to rock-n-roll...
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| subcity |
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Lyrics from Tracy Chapman's "Subcity"
People say it doesn't exist
'Cause no one would like to admit
That there is a city underground
Where people live everyday
Off the waste and decay
Off the discards of their fellow man
Here in subcity life is hard
We can't receive any government relief
I'd like to please give Mr. President my honest regards
For disregarding me
They say there's too much crime in these city streets
My sentiments exactly
Government and big business hold the purse strings
When I worked I worked in the factories
I'm at the mercy of the world
I guess I'm lucky to be alive
They say we've fallen through the cracks
They say the system works
But we won't let it
Help
I guess they never stop to think
We might not just want handouts
But a way to make an honest living
Living this ain't living
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| the revolution will not be televised |
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Lyrics from Gill Scott Heron's "The Revolution Will Not Be Televised"
You will not be able to stay home, brother.
You will not be able to plug in, turn on and cop out.
You will not be able to lose yourself on skag and skip,
Skip out for beer during commercials,
Because the revolution will not be televised.
The revolution will not be televised.
The revolution will not be brought to you by Xerox
In 4 parts without commercial interruptions.
The revolution will not show you pictures of Nixon
blowing a bugle and leading a charge by John
Mitchell, General Abrams and Spiro Agnew to eat
hog maws confiscated from a Harlem sanctuary.
The revolution will not be televised.
The revolution will not be brought to you by the
Schaefer Award Theatre and will not star Natalie
Woods and Steve McQueen or Bullwinkle and Julia.
The revolution will not give your mouth sex appeal.
The revolution will not get rid of the nubs.
The revolution will not make you look five pounds
thinner, because the revolution will not be televised, Brother.
There will be no pictures of you and Willie May
pushing that shopping cart down the block on the dead run,
or trying to slide that color television into a stolen ambulance.
NBC will not be able predict the winner at 8:32
or report from 29 districts.
The revolution will not be televised.
There will be no pictures of pigs shooting down
brothers in the instant replay.
There will be no pictures of pigs shooting down
brothers in the instant replay.
There will be no pictures of Whitney Young being
run out of Harlem on a rail with a brand new process.
There will be no slow motion or still life of Roy
Wilkens strolling through Watts in a Red, Black and
Green liberation jumpsuit that he had been saving
For just the proper occasion.
Green Acres, The Beverly Hillbillies, and Hooterville
Junction will no longer be so damned relevant, and
women will not care if Dick finally gets down with
Jane on Search for Tomorrow because Black people
will be in the street looking for a brighter day.
The revolution will not be televised.
There will be no highlights on the eleven o'clock
news and no pictures of hairy armed women
liberationists and Jackie Onassis blowing her nose.
The theme song will not be written by Jim Webb,
Francis Scott Key, nor sung by Glen Campbell, Tom
Jones, Johnny Cash, Englebert Humperdink, or the Rare Earth.
The revolution will not be televised.
The revolution will not be right back after a message
bbout a white tornado, white lightning, or white people.
You will not have to worry about a dove in your
bedroom, a tiger in your tank, or the giant in your toilet bowl.
The revolution will not go better with Coke.
The revolution will not fight the germs that may cause bad breath.
The revolution will put you in the driver's seat.
The revolution will not be televised, will not be televised,
will not be televised, will not be televised.
The revolution will be no re-run brothers;
The revolution will be live.
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