:: to the teeth ::    thoughts on social justice, medicine, race, hope and beats

"Another world is not only possible, she is on her way.
On a quiet day, I can hear her breathing." :: Arundhati Roy ::

"The most common way people give up their power is by thinking they don't have any." :: Alice Walker ::
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:
Surgery Resident:  "Ah, you're interested in family medicine -- isn't that field going to become obsolete real soon?" 
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."
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."
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).
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.
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."
Surgeon:  "Ah, you're interested in family medicine.  Do you really just want to see runny noses and sports physicals?"
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."
Internal Medicine resident:  "You're too smart for family medicine.  Don't waste your education on it."
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 Anjali Taneja | 7/20/2004 05:06:00 PM | |


Post a Comment
cure this!
what's "to the teeth"?
hot links
dope orgs/sites
to the teeth archives
poem: history
Willing to Fight
the revolution will not be televised