As I was looking through my comments tonight, I saw a very insightful comment left by someone who goes by the name of “Deaner.” He or she was responding to my post entitled Medical Students v 2.0. That post is very old, so I wanted to repost it here so that it will get some views. He or she makes some very good points, and it’s an incredibly well-written comment. Here it is, thanks Deaner:
I was recently describing the generational difference to a group of friends. Generation X and Y. Its not that we are “entitled, lazy, arrogant or non-caring.†It isn’t even that we leave in the midst of patient care and never would we refuse to be involved in an opportunity for education– as the physician above implied. This is a misinterpretation by an older generation that comes from their lack of regard to our goals, our mission and our acute understanding of our surroundings.
Looking at the physicians that make up today’s medical field, we are able to deduce the effect that traditional medical education has on its participants. We the older generation of physicians who are bitter, overworked, validation (read: money)-hungry doctors many of whom practice medicine without respect to the patient and without love for their work. We (generation X and Y) on the other hand, are committed to our own sanity, health and future. We want to be good doctors. Period. So when we see inefficiency and ineffectiveness in medical education, which leads to suffering and sacrificing of health, we want to fix it. We recognize that it takes not just one, but two elements to allows us care of patients in our fullest capacity:
- Rigorous and extensive education.
- Our own mental and physical health and continued enthusiasm towards patient care and medicine.
So we put our heads together to change what could be better. Cut out anything that is either impinging on one of the stated elements without fulfilling the other. Why? So we have more free time to play? No. Because we think we are too good for traditional methods? No. Because we think we’ve somehow earned it? No. Because we don’t care about medicine? Absolutely not. We want to fix it because we want to be good doctors. We want to learn every second that we are not working to stay healthy (sleeping, eating, feeling.) We know that we must stay positive (not resent the hospital or our patients) in order to open our minds to allow the maximal amount of education to enable us to be both wise and compassionate doctors.
We refuse to have our potential to be great and healthy physicians stripped from us by our experience with medical education.
I am not bothered by older doctors saying “blah, blah, we worked so much harder than you…†Instead, I pity them. I pity them for justifying their misery but ridiculing our commitment to change.
Rationalization is a beautiful thing.
Yes, deep down we just really want to be the bestest doctors evar, that’s really why we’re taking off early. It doesn’t have anything to do with priorities, no sir. To be honest, in the final analysis, that bitter, jaded, hateful, money-grubbing attending who lives to work in no small part because everything else in his/her life is in complete shambles is really probably making the world a better place than the self-actualized slacker working 1/2 of the hours and carrying 1/4 the patients. Sorry, folks, as a general rule we don’t get to have our cake and eat it, too. Being some new-agey complete and fulfilled person who radiates self-actualization through every pore isn’t a prereqisite to completing useful and socially valuable work, otherwise civilization would have disappeared, oh, say, a few thousand years ago. If directing every moment of your life towards maximizing your service to mankind is your chief and only goal in life, then seriously, go on and take that q3 call for the next 40 years. It’s doable, and if your only priority in life is seriously making the world a better place through the judicious practice of medicine, it will be it’s own reward.
Sorry bro, you’re really not making the world a better place by daring to slack. Your downtime isn’t a deliberate attempt to make the world a better place, you’re just making your time on this earth a little more pleasant. Which really isn’t something you should have to apologize for. Last time I checked it’s not necessary to either have or fake a martyr complex to be a productive member of society and be able to honestly say you were a net non-waste of resources and oxygen when your time finally comes. I mean if telling yourself it’s really all for the patients is what helps you get through the day it’s cool and all, but if you’re making a habit of shoveling this line to everyone before ditching, that might be why the older generation doesn’t “get” you. Doctors have to work with deception, especially the self-directed variety, from their patients and co-workers every day. Just because you’ve managed to fool yourself doesn’t obligate the rest of the world to fall in line.
Wow … Shining Hector you’re displaying one of the most consistent qualities I’ve noticed thus far throughout the medical establishment: the willingness to tear your colleagues apart. Yes, medicine remains one of the few professions where the practitioners haven’t wised up to the fact that you get nowhere by eating your own. Do you feel smarter now? Do you feel better than Deaner? Like most physicians and physicians-in-training, you may think your comments make you look better but to everyone else they just make you look like an asshole.
I find it so ironic. Be it with regard to working hours or personal interactions, the “caring” profession … the one dedicated to helping its fellow humans … seems to view its own as anything but human.
So do you actually disagree with anything I said, or did my tone just give you flashbacks of people who treated you like crap because they could and you let them? I gave it a couple of shots but can’t really find much of a point in there other than “Shut up, meanie. I hate you all!”
At the risk of seeming presumptuous, try directing your angst at the next real person you feel is mistreating you. While it’s true that it may involve more consequences than laying into anonymous slackers playing Devil’s advocate on the Internet, you might be surprised at the results.
I think Shining Hector has written one of the most brilliant posts I’ve read on this website. I say this with complete honesty. I found the above blog article false, by personal experience, and I find much truth in Hector’s reply. Bravo!
I once was a medical student, a long time ago. I had similar thoughts. I had similar aspirations. I then finished residency and saw the other side of medicine. It’s a cruel world out there. I am sure we all can relate to the post, but medicine is not what it seams when we are being guided and pampered. The real world is quite ugly.
Great post, Hector.
“Sorry, folks, as a general rule we don’t get to have our cake and eat it, too.”
Summed up perfectly.
I guess I’m part of the younger generation who believes that quality of life is important just because I like sleep and food, not because it’s better for patients somehow.
I know I work better when I’m rested, well fed, have been hugged recently, etc. But that’s not the whole reason I want a life. Basically, I just want a life because medicine isn’t the only thing i would like to do with my time, nor is it even the most important to me.
Even though on every single one of my evaluations you will find written evidence that I care very much about my patients, I would argue that the point of life is not to help others, but to live well. We are all selfish beings, in my opinion, and I like helping people because it makes me happy, which is selfish. I also like nice clothes, healthy food, going to the gym, and waking up refreshed in the morning.
Though I agree medicine does not need to be like the days of yore, I also don’t think we need to be “fake martyrs” as one commenter noted. I think it’s quite impressive the sacrifices people have made in the past to this profession. I can understand why the older generation is sad to see that kind of dedication go by the wayside. But I also stand firm in my desire to take care of myself along with my patients, because I’d like to enjoy this life, it’s the only one I have.
The old school OB/GYNs are the best example of this that I can think of. Can you imagine, ladies, having the same doctor for each one of your prenatal visits, and that same person delivers your baby? That is great continuity of care, but the days of the single-practice OB are dying out (unless you are able to pay lots of cash). I’m sure it’s not the same in terms of patient care now with larger OB practices, but the obstetricians have lives! Maybe enough of a life to have their own babies and be present for their own partner’s birth. It’s a tradeoff. And it’s about values, and the values have shifted.
I just wish we could all respect each other. Derogatory comments on either side of it get us nowhere.
why can’t we have our cake and eat it too?
the root if the problem is the persistence of the old school way of doing things – it is extremely inefficient and error prone! examples ….
1) one hospital that i rotated at claimed to have EMR, but their “EMR” was basically having someone scan individual paper documents into a computer. then when someone wanted a copy, they’d print it out for them. why can’t we devise some system that’s 100% digital so we can use templates, edit, and send the information to the people who need it? also, some of my biggest annoyances and time consumers when i round is looking for the chart, trying to read what someone wrote in the chart, and then finally trying to find the patient (did he/she got down for an MRI??)
2) i once got a page from a nurse who was told by the resident to contact me. i paged the resident and waited by the phone for about 10 min for the return call. the whole point of this? – that we were rounding on the 5th floor … 5 minutes ago. why don’t we have a better way of communicating with each other???
it seems that doctors are very reluctant to give up hand writing notes, faxing information, using pagers, and having paper medical records. if we could utilize the advances in technology that we have today, we could make things soooo much faster without sacrificing quality.
Somz, that’s hardly the point that Hector was trying to make when he said that we can’t have our cake and eat it too. Improving the efficiency of an out-of-date system isn’t the same thing as leaving early or pursuing other aspects of life outside of medicine, and making the claim that it’s somehow “all for the patients.”
Yup. Efficiency is great and all, but it’s not really the point. (For the sake of space, we’ll ignore the fact that increased efficiency usually just seems to result in no net gain for anyone but officious bureaucrats who then have an excuse to pile on more paperwork.)
To be honest I do respect the hell out of the docs who work their asses off (with or without any resulting psychological sequelae), but it’s really just not for me. Respect and money are a mighty poor trade for down time in my book, and I really just don’t have the martyr complex necessary to turn my entire existence into a burning effigy to medicine. I’m secure in making that decision for no other reason than it’s mine to make, though; no excuses are necessary. I still care about my patients and want to do my job well, but the satisfaction of knowing I’m spending every waking moment striving to be a paragon of doctorhood just isn’t enough in itself to carry me through any and all adversity, sorry.
Were I one of those workaholic attendings, though, I’d probably be first in line to tear Deaner a new one on the wards if he/she expressed those sentiments for the sheer presumptuousness of it all if nothing else. It’s one thing have a different set of priorities and the conviction to stand your ground when they’re challenged, another entirely to say that everyone else who doesn’t share your priorities and motivations is just a tool for working longer and harder than you. All the medical martyrs out there have my sincerest respect and admiration, and I’d undoubtedly be a better person and do a better job of fulfilling my mandate to save the general populace from themselves if I could muster the drive to pull it off, too, but it’s probably just not going to happen.
Just stumbled onto this page and I have a few comments. I was in medical school not too long ago (graduated 2004) and I had a similar attitude, in terms of not wanting to “sacrifice everything” for my career in medicine. Had a lot of the same conversations that you have mentioned with friends in my class. Here’s my observations:
1) There is something you go through as you are being indoctrinated into this profession; something that many of us experience, which is a combination of fear over the life you may have chosen, desire to do things differently than workaholics from the old school approach, and generally just coming to grips with the huge responsiblities that will be on your shoulders soon. We’ve all been there. That’s clearly where you are right now. Find your niche. It will work out well. Sounds like a career in surgery is not what you’re looking for, but there is more balance for people in many fields than there used to be.
2) I would echo the anonymous post about willingness to tear colleagues apart. It’s something in the personality of those who choose this profession. It’s not always pleasant to see that side of people. There are a lot of malignant personalities in medicine. Don’t be one of them. Every first year medical student thinks they are going to be the best doctor ever and do things different than anyone ever before. You are in an elite group. Eventually you will be humbled in the educational process and learn a few lessons.
3) If you want to criticize the methods of those with more experience than you, just wait until you are in their shoes. Wait until it all rests on your shoulders. Wait until you’re making the big decisions all day every day. It’s a different deal. It will motivate you and drive you more than you could ever imagine.
One thing I forgot to mention in my previous post: If you have ambitions in life to do anything challenging, anything intellectually stimulating, anything monetarily rewarding, even if it’s not in medicine, you WILL have to work for it. This is a basic truth.
I have friends in other high paying respectable jobs (not in medicine) who work as much as I do or MORE than I do, now that I’m an attending. They have stress of their own, they make a lot less than I do currently. One of them is a broker whose monthly income fluctuates from $500/month to $30,000 a month. Sometimes he hardly breaks even and he has to pay his company for the right to work with them.
Another friend owns his own business, makes about HALF of what I do, works weekends and late nights rather frequently and puts in a LOT more hours than I do.
If you’d rather be “free” than work hard and have a nice income, by all means get your 9 to 5 job and make yourself happy. If you’re motivated to do something that potentially might make you a much better salary, and give you financial freedoms you couldn’t have otherwise, expect to work for it—whether it’s a career in medicine or not.
The biggest problem with the old school physicians that you are talking about it not that they are so “money hungry” but that they spend everything that they make. Most of those people could have retired young if they didn’t try to live beyond their means. That is why they are miserable more than anything.
And finally, I can’t help but wonder why you continue this blog if you’re not in medical school anymore? It sounds from previous posts like you’ve chosen a different path. Is there a good reason you are still so hung up on this topic? I hope you figure all of this out one way or another and things work out well for you.
Check out a new med student blog with videos and great notes.
Edit: Pay for advertising like everyone else does. If you’re so “e-thug” surely you can afford it.
http://www.imcheap.com
I have to agree with docDFW, and more generally . . . after reading this blog, what are you doing, Hoover? You don’t want to be a doctor, then don’t be a doctor! But the rage toward your thwarted profession is overwhelming and destructive. Do you think you’re exposing anything in these comments that hasn’t been stereotyped and obvious all along? What are you so angry about? You made a bad personal choice, you suffered for it, and now what, you expect other medical students to read this blog, smile wryly at your “refreshing bluntness and truth-hawking”, and do . . . ? What? Agree with you? Sympathize? Empathize? Experience some revelatory moment where they understand the cruelty of medicine in a new way?
Who laughs last, Hoover? While you fritter away your life on WoW and writing these missives to nowhere, other people will live and die and live under the auspices of physicians who chose to labor long, and live with that choice.
Shut the fuck up and go save some lives.
Anon, it’s funny that you choose to juxtapose the phrase “who laughs last” with a speculative caricature of Hoover’s post-medical life and the long labors of medicine. To me (and I’m sure alot of people would agree), the last laugh belongs to the guy who is doing what he wants to do, and isn’t bound by life-consuming professional obligations.
If sleeping in every day and playing WoW makes you feel fulfilled, by all means do it. And if you are going to look back on life with a sense of pride and feel that you had a meaningful existence in doing so, then by all means make yourself happy. I can promise you I’ll never devote a blog to why your ways are wrong or what I don’t like about it.
Wow Hoover. I had no idea this was up here. Given that I am working my ass off in medical school, contrary to what the responders implied above, I don’t have much time to browse the web. Honestly, I have gained a new appreciation for you in that it makes you extremely vulnerable to write on here. Being in medical school makes you subject to enough judgment and presumptions than to put your motivations on a page and let people tear you apart.
Here is the thing. Hoover didn’t write this blog. I wrote this blog. I want to be a doctor. With all my heart I want to be a doctor. I want to go into primary care. I want to work abroad and in a community hospital here. I want to be a faculty physician because I am devoted to changing medical education before our system falls apart. As some of you may or may not know, we are in a health crisis. Less than 5% of medical students want to go into primary care. Our emergency rooms are full and our bills aren’t being paid. The solution to this, starts in medical education. We need to start focusing on how a medical career can be fulfilling and, yes, tolerable because money doesn’t drive this ship anymore. We need to stop tearing each other apart, focusing on the faults of the new generation and we need to focus on patients. Why? Because if we don’t fix medicine, starting here, we are going to have a country full of sick (poor) people. (Though I do not presume that you care…)
I work hard. I spend long hours at the hospital. I don’t convince myself I should leave for some “new-agey” understanding of mental health. In fact, my evaluations are shining despite my commitment to take care of myself and not kiss ass. I respect the places where I am being taught and am grateful to all hell for the people who take interest in teaching. I ask questions. But I sleep enough to wake up in the morning and feel decently about getting back to the hospital.
Work-a-holic doctors are one thing. I suspect I will be one as soon as I am able. I mean, I want to work with populations who have no one else on their side, so I’d be fooling myself if I didn’t think I would be. I love medicine. This doesn’t bother me. I respect the hell out of someone who loves their job. This is why I am doing this.
Medical school is a different thing all together. To spend hours upon hours of inefficient, ineffective time at the hospital where no one looks in your direction or bothers to answer questions. Unacceptable. The new generation will NOT tolerate mistreatment. It seems this is a lost concept on older generations who just sucked it up and kissed ass to get through the grueling time that is medical school. But there was more to look forward to after they got through it: Good pay, societal respect, practicing evidence-based medicine without always thinking about CYA. Even primary care was a medical profession of dignity, unlike now where the other in the field are disrespectful and half your time is spent dealing with the system.
So yes. Things need to change. Medicine is taking on a new name and medical education needs to change with it. If not for the sake of future physicians, but for the sake of patients and, moreover, for the sake of an unhealthy society.
If you disagree. Wake up. Turn on the news.
Here’s a simple thing that would make medical education better…
Get rid of the first two years.
My classrooms are empty. Everybody just listens to the lectures and reads review books. A good Kaplan course would teach me more than most of my professors and cost way less. Why pay tens of thousands of dollars for this?
Solution:
1.) Accepted to medical school.
2.) One or Two years to study for USMLE.
3.) When you pass the step, you begin your clinical training.
Another suggestion (I’m an M2)…
Make all clinical rotations optional.
Less than 3% of my class goes into OB/GYN. Yet we all have to suffer through it. Why? To expose us to a field that we have no interest in? 50,000 dollars for a glorified extended career day?
The days of a physician being able to practice all aspects of medicine are long gone. This system is archaic. The quicker we get physicians learning what they need to be learning the more productive they will be in society and the less painful it will be for the students.
Deaner said, “The new generation will NOT tolerate mistreatment. It seems this is a lost concept on older generations who just sucked it up and kissed ass to get through the grueling time that is medical school. But there was more to look forward to after they got through it: Good pay, societal respect, practicing evidence-based medicine without always thinking about CYA.”
Well put.
Great post!! Thanks for sharing such an wonderful information …
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