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:

1. Rigorous and extensive education.
2. 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.

Sexual harassment on student rotations is probably something that happens more often than we think. I honestly believe it gets under-reported due to fears of a bad evaluation or getting kicked out of medical school altogether. Residents or attending physicians that make inappropriate advances or comments toward students are a vital part of a medical school’s academic program and seeing a big stink over a sexual harassment case is the last thing that the administration wants. That being said, programs and departments will go to great lengths to attempt and cover up or candy coat any sexual harassment complaints that a student may have.

As I was browsing SDN today, I came across a thread about sexual harassment during student rotations. Reading through the replies, you’ll see that feelings are mixed. Some students believe in reporting the offense immediately while others would decide to let the offense go in lieu of a poor evaluation.

Here are some examples from the thread:

The chief resident was staring at a medical students breasts, and made a ridiculous comment about them in front of the group.

A surgery attending asked if a student wanted to see his persian cucumber.

A resident created a nickname for a medical student, which happened to mean vagina in another language. He called her this in public.

An anesthesia attending touched a nurse inappropriately, but she just brushed it off.

A chief resident grabbed a medical students hands and would not let it go. He gave suggestions along the lines of she should come back with him.

See, here’s the problem. People are still scared to report inappropriate work environments, even when we’re dealing with something as serious as sexual harassment. Guys, we’re going to have to get rid of these ideas that your medical school has brainwashed you into believing if this kind of crap is ever going to stop.

I want to see sexual harassment offenders lose all practice priveleges, be terminated from the institution in which they practice, and have their medical license brought up for review by the licensing committee. If serious actions are taken, these assholes will quit thinking that they’re God and start playing nicely.

If you’re the victim of sexual harassment while on rotations as a student or resident, here’s what I think you should not do:

• Don’t bring up any complaints to junior staff. They’ll most likely side with their superior and probably don’t want to get involved with it anyway.
• Don’t mention the offense to the perpetrator. The offender knows that he or she is doing wrong and will blatantly deny that any offense ever took place.
• Do not take your complaint to the Dean of Medicine, or anybody else in the administration that is linked to the practice of clinical medicine or rotations at your institution. As explained earlier, they’ll do all they can to protect the school and program. You are not in their best interest.
• Do not wait until your grade is released to file a complaint. This could backfire on you.
• Do not threaten the perpetrator that you will turn them in. Let them think that all is harmless.

OK, so what should you do if you’re a victim of sexual harassment on rotations?

• Contact a lawyer for advice. Preferably get one that specializes in workplace sexual harassment abuse.
• Contact your hospital’s legal department and risk management informing them that you have been a victim of sexual harassment. Let them know you have already talked to your lawyer, which should expedite getting your appointment scheduled.
• Set up an appointment to talk to risk management about the incident and make sure that your lawyer accompanies you to the meeting.

In my opinion, you should bypass all clinical faculty completely. I know that administration tells you to let them know about problems such as these, but I honestly believe it’s because they want to intercept the problem before it reaches legal and/or risk management. Take it right to the source immediately.

What Are The Implications of Reporting?

Most of you might be worried about the implications of reporting an incident. I’m not going to lie and tell you that other attendings aren’t going to know that you were the one who squealed. I think you’ll find that the majority of attendings and staff are not going to show any ill-feelings towards you. You certainly will not be dismissed from school and your grades on other rotations shouldn’t suffer.

Take a lesson from the movie North Country and report the abuse. Only then will change take place.

Lately I see more and more talk of “arrogant, entitled, lazy, and non-caring” medical students coming mainly from attendings. They’re actually referring to these students as the “new generation of medical students.” You see, they don’t understand why some of you guys are finally starting to “get it.”

Enter Medical Student 2.0

You guys are starting to wise up, and it’s about fucking time. I couldn’t be more pleased. Long gone are the training days of 1953, where students and residents practically lived in some run-down shit hole of a hospital room. Back during these wild west days, students would do just about anything that was asked of them. I can see the changes even from my training days just a few years ago. The balls are getting bigger, so keep eating those Wheaties.

This isn’t to say all of my work is done as it will never be fully complete. There will always be that subset of students who will kiss ass to get ahead. Ignore them as they will very soon be in the minority.

Majority Rules

One thing this new generation needs to keep in mind is the power of majority. If you have a majority on your side, you can get away with a hell of a lot more. What are they going to do, punish 80% of the class? I don’t think so. Ask for forgiveness, not permission. Your time will come when the majority of your class will be comprised of this “new generation” of medical students.

How Do You Become Part of the New Generation of Medical Students? Follow These Simple Rules:

• Always, always question authority. Medical training is extremely inefficient, so questioning authority in the medical training setting is appropriate more times than not.
• If an unreasonable task is asked of you, simply refuse to do it.
• Never, ever complete menial tasks for residents or attendings such as fetching food or coffee. Tell them to pick up their own dry cleaning. Remember, they knew what they were getting into when they matched into their specialty. They sowed the seeds, now it’s time for them to harvest the crops.
• You are paying for your education, therefore you are owed an education. This goes with the above bullet point. You aren’t paying $xx,xxx per year to run copies or obtain vitals. You’re paying to learn. Make them teach. If an attending doesn’t want to teach, he should get his pretentious ass out of academic medicine.
• If you don’t want to participate in a procedure, tell them. Studying for your shelf exam is much more productive than “assisting” on a chest tube insertion. If they give you any lip, remind them that you’re paying for your education and that you get to call some of the shots.
• Never skip conferences in lieu of scut. Conference time is break time and it’s often protected time for students at most medical schools. If an attending or resident demands that you skip conference to play human retractor or to complete some other meaningless scut, report them to your Dean. If they need someone to retract, they can pay an OR tech $20+ an hour to do it.

I hope that MSH can continue to shape future next-gen medical students and stop the abuse. All I can do is to continue to spread the word.

This is a reply to a comment made by Johnny Youngblood. I’m not calling Johnny out personally, but I think his comment exemplifies the way an average medical student thinks.

I really don’t want to hear another medical student, resident, or physician complain about the money. Lots of people work overtime. Lots of people work 2 jobs. Very few make 6 figures by the time they’re 30.

He makes some very valid points with his comment, and it’s absolutely true that few people are pulling in six-figure incomes by 30 years of age.

Having a strong work ethic is important, but you need to realize that working hard does not equal working smart. Many who have graduated from the school of medical training think that if you’re not working every waking minute that you’re slacking. I absolutely know some of you feel this way now — I used to feel that way myself, especially early during my medical training.

Working two jobs, excessive hours, or any combination of the two is just plain inefficient. Sure, many people do it. It’s not wrong, per se, but it’s also not right for many people. Working like this leads to faster burnout rates, decreased productivity, and overall decreased well-being.

Do you really love your job as a medical professional? Not just happy doing it, but I mean really love it. My guess is that most people will probably — deep down inside — say no. Whether you want to admit it or not, for most of you I bet that medicine is a decent job with lots of status and above average pay. Nothing more, nothing less.

What I Did

As most of you probably know by now, I got enough of medicine during medical school. I didn’t want to pull the ridiculous hours doing something that I wasn’t too excited about to begin with. Somewhere around the beginning of my junior year, I started pondering exactly what I wanted out of life. For me, medicine didn’t fill any of my expectations. I could care less about status, but I wanted to make a comfortable living and be able to do so with more free time that I could get out of a lifetime of call and pagers.

Some called me a slacker, others thought I was lazy. I’m actually the exact opposite.

You see, my work ethic is stronger than most of the students that I went to school with. We just think differently. My classmates — and countless medical students like them — have been brainwashed into thinking that you must work your entire life doing something that you may or may not like. My brain was once programmed along the same frequency.

During my junior year after I started having second thoughts of medicine, I used to sit and daydream about what life would be like to not have to go to a job that you hated. I wanted to be excited about what I did for a living. I wanted to love it.

Daydreams soon turned into a burning desire and obsession to find the meaning of life for me. My parents told me I was crazy. My wife didn’t support me at first. My grandma began to worry about me. They were all preaching ‘a house, a wife, a job, a white picket fence, and 2.5 kids.’ After all, that’s the American Dream right?

Medicine could give me a nice house with a white picket fence, and I could afford 2.5 kids and sail off into the sunset pulling the same routine until I’m 65 and become one of those old docs who are too senile to really practice anymore, but still show up to grand rounds for the free meal and CME credit. But hell no, I didn’t want that. That’s what everybody didn’t understand. They didn’t understand that I needed to do this for me.

Leap Of Faith

I wanted the ability to work from wherever I choose. I wanted to be able to go to the gym at 11:00 am or midnight. I wanted to be able to take as long as I wanted for lunch, and not to have to ask permission to take a piss. I wanted to call all of the shots without the political bullshit that accompanies most positions of power. I wanted to be able to take a two-week vacation at the drop of a hat and then extend it to four weeks when I realize what a fun damn time I’m having. I wanted to stay up until 3 am if I felt like it or sleep in until noon. I wanted freedom. After all, these are the best years of my life and I sure as hell was not getting any younger.

I soon realized that being an entrepreneur was what I wanted. I wanted it more than anything. I worked my ass off, but I was finally enjoying my work. In fact, I loved it and still love it to this day. My businesses took off. I then began to launch passive streams of income. I’m now happier than I’ve ever been in my life.

I knew what I wanted. I saw other people living great lives with an abundance of happiness and I knew I could have that too. I didn’t sit on the fence and cry that I couldn’t have that life too. I went out and did something about it.

I contribute it all to the medicine work ethic.

Dear Medicine,

Although I dislike your training practices very much, I would like to thank you for the strong work ethic that you have taught me. Many countless hours studying for your shelf exams and Steps taught me valuable time management skills that I use to be successful today. Seeing many overworked physicians who were unhappy and complaining about their paycheck made me desire something more. Had I not seen the light because of you, I might have been just another pawn in a never- ending game.

It was worth the months on surgery and OB/GYN. Every prostate that I examined made me want something better out of life. I am thankful that you gave me the adequate number of prostates to examine. Each pelvic exam, while oftentimes smelly and always unpleasant, taught me that I must persevere.

Every attending surgeon that ever belittled me during rounds or in the OR gave me a thick skin. I have used that thick skin while failing numerous times on my way to victory. Each case I scrubbed helped to build my foundation of freedom.

The long nights on call taught me that I’m not that efficient while sleep deprived. Now, I always work well-rested. Thank you medicine, I’ve increased my productivity because of you.

I now work smarter instead of harder, and it’s because of you. You have given me so much — the drive and desire to not be unhappy with life. The drive and desire to do something I am passionate about. The drive and desire to finally be free.

Thank you, Medicine, for four years of hell. Had it not been for those four years, I might have spent a lifetime consumed by fire.

The Bottom Line

You can bitch and moan all you want about the decreasing pay or increasing work hours, just like I did. Just make sure you do something about it — turn all of those negative emotions into positive actions.