Thursday, October 04, 2007
The Student Prints
I like med-student blogs. They remind me of the excitement, the frustration, foreboding, and fun of those times. More than that, from the quality of the writing and the depth of the thoughts expressed, it gives me hope that when I'm sick there may still be doctors out there interested in taking care of me in the way I'd have taken care of them. On the other hand, some of what I read is disturbing.
It's a predictable pattern: someone writes about her/his surgery rotation, and -- if not perfectly word-for-word -- certain statements will be made, and an inevitable array of comments will follow. The cast of characters is always the same: the asshole resident, the overbearing and brutish professor, the student who hates everything about it, sometimes with one or two who love it (and whose motives and sanity will likely be challenged.) Rarely, there might be a supportive resident or two. The behaviors described recur time and again. Berating, humiliation; a senior attending who not only treats the students and residents like shit, but his patients as well. The author, and the commenters, in the most vituperative and unforgiving of terms, validate their owns similar experiences and roundly condemn the surgeons and their method of teaching.
Keep your fingers off the keypads for a minute, kids: I'm with you. The reason this is disturbing is that it's true, and I hate hearing it. By far the worst thing to read -- and I've read it in commentary by patients as well -- is the description of a doctor (any doctor, but particularly a surgeon, because they seem to be the most frequent offenders, in these fora, anyway) being disrespectful and uncaring toward a patient. For that, there's no excuse, ever. And whereas I don't think for a minute that it's limited to academe, I believe -- from observation -- that such behavior is more common within the ivory walls than outside. Maybe it's tenure; maybe it's the academic rat-race; or maybe it's slop-over from the anti-Socratic method of discourse that's become embedded in surgery training like dogshit in a Doc Martens.
The operative phrase is "shit runs downhill." Profs dump on the chief resident, who dumps on the senior resident, who dumps.... But it needn't be like that. I wasn't like that.
In training, as I worked up the ladder, I was a good and patient teacher (or so I'm saying!) I had interns and junior residents over for dinner; I made jokes on rounds, and pitched in on the scutwork. I relished showing technique and explaining reasons for things. I rarely -- if ever -- grilled, and when I did, it was to get somewhere rather than to debase. It can be done. I don't recall chewing someone out, ever. But when I became a real doc, bearing all the responsibility myself, some things changed. I NEVER treated my patients with anything less than respect and empathy. But I know I could be hard on the nursing staff, and even referring docs, when I thought something had been done less perfectly than I demanded of myself. Believe it or don't, I was much harder on me than on anyone else if anything diverged from my view of excellence, but I make no excuse (OK, I do: it was based on hyper-perfectionism and not arrogance): things can be said in less off-putting ways. (In fact, in my second incarnation, after brief retirement and time to relax and reflect, as a surgical hospitalist I had an entirely different attitude. Nurses who'd known me before said they'd never seen me so happy. I think it partly had to do with sleep. And, yeah: being old and beat up enough to let some things go.) But there's a point here.
Not everyone will buy it without offense, yet it's true: surgery is the court of last resort. A surgeon is judge, jury, and -- God forbid -- executioner. Every other doctor can punt, and they do. Often. A surgeon can't, especially in the OR. And so, whereas it needn't be as punitive and degrading as it is in some places, surgery training will always be long, and hard, and demanding. I accepted a certain amount of misery when I went through it (and worked hours far more brutal than now) because I felt urgency and necessity. I thought then, and still do, that surgery training does more than the others to inculcate a sense of responsibility, the knowing of one's limits, and a commitment to perfection; and it must, because there are no hiding places in an operating room. If some students are put off by it, it's not entirely a bad thing. They will, and should, make another choice.
I read a student blog the other day. The writer said she hadn't read up on the operation in which she'd be participating, and was taken to task by the operating surgeon. With relish, evidently. Her post was followed by lots of comments deriding the attending in particular and all surgeons in general. There was an echoing chorus of animus: they're dehumanizing, bunch of egomaniacs, surgeons are terrorists. But along with the cringe of embarrassment for being associated with the evident scum of the earth, there was a twinge of an opposite thought: if I were to show up to an operation unprepared, someone might die, or be maimed forever. I'd hope that people who choose to become surgeons are the sort that don't need reminding, and are, in fact, the kind that wouldn't show up unprepared in the first place. But in training, some do. And they don't last. If they don't respond to whatever method the attendings or the senior residents bring to bear to point out and correct their failing, they get tossed. As they should. And, as someone who might some day lie on a table in the most vulnerable position you'll ever be in, aren't you glad to know that?