Just have to get this one off of my chest. I work full-time in an ED as an EMT and have been doing so for the last 5 years of my life. I love it. Every shift is different - every patient is different - I never know what my day is going to be and I get to meet and help people every day I am in the ER. Working in the ER is what ultimately led me to decide to take the plunge and go back to school and finally do something about my dream to become a physician. What drives me nuts is the cynicism. When the docs and PAs and nurses in the ED hear I am applying to medical school, they all try and talk me out of it. I don't get it. They say I'll hate it. It's not worth it. I should just go to PA school. It's too expensive . . . etc, etc, etc. It's everything I have not to tell them that THEY - NOT ME - clearly went into the wrong field. I have had plenty of time to ponder this decision - I have had several careers - more school than I like to think about - and all of the time in the world to consider my decision to become a doctor. Why try and discourage me? What happened to all of the excited, anxious, nervous pre-med students who are on this forum? Do we all turn into grumpy, dis-enchanted, angry, cynical doctors once med school and residency are over?
Why the cynicism?
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QofQuimica
Seriously, dude, I think you're overreacting....
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Residents are miserable because residency is miserable. Attendings? I think what it comes down to for many is feeling trapped in a job that they don't particularly like because they have six figure loans and no other way to pay it back. As for encouraging versus discouraging you, I think it's good that they're trying to discourage you. Listen to them and take what they say seriously. If they manage to talk you out of it, then that tells you you weren't as committed as you thought you were. If you're determined to go forward no matter how many times people tell you not to, well, then maybe things will be different for you. But keep in mind that the doctor grass looks much greener to you right now than it will once you're actually a doctor.
Hello 2002 self. I'm reading a time capsule of me.
Being a tech is all the fun of patient care with none of the worries and stresses. And none of the costs. We only had to what...take a course at the CC for 6 months of night school and show up with a strong set of vitals ready to work hard. I was still in my 20's feeling like a stud. Like Joan Jett in 82. [YOUTUBE]http://www.youtube.com/watch?v=u0ZicY7Oqmg[/YOUTUBE]
Now I'm just hangin on. With not much awesome to say to my 2002 self except damn...you stud...stay free.
Cynicism....? I'm watching aliens writhe and burst out of wombs splashing into the world in a hot mess of agony. To young and hopelessly dumb kid/parents who couldn't be bothered from watching cartoons to hear about proper maternal glucose control. Much less about how not to cum in each other long enough to stop the cycle of poverty and uneducation and poverty. I do this while being expected to be enthusiastic. For a grade. Everybody watching, commenting, evaluating. I've been doing it so long I forgot how to think like a real person. I look for angles on how to present myself well as easily as taking a wiz. Stepford like.
I'll be a 40 something rookie. Hundreds upend hundreds of thousands in the hole. So yeah, curb your enthusiasm. Until you've tasted and been tested yourself.
I found a side street I feel like I can inhabit with satisfaction and contentedness. But bushy tail wagging enthusiasm. Yeah....f@ck all that.
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You had to get into to med school to experience people in your care constantly self-destructing? I feel like I've been seeing that straight away from my first clinical job.
Well no. But things look different tip toeing on the shells of eggs in you 23rd hour of something you don't like. After you've seen the wrong side of too many of life's punches. Things get wearisome. And look different. It sounds melodramatic. Exaggerated. It's neither. It 's how I feel. And the OP is how I felt then. It's comical and ironic and sad at the same time. This stuff takes something out of you.
It's a great career. It is for me....worth it. But not the way I thought. I too thought I knew better for myself than anyone. And perhaps that's as true as anything. But it was luck that made it turn out alright. And none of the self-assured bravado I had when in the OP's shoes.
Your own cynicism is hard enough. Other people's is an f'n drag. I get it. But you guys will be on the other side of it soon enough. And you'll have to manage your own cynicism.
I like to ruminate on mine, find some dark humor, and then realize the deal has been struck, and recalibrate to fit my current suck, and relax into contentment in my new low. I repeat this cycle again and again.
But, know this, you will find the tunnel visioned exuberance of being a premed darkly funny at some point. Or at least most people do. And it's ok.
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Legit commentary.
I have to say I chuckled when I read 'the exuberance' of being a pre-med. Not because I think you're wrong but because I feel as though I passed through that a while ago. I remember how very quickly it starts to die when you realize you can only accomplish so much. It feels much better than not being able to accomplish anything at all for me though.
I can't fathom what goes through one's head delivering a crack baby, unlikely to be the first, to an unfit mother (I just drove mother to be to the hospital on a couple of occasions) yet, bizarrely, I'm working hard to get into a career that may let me find out. That prior sentence alone should be enough reason for anyone to remember 'if there's anything else you'd rather do with your life, for ****'s sake do it!'
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Top Gear turned me down because I'm an American, so I'm stuck with trying to become a mere doctor...
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I'm sorry to hear that.
MIT turned me down for entering their graduate program in combinatorics because I'm, well, dumb. So I also have to settle for medicine.
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Yes, I think we all turn into grumpy, dis-enchanted, angry, cyncial doctors. Med school drives the compassion out of you so by the time you get to residency, all you see patients for are annoying obsticles that get in your way of finishing your work in a timely manner.
Ok, maybe not every day is like that....but enough are so that when the friendly ER tech talks of their med school plans, it's hard not to steer them away sometimes.
Hang in there, if you want it, go for it.
QofQuimica
Seriously, dude, I think you're overreacting....
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It's not med school that turns people cynical, or more precisely, it shouldn't be. Medical school is a time of playing at being a doctor, and if one is developing cynicism as a medical student, then they're playing at being a cynic. As a med student, you have the least responsibility and can spent the most time getting to know patients as human beings. It's criminal for physicians to teach medical students cynicism along with teaching them SIRS criteria and the five W's of post-surgical infection.
Residency is a whole 'nother ball of wax, and internship in particular. It's a painful time. But if three months into your intern year, you're seriously at a point where you see patients as "annoying obstacles that get in your way of finishing your work in a timely manner," then it's time to consider hanging up that stethoscope, my friend. Caring for those patients *is* your work. It's the fundamental sickness of the health care training system, not the patients, that creates those obstacles to being able to do your work.
Well I beg to differ, although I'd have to return to this thread in a few years to prove it. At least you're getting paid. Having been in the grown world for too long, playing at stuff doesn't appeal to me. And it is playing, although if you could remind my superiors that it's all fun and games that would go along way.
It's possible to be cynic at any time of your training. There's quite a lot to inspire cynicism throughout.
Furthermore, the Bambi-esque interpretation of the state of mind is not something I relate to, with all it's scolding cheerfulness. To me a cynic is a stark realist, without false hope, with a proprer mistrust of the common wisdom. It can give an edge and a bite to your sense of humor. And it can be cathartic.
To me it's a sublimation of disappointment.
Sorry Q, I think I misread your post in a post call state of mind.
If I take you to mean compassion should be maintained despite all challenges....then absolutely I agree.
What I would say though is that cynicism to me is the struggle to maintain oneself against the absurdity of the modern condition. Violent spasms of absurdity populating every aspect of one's activity from the time you start to try to become a doctor.
One aspect of absurdity is that what we are expected to show to gain admission to the profession is so clearly at odds with a realistic day-to-day affect that we have in the lives of our patients.
I don't think it's mutually exclusive to be cynical about the space of doctor and patient being one of absurdity and giving yourself wholly to the companionship of the person in it with you.
You don't get to be 300 lbs without stuffing your face with garbage and laying around on your @ss, and yet my team is tinkering with your insulin dosages and all of your fat person medical problems, in scientific isolation. I could spend a career investigating the grays of degrees in pharmaceutical efficacy in some narrowed parameter in the health of the obese and people will multiply their ranks in this morbidity by the millions nonetheless. You would have to be out of your f'n mind not to be cynical about the repetitive nature of these encounters. It's a healthy reaction.
That doesn't have to mean I don't have compassion for my obese patient. In fact maybe my cynicism forces me to think out of the box to try to reach the person. To inspire any attempt to actually modify lifestyle instead of continuing to diligently chart my way along the person's natural decline towards death. In perfectly reasonable and responsible medical management.
So I see cynicism as an active struggle of the mind against the futile and the inevitable.
If I take you to mean compassion should be maintained despite all challenges....then absolutely I agree.
What I would say though is that cynicism to me is the struggle to maintain oneself against the absurdity of the modern condition. Violent spasms of absurdity populating every aspect of one's activity from the time you start to try to become a doctor.
One aspect of absurdity is that what we are expected to show to gain admission to the profession is so clearly at odds with a realistic day-to-day affect that we have in the lives of our patients.
I don't think it's mutually exclusive to be cynical about the space of doctor and patient being one of absurdity and giving yourself wholly to the companionship of the person in it with you.
You don't get to be 300 lbs without stuffing your face with garbage and laying around on your @ss, and yet my team is tinkering with your insulin dosages and all of your fat person medical problems, in scientific isolation. I could spend a career investigating the grays of degrees in pharmaceutical efficacy in some narrowed parameter in the health of the obese and people will multiply their ranks in this morbidity by the millions nonetheless. You would have to be out of your f'n mind not to be cynical about the repetitive nature of these encounters. It's a healthy reaction.
That doesn't have to mean I don't have compassion for my obese patient. In fact maybe my cynicism forces me to think out of the box to try to reach the person. To inspire any attempt to actually modify lifestyle instead of continuing to diligently chart my way along the person's natural decline towards death. In perfectly reasonable and responsible medical management.
So I see cynicism as an active struggle of the mind against the futile and the inevitable.
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first, residency is not all gloom and doom. It just contains a lot of obstacles. The further along you get, the better at it you get, and it becomes less painful, and maybe even halfway enjoyable. But sure, running around the hospital at all hours of the night, sleep deprived, cranky, and not having had a good meal or seen you home in days isn't everyone's idea of fun. It's not hard to see how such a person might be inclined to be cynical.
Second, I wouldn't characterize the patients so much as obstacles, and I wouldn't worry so much about losing compassion. It's more of a different analogy. It's more like being one of those variety show folks who are spinning a dozen plates on sticks. The patients are the plates, and every call night you are doing your darndest to keep all those plates spinning, the whole night through. It's hard work, and you are on high alert the whole time. You absolutely feel bad every time a plate falls and smashes, but you don't really have time to stop and think about the fallen, because all your other plates are getting wobbly. You get very very adept at spinning plates. You also get very good at not dwelling on the ones that didn't make it. You still feel bad, but handle it much better the further along you get.
I can't help but to note....with cynicism....the pattern of this conversation is the love affair with hierarchy in medicine played out to a T.
You can't even have your cynicism or for distaste for it without working it up the chain. Haha! We're all f'd in the head.
You can't even have your cynicism or for distaste for it without working it up the chain. Haha! We're all f'd in the head.
QofQuimica
Seriously, dude, I think you're overreacting....
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That's what I mean. If you don't see caring for patients as your real work, then wtf *is* your real work? Making phone calls? Entering orders or notes into an EMR? Spending 45 minutes with your team blocking the hallway to discuss whether to replete a potassium of 3.4? Yeah, you have to do those things when you're in training, but they're not real work.
FWIW, I don't see being realistic and being cynical as the same thing. Being realistic means knowing that your 300 pound patient is probably not going to become a 200 pound patient even though you (and they) know that being 300 pounds is ruining their health. But you still give them your best effort anyway, because that's your job. Being cynical means that you figure, why bother, since nothing I do is going to change anything anyway? And that inevitably leads to giving that patient substandard care as if you were punishing them for not doing what you told them to do.
See, now, I'd argue against thinking of patients as plates at all. Or as any other inanimate object, for that matter.Law2Doc said:
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It is difficult to not get cynical when you have patients coming in demanding certain drugs, drug addicts using resources for their fix, you get yelled at by patients and families, administrators, and feel you disappoint yourself and your attendings when you don't know enough (which is frequently especially as an intern).
You work your butt off, have little time to enjoy life, get paid darn little, and for this privilege you get treated like crap by many (usually patients). You argue with people on websites who insist you are a total ***** because you obviously misdiagnosed their bugbite which is so totally a leukemic vasculitis because the internet says so right here, and why aren't you running all these tests (or why are you running all these tests) and what do you mean it takes a couple hours until my mother is going for an MRI for knee pain she has had for 27 years? It's an emergency NOW NOW NOW NOW NOW. And I can't BELIEVE you aren't in her room the entire time she has been here. What do you mean we only see the doctor once a day? What are we paying for? I'm sorry you have 17 patients all crashing and are running two codes at once, one via phone, but doctor your patient hasn't pooped in 17 hours and I need something NOW before I go on my break. Oh, and the patient in room 27145 is leaving because you won't let her have fried chicken and sausage now that she has had her 17 stents placed 3 hours ago for her horrible coronary artery disease. Don't get me started about resident clinic. We had to call the cops more than once for a patient going bezerk when you say you won't give them more pain medication. Oh, and that patient who insists on eating 13 bags of snickers even though she is a diabetic with an A1c of 28? You get penalized for that one because "the patient WANTS to be better - you are failing them as a physician."
Yeah. you get a little cynical. In spite of that, however, the work can be rewarding, and there are still people out there who value a good physician, good clinical judgment, and want to learn what you impart about their health and well being, and the constant learning can be fabulous if you thrive on that sort of thing. Unfortunately, administration, dealing with insurance companies and unreasonable patient demands are becoming a rather large unpleasant slice of the job.
You work your butt off, have little time to enjoy life, get paid darn little, and for this privilege you get treated like crap by many (usually patients). You argue with people on websites who insist you are a total ***** because you obviously misdiagnosed their bugbite which is so totally a leukemic vasculitis because the internet says so right here, and why aren't you running all these tests (or why are you running all these tests) and what do you mean it takes a couple hours until my mother is going for an MRI for knee pain she has had for 27 years? It's an emergency NOW NOW NOW NOW NOW. And I can't BELIEVE you aren't in her room the entire time she has been here. What do you mean we only see the doctor once a day? What are we paying for? I'm sorry you have 17 patients all crashing and are running two codes at once, one via phone, but doctor your patient hasn't pooped in 17 hours and I need something NOW before I go on my break. Oh, and the patient in room 27145 is leaving because you won't let her have fried chicken and sausage now that she has had her 17 stents placed 3 hours ago for her horrible coronary artery disease. Don't get me started about resident clinic. We had to call the cops more than once for a patient going bezerk when you say you won't give them more pain medication. Oh, and that patient who insists on eating 13 bags of snickers even though she is a diabetic with an A1c of 28? You get penalized for that one because "the patient WANTS to be better - you are failing them as a physician."
Yeah. you get a little cynical. In spite of that, however, the work can be rewarding, and there are still people out there who value a good physician, good clinical judgment, and want to learn what you impart about their health and well being, and the constant learning can be fabulous if you thrive on that sort of thing. Unfortunately, administration, dealing with insurance companies and unreasonable patient demands are becoming a rather large unpleasant slice of the job.
I disagree. Knowing something won't make a difference--cynicism--and doing your best by them is being a poet warrior. Imagining yourself going around saving souls and health--naïveté--is being a grandiose delusional fool, to which natural cynicism is a healthy immune defense against.
Lot's if not most of the things I do are completely useless--cynicism--and yet I do what feels right including getting paid well to work hard in the service of others--reaffirmation of myself without regard of moral reward and without woofing down a hypocrisy burger with a side of self-importance, common among the physicians who consume their own mythology.
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Patients eating bags of Snickers, contracting STDs, delivering crack babies, and going berserk are symptoms of our society. Due to unfortunate circumstances, they aren't self-aware. Many will push on to fulfill the natural role they've inherited (ignorance) and destroy themselves with poor decisions. Doctors can't fix this. These are cultural problems and take generations to heal.
Consider this:
Our path from premed through medical school demands incredible will power, sacrifice, and hard work. While we toil through academia, surrounded by fellow intellectuals and witty peers, we tend to become sheltered. The ugliness, chaos, and senselessness of reality can be shocking and so it's easy to build a wall of cynicism (perhaps to cope?). Patients shouldn't be expected to react as we would or to show equal reserves of will power and logic.
Don't let patients affect your ego. Your own good work and accomplishments should feed it.
I started premed 10 years ago and quickly became disenchanted because I was caught up in becoming a doctor for the wrong reasons. Since then, I've experienced other fields and real-world ugliness and beauty. I've done enough soul-searching to know I'm pursuing medical school for the right reasons and this understanding fuels my determination.
Consider this:
Our path from premed through medical school demands incredible will power, sacrifice, and hard work. While we toil through academia, surrounded by fellow intellectuals and witty peers, we tend to become sheltered. The ugliness, chaos, and senselessness of reality can be shocking and so it's easy to build a wall of cynicism (perhaps to cope?). Patients shouldn't be expected to react as we would or to show equal reserves of will power and logic.
Don't let patients affect your ego. Your own good work and accomplishments should feed it.
I started premed 10 years ago and quickly became disenchanted because I was caught up in becoming a doctor for the wrong reasons. Since then, I've experienced other fields and real-world ugliness and beauty. I've done enough soul-searching to know I'm pursuing medical school for the right reasons and this understanding fuels my determination.
But. It's quite possible that that is just my way of scripting my own internal dramatic conflict. Insensible to anyone. I just like a cynical hero role for myself. And I can't accept that I'm the bad guy. So this is how my comic book goes.
Cynical dr cox from scrubs like guy convinced the entire world is a bull**** merry-go-round but steadfast to the patient in front of him, to only the patient. against the world. A cynic without a cause. Starring me.
Cynical dr cox from scrubs like guy convinced the entire world is a bull**** merry-go-round but steadfast to the patient in front of him, to only the patient. against the world. A cynic without a cause. Starring me.
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Good luck on that.
What we (and those co-workers) are trying to point out is almost certainly going to be an interview question.
Why a doctor specifically?
Your coworkers all know that, "for patient care" or "practicing a healing art", aka - whatever cliche you can come up w/ is EASILY countered by, "well why not PA or nurse, or associated healthcare profession"
I am an MS3 but I vibe w/ what has been said here so far too. In the basic science years, when you sit on your duff studying 12-14 hrs day (man, I wish I was exaggerating) you are motivated by something like, "it will all be worth it when I get to patient encounters and clinical medicine" Cuz being a desk-jockey, studying your brains out...NOT fun. Even the nerdiest of the nerds I knew in my class at some point would get very angry and think, "THIS IS RIDICULOUS". They are supposed to be the ones who ENJOY studying. What about the rest of us.
Then you isolate yourself from most of your loved ones. You can have a significant other, even another fellow student, HOWEVER, there's no ways about it, you need 1/2 a day by yourself, just to study.
Fast forward to clinical 3rd year. The patients you see, a large number of them, will be bluntly put, stubborn or just stupid. For every really sweet old lady w/ atrial flutter and low GFR who is a joy to see, there's 5-6 "stubborn or just stupid" people. The guy who my preceptor refuses to admit anymore because he'll show up DKA every other day because he truthfully believes he doesn't need his insulin! The generalized seizures guy who won't stop huffing spray paint. The obese woman on a restricted diet, who has her family just bring her Burger King anyways cuz she doesn't like the way the hospital food tastes.
Great! And so I (we) ask ourselves, WTF were the last 2 years of toil for when these are the people we want to "practice a healing art" for?? This is what you need to be aware of.
Do I feel like I totally got hosed pursuing this dream? ABSOLUTELY NOT. Because I didn't have any of those cliche answers for my reason to wanting this. I am still highly fulfilled in the ways I anticipated by becoming a physician. I am still in awe everyday I get to don my white coat, scoot to the hospital and round.
But if the cliches are your only reason up to this point, take heed on what is being told to you. A majority of your patients won't think ANYTHING even remotely noble or respectful of you. They'll NOT listen to you, and then ask you about the bill and talk down to you. And if that was my onus, heck yeah, I should have saved my time and $$ and just went to PA school.
Good luck!!!
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Question- are you all cynical towards the patients or about the patients? I'm asking in the context of patients blaming you and/or non-compliance. Do you yell at them back? Do you call them idiots and say they're going to die? If not, what's preventing you?
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I flourish in these situations. I like the dark and macabre side of humanity. It doesn't discourage me. I love to help and at the same time I love the ridiculousness, the stupidity, and the ignorance of it all. It's part of why I want to be a doctor. It's a shame that medical school admissions members would rather admit a happy-go-lucky idiot into medical school -- a financial death sentence -- rather than a cynical bastard who has a vague idea of what he's getting into.
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Patients have lots of avenues to complain about you, and you can be fired for not behaving professionally. So no, you aren't going to yell back at your patients, call them idiots, etc. In appropriate contexts, you can provide them with evidence that their habits will shorten their lives, and you can tell them firmly they need to quit smoking, using drugs, alcohol, having unprotected sex with prostitutes, etc.
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The tank will run empty at some point. When it first runs out and how and if it is replenished will depend on your individual experience
You so get me. We should have an online bromantic fling.
Kidding, but yeah, why it's considered less than to recognize the darker side of things has never made sense to me.
I would say my cynicism is directed at the world that surrounds the encounter, the culture of medicine, and the unreasonable expectations that the doctor mythology creates. People watch too much f'n TV. And yes I feel comfortable saying to someone they're going to die. I was the only one on my team who would engage the smoking habit of our schizophrenic pregnant patient with any earnestness. I told her 4 times her baby was getting hurt by the cigarettes and that were like to kill her if she continued to using them. So ascribing darker meanings to what makes the world tick obviously does not impede the intensity of my engagement with our enterprise. I would maintain that there is fragility in the opposite perspective that makes them cringe with situations that don't inherently feed the physician-as-morally-superior-hero dynamic.
Consider the maternal fetal medicine service at my hospital. They go to the wall for the highest risk patients in the country. Doing what no one else will do. And when things go wrong, and things always do when you're the one they go to when things are way passed F'd. Then here they come with a sharky lawyer to comb through every single thing you wrote in the chart, any minute error in any aspect of documentation and you can get screwed. And even when you don't...how does it feel to be dragged I to court to get grilled for doing your job thanklessly. ?.
So yeah....the pain of that I see I their eyes....it through the gaze of cynicism.
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I'm the same way. Usually, I can enjoy the absurdity of people's behavior and how they're interacting with the system. But when pressed with 60-70 hours a week of it for several weeks, sometimes with only a few hours of sleep over the course of a few days, it takes it out of you. You're not the same person. Situations that you would've previously discussed calmly and rationally with patients (then chuckled about after leaving the room) will have you either washing your hands of them and letting them do as they please, or getting argumentative and causing the situation to escalate.
I remember working part time as a tech in the ED to gain some experience and pay down loans as I was working on my bachelors degree. I saw all the jaded, bitter people too and said there's no way I'd be like them. Fast forward a few years later to a gap year where I sometimes worked 21 days straight, 8-16 hours per day, and I occasionally found myself thinking about and interacting with patients in ways that would've been inconcievable before (though I like to think less egregious than what I saw in some of my coworkers), and that I would later be embarrassed about when I wasn't so burned out. One of my fellow techs did the opposite. He worked full-time and then some, but cut down to 20 hours a week when he went back to school. He went from cynical back to the incredibly positive nice guy that he really was.
Now consider that while we were the low men on the totem pole and got dumped on accordingly, the buck didn't stop with us, and we didn't have to bear the brunt of patient non-compliance and unrealistic expectations. That went to the physicians. I completely understand why they feel the way they do. I'd caution you not to dismiss it, but to take it as a warning. I'm almost completely certain that it can happen to you too. No matter your mindset or how well fortified your internal defenses are, you're still human.
Now that I'm a medical student in my pre-clinical years and safely removed from those unpleasantries, I can say that I'm looking forward to getting in there and dealing with patients again. I know I won't have control of how much I'm working during rotations and in residency, but at least I now know that limiting my hours as an attending will make it easier to be the person and physician that I want to be.
There was a thread in the EM forum a while back on burnout. Not surprisingly, the guys who were least burned out tended to live within their means, which resulted in fewer hours. I'm sure it's difficult to say no to a few more hours when it adds up to thousands of dollars per week (I was willing to subject myself to that in the past for a mere $13/hour or so as a tech), but I think it's important. And even if you're head-over-heels in love with patient care, ask yourself how happy you'd be eating your favorite food for every meal of the day. It'd be great for a while, but eventually, you will get tired of that steak/lobster/ice cream.
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Hang up the stethoscope and...do what? Besides spend your life running from the debt collectors.
Anyways, as a physician can't you just write yourself a prescription for fluoxetine or something?
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Ouch! Hang up my stethascope, eh? I guess I though my remark was more blatantly sarcastic and perposterous than it probably was. All in all, being a doctor is as good as any other career and I wouldn't discourage somebody from going to med school if they really want it - there are a lot worse things one can do for a living! And, of course (most) patients aren't just annoying creatures or obsticals - nothing is better than when you actually have the time to spend some time with them and their families.
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I'm an MS-1 and absolutely miserable. My classes are very tedious and I never spend any time with family, friends, or my girlfriend. But you know what makes it worth it? Seeing that white coat hanging in my room, and knowing that I have wanted to do this my entire life, and nothing else would make me happy.
I've been in the business world, and it was just a bunch of unfulfilling crap. I'd rather go through this difficult path for a few years than to spend my whole life doing something you hate. This is the rest of your life that you are talking about. There's a reason you want to be a physician, and if you were anything less, you would probably be unhappy.
I've been in the business world, and it was just a bunch of unfulfilling crap. I'd rather go through this difficult path for a few years than to spend my whole life doing something you hate. This is the rest of your life that you are talking about. There's a reason you want to be a physician, and if you were anything less, you would probably be unhappy.
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So what do you think it is? Is it as simple as feeling worn-ragged?
I've shadowed to doctors in the same family practice group. One jovial, one kinda bitter. They are both close to my age (40ish) and work the same hours and make the same amount of money.
I think, maybe, some people are just better at letting other people's stupidity not get them down.
I also think that some specialties are inherently more "downer" than others. I don't think I'd enjoy doing diabetes all day if that means 80% of my patients don't take care of themselves. (LOL! It's all just silly supposition for me until I start rotations.)
This is the biggest sack of **** sold to premeds and med students. Mindless adherence to an architecture of hierarchy. Once you're big and grown....then.....
Then what?! You slap together a hasty decision on what career you'll spend the rest of your life with doing day in...day out. Don't believe it for a minute. You know yourself better than anyone. You're capable of making incredible leaps of intuition into what sort of activity you like and what sort of thought patterns that satisfy you.
The world is your book. Everything you ever wanted to know written in lives of people you meet. Pieces of yourself reflected in every feeling they put out.
Dead certain I'm going to be psychiatrist and haven't even done my core rotation. Consulted with the psych today from my OB service for a complicated patient. Exhilarated by my interaction with the psych team in the 11th hour of long OB shift. Tickled to my toes that I like something in an otherwise tedious succession of waiting for cervixes to dilate....labor agonies to begin and end and begin again....everyone a technical problem of heads and pelvises and blood sugars and pressures.
You can and should make these assessments. Continuously from now. Like a mormon on a mission.
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It's multifactorial. For some, the hours are a big thing. Others may have just gone into the wrong field (either the wrong specialty or in choosing medicine in general), and some people are just not good at being happy. I think the length and expense of training compounds all these things.
I would say that the average pre-med doesn't have a very good grasp of what the average healthcare consumer is like, or even what the average human is like. So many come from upper-middle class or better, and even those coming out of poverty probably had a more sanitized and polished social environment than that experienced by many of their patients, especially if you're doing rotations or residency in depressed urban areas.
If you went in all about helping people, but then found out that human nature wasn't what you thought it was, I think it would be difficult to not be at least partially dissatisfied with medicine.
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Key word being average...
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And I'd say that it is precisely my understanding of human nature that drives me towards practicing medicine. Life is gritty and messy and usually doesn't make sense like you think it should, but it is also amazing, and joyful, and full of endless opportunities. I appreciate the candidness of this thread.
I do think, sitting on this side of rotations, that it is hard to appreciate what different specialties "take." I love the concept of primary care (so, so much that I love about it), but I would also love to work with cancer patients. I'd love to solve the puzzles presented by neurology (yeah, I know that all fields have them). I kind of feel like my 18-yr old self combing through the (paper) college catalog feeling overly fascinated by so many majors and also a bit disappointed that I didn't invest the time to quadruple-major. (Hence, family practice?)
I feel like I've come across more cynicism at SDN than I have in face-to-face conversations. Perhaps that is because we are liberated by our annonymity to share our true feelings? Or perhaps it is because people shoot off messages when they are feeling particularly over-worked and under-appreciated?
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Abider, I agree with you here. The truth is, however, I haven't had enough exposure to know what my options really are. I think part of the cynicism is based on romantic notions of medical practice being violently torn away during rotations and residency. I recognize that I have some unrealistic ideas about what X, Y, or Z specialties look like.
I've shadowed an endo...I don't want to do that. I like the mental health work family physicians do. I've heard that most psychiatrists are feeling like med-pushers, which doesn't appeal to me. I've worked OB, and know what that entails--I loved it, but I think there is even more I'll love when I get my feet wet during rotations. You know, someone started a thread along the lines of "could you be a colon doc and deal with poop?" Deal with poop? After potty training 5 kids, I'm open to the idea of being PAID do deal with poop. Poop happens...
Somehow I think I'd need more information than what I've gleened from the forums.
Yeah good. It's a funny thing that we all have our tastes. And also funny that we're all together in the anatomy tank and so on until we all scatter into separate corners of the medical universe. The fields really are different from each other. Vastly so. And that makes your job easier in a sense. You're navigating correctly. You can use conversations to sample the intellectual and cultural aspects of a field. And experience and relationships with those with experience to sample the physical. You can glean so much from both. That it's really just a lack of insight and effort and to my earlier point--being lied to--that keeps people from making a sound career choice.
There are limitations in the core curriculum of 3rd year. Many fields you will never know about unless you investigate on your own. So how people can get away with telling others to wait until then to decide is mysterious to me.
Of note. Never listen to what you've heard detractors say about a field. Like OB in my case. I flat don't like deliveries. So whatever I say is distorted by that repulsion. And there are complexities of thought that my mind won't touch in this realm because I'm just a passing traveler. With an emphasis of passing quietly and quickly as I can. In defense of psych, no field has more nonsense propagated about it by so many who know so little. I like psychopharm. And we all use pharmaceuticals. We're all pushed from the artful to the mechanical in the current health care delivery system and economical context. So any comment about that is more universal than specific.
Keep searching like Roy Ayers in 72.
On the one hand, I can see why a lot of young premed people take this naive view towards medicine. All the idealism and lack of real experience aside, you have to factor in the aspect that most won't get into medical school. So, they approach medicine in awe and feeling unworthy. How could someone else look down on it?
But I agree with the others. The attitude is kind of sickening to hear. Medicine is a job, and a really difficult one at that. Is it a good job? Sure, but people are people. They have needs besides a good job... like spending time with their loved ones, having time to recreate, feeling like they didn't let their life pass by them in the library.
The last two years of premed really took a toll on me. I have the competitive grades, MCAT, ECs... but I really shelved all my other needs. And it was damn frustrating. I'm not going to do the same in med school, but premed is just brutally punishing. If people had to endure "premed" throughout their med school and residency days, yeah, I can definitely see how pissed off they would be.
But I agree with the others. The attitude is kind of sickening to hear. Medicine is a job, and a really difficult one at that. Is it a good job? Sure, but people are people. They have needs besides a good job... like spending time with their loved ones, having time to recreate, feeling like they didn't let their life pass by them in the library.
The last two years of premed really took a toll on me. I have the competitive grades, MCAT, ECs... but I really shelved all my other needs. And it was damn frustrating. I'm not going to do the same in med school, but premed is just brutally punishing. If people had to endure "premed" throughout their med school and residency days, yeah, I can definitely see how pissed off they would be.
Yeah man. That's an elegant turn of mind, perspective, and phrasing. You sum up well how differences of what and why cynicism is could develop.
An towards the bolded: They do. And are. Ingenious defense systems have to be employed to protect yourself. And some tracks--I'm convinced--only lead towards burn out and disappointment. And in light of the original topic, cynicism is active engagement with disappointment, a defense against fatigued idealism. If like me....most cynics....are protecting the heart of an idealist.
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What I think, in what I've read, is even tho this is a pre-med thread, folks reading this are "non-trads" so that implies a level of maturity that most college seniors don't possess. Let's face it, REAL LIFE outside the halls of the college cocoon offers one a cold realistic view of life.
I've rounded w/ an attending internist, and yeah, there were some real "pieces of work" but the way I see things, there is so much depth to the human condition. As "stubborn or stupid" some lousy patients might be, I understand there are reasons for their behavior. Reasons we probably didn't have time to delve into and assess. In the end, when I get miffed by a patient encounter, I just make a scenario up, that adds fictional meaning to their behavior.
The alkies who are admitted w/ DT's who are mean and aggressive, I sometimes just make a brief Intervention-esque backstory to them. Understanding there is a hypothetical root cause to anyone's unhealthy behavior(s) enhances your patient encounter to an extent. Whomever wrote about possibly going into psychiatry, that IS something that I would find attractive about choosing it as my specialty.
It also is helpful to remember and understand that most people (including ourselves) are at their worst when they are sick and miserable anyhow.
I've rounded w/ an attending internist, and yeah, there were some real "pieces of work" but the way I see things, there is so much depth to the human condition. As "stubborn or stupid" some lousy patients might be, I understand there are reasons for their behavior. Reasons we probably didn't have time to delve into and assess. In the end, when I get miffed by a patient encounter, I just make a scenario up, that adds fictional meaning to their behavior.
The alkies who are admitted w/ DT's who are mean and aggressive, I sometimes just make a brief Intervention-esque backstory to them. Understanding there is a hypothetical root cause to anyone's unhealthy behavior(s) enhances your patient encounter to an extent. Whomever wrote about possibly going into psychiatry, that IS something that I would find attractive about choosing it as my specialty.
It also is helpful to remember and understand that most people (including ourselves) are at their worst when they are sick and miserable anyhow.
^ This^This, and um ^This. I may get slapped at for chimming in here, but I have been up close and personal to this in my job over a very decent period of time.
The med students aren't the one's that get beaten into the ground. It's the residents. It's like it is some kind of tradition--almost cultish at times. Sadly, it's even expected. I mean I think the kind of residency does make a difference. But if you are talking internal medicine or surgery, something like that, my view has been one of seeing a good amount of certain kinds of abuse with a very low rate of financial compensation for time invested. I get that residency and fellowship salaries are more like stipends, but wow.
I don't know the whole experience, b/c I personally have yet to go through it, but I have lived and worked up very close to it. This is how I know that what Q is talking about is true. I am not saying there aren't better days. It's just hard, and it seems to me as nose-to-the-grindstone as medical school can be, it's nothing compared to most days, weeks, months, and years as a resident physician.
It seems to help if you have some good people to work and let down your hair with. I am not advocating alcohol use for abuse, but a few years after I became a nurse, I worked in a cardiac unit in a hospital that had Friday Liver Rounds. They didn't last all that long, but the were nice, fun. People would go up to the top of floor of the old hospital solarium and kick back. Don't see that too much anymore.
Residents used to have more ways to blow off steam, but darn, all the places are so wickedly uptight about every little thing any more. By the time you can get away from the hospital to let off some of the steam, it's like everyone is just too tired. But in the "old" days, the docs and some nurses used to get together and do some fun stuff right there--like on the roof or some old solarium or somewhere. (To whomever it concerns, get your mind out of the gutter.) You treasure those times when the stress was broken up by people that knew how to laugh and be silly. I remember once a CT surgery resident came around to do night rounds on roller blades. He was awesome. I know another guy that shot methylene blue into the pt's foley bags on St Patty's day. LOL. OK, these were fresh post-ops that weren't looking to have them in very long anyway. Working with people that know how to laugh makes all the difference IMHO. But nowadays some supervisor would shoot out an email about those kind of antics faster than a toilet flushes. (Can't wait to see what the former lawyer has to say about such antics.) No one ever got hurt, and people just knew how to not be so uptight and stressed all the time.
Everything seems to be so rigidly monitored anymore. There are video cameras everywhere, which is fine and good in a number of ways, but there are less and less ways for stressed out people, stuck in a hospital for umpteen hours, to let off steam. The residents used to have more fun when they could. When people are stuck in the hospital all those hours doing grueling work or monotonous paperwork or trying to deal with all the other crap and codes and crises, well they need a release. I say, embrace those with good right brain functioning!
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^ This^This, and um ^This. I may get slapped at for chimming in here, but I have been up close and personal to this in my job over a very decent period of time.
The med students aren't the one's that get beaten into the ground. It's the residents. It's like it is some kind of tradition--almost cultish at times. Sadly, it's even expected. I mean I think the kind of residency does make a difference. But if you are talking internal medicine or surgery, something like that, my view has been one of seeing a good amount of certain kinds of abuse with a very low rate of financial compensation for time invested. I get that residency and fellowship salaries are more like stipends, but wow.
I don't know the whole experience, b/c I personally have yet to go through it, but I have lived and worked up very close to it. This is how I know that what Q is talking about is true. I am not saying there aren't better days. It's just hard, and it seems to me as nose-to-the-grindstone as medical school can be, it's nothing compared to most days, weeks, months, and years as a resident physician.
It seems to help if you have some good people to work and let down your hair with. I am not advocating alcohol use for abuse, but a few years after I became a nurse, I worked in a cardiac unit in a hospital that had Friday Liver Rounds. They didn't last all that long, but the were nice, fun. People would go up to the top of floor of the old hospital solarium and kick back. Don't see that too much anymore.
Residents used to have more ways to blow off steam, but darn, all the places are so wickedly uptight about every little thing any more. By the time you can get away from the hospital to let off some of the steam, it's like everyone is just too tired. But in the "old" days, the docs and some nurses used to get together and do some fun stuff right there--like on the roof or some old solarium or somewhere. (To whomever it concerns, get your mind out of the gutter.) You treasure those times when the stress was broken up by people that knew how to laugh and be silly. I remember once a CT surgery resident came around to do night rounds on roller blades. He was awesome. I know another guy that shot methylene blue into the pt's foley bags on St Patty's day. LOL. OK, these were fresh post-ops that weren't looking to have them in very long anyway. Working with people that know how to laugh makes all the difference IMHO. But nowadays some supervisor would shoot out an email about those kind of antics faster than a toilet flushes. (Can't wait to see what the former lawyer has to say about such antics.) No one ever got hurt, and people just knew how to not be so uptight and stressed all the time.
Everything seems to be so rigidly monitored anymore. There are video cameras everywhere, which is fine and good in a number of ways, but there are less and less ways for stressed out people, stuck in a hospital for umpteen hours, to let off steam. The residents used to have more fun when they could. When people are stuck in the hospital all those hours doing grueling work or monotonous paperwork or trying to deal with all the other crap and codes and crises, well they need a release. I say, embrace those with good right brain functioning!
No one...in the history of people....has said med students have it rougher than residents. And no one has said in this discussion that cynicism is a health care worker to patient one way street.
You're free to love the schmooze and butkissery of making your way up the medical pyramid. Your free to love the company of sharks and cuttthroats and have that praised by your overlords. Your free to love the multi-hundred thousand dollar debt. The constant micro-evaluation of your every move and utterance. Your free to love being a useless tool that the seasoned nurses feel the need to mock and make scurry about in their wake as the plod through the decades on 3-east.
Celebrate it. Pledge allegiance to it. Get patriotic or religious about it.
I will not. I don't think it's any worse than most of the world has it by a long shot. But it needs cynicism to contrast it's methodology of worship and idolatry.
I would never de-value someone's opinion that is at a different point in the process than mine...common though it is to do so....because I've worked harder as a premed at times than I have as a med student as many of you are currently. But I tell you this I will never become that self-infatuated old windbag that loves to hear himself prattle on to the young ducklings. You see....my cynicism won't allow it. I doubt the sincerity and effect of my own words often enough.
Can we get beyond this 1-dimensional thinking about happy bears and angry bears and how angry bears need to go to bed without supper says the medical groupthink type stuff or what? Cause I got plenty of vaginology to work on.
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So what's the secret to discovering the toxic residencies and avoiding them? Seems like the simple answer is rural family medicine, but I'm not even sure that's the truth.
I worked at a clinic in which hazing interns was seen as normal. One day when the queen bee felt the need to turn on me, I just thought, "If I'm going to put up with this crap I ought to have an 'MD' behind my name." I guess I discovered I *could* put up with a fair amount of crap, but only if I felt like what I was learning was worth it. (I was supervising interns at the other place.) I could take it, but I NEVER dished it out. No need to. That's not how competence is developed in any field. Assertive isn't the same as vicious. Some of the stuff I've seen/read is just plain vicious.
I worked at a clinic in which hazing interns was seen as normal. One day when the queen bee felt the need to turn on me, I just thought, "If I'm going to put up with this crap I ought to have an 'MD' behind my name." I guess I discovered I *could* put up with a fair amount of crap, but only if I felt like what I was learning was worth it. (I was supervising interns at the other place.) I could take it, but I NEVER dished it out. No need to. That's not how competence is developed in any field. Assertive isn't the same as vicious. Some of the stuff I've seen/read is just plain vicious.
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I'm only a Chiropractor, so the decisions I make regarding patient care are not life and death. However, I am confronted with patients everyday whom I have to argue with concerning the benefits of rehab and PT after an injury event.
With that said...reading these posts here make me wonder where the cynicism is coming from? In the ~32 years of my life, I have yet to find something that sustained a 24/7 euphoria. Not a single video game, sporting event, job, book, food, sleep, relationship etc. Everything eventually filters down into the nuts and bolts of reality. The issue then becomes a disconnect between what reality is and what we want it to be.
Cynicism is a lack of faith, lack of hope. Why though? Are you worried you are a hamster in a wheel? Running, running, running and getting nowhere? Even if you are, you are still a Doctor. At the end of the day, you are making a living that far supersedes that of a ditch digger, or the janitor who continually mops the floor, who, out of everyone, should have the right to be a cynic.
I always refer family, friends, patients, whomever to Man's Search for Meaning whenever I get the hint of too much cynicism. Living your life everyday with the understanding that you do make a difference, regardless of, or lack of, feedback you get.
As I said, I cannot ever compare the decisions I make regarding my patients to that of your average ER physician; however, we are both in the people business and I have learned that when you invest in people and show them compassion and care for no reason other than they are a fellow human being; that's a rewarding experience.
With that said, I look forward to applying and getting into medical school. I look forward to the adventure of long nights, of texting my girlfriend (perhaps wife some day) that I am sorry I cannot meet her for dinner tonight, I will be at the hospital much longer than I thought. Why? Because this next chapter of my life will give me the ability to have a much greater affect on peoples lives.
I'm excited.
With that said...reading these posts here make me wonder where the cynicism is coming from? In the ~32 years of my life, I have yet to find something that sustained a 24/7 euphoria. Not a single video game, sporting event, job, book, food, sleep, relationship etc. Everything eventually filters down into the nuts and bolts of reality. The issue then becomes a disconnect between what reality is and what we want it to be.
Cynicism is a lack of faith, lack of hope. Why though? Are you worried you are a hamster in a wheel? Running, running, running and getting nowhere? Even if you are, you are still a Doctor. At the end of the day, you are making a living that far supersedes that of a ditch digger, or the janitor who continually mops the floor, who, out of everyone, should have the right to be a cynic.
I always refer family, friends, patients, whomever to Man's Search for Meaning whenever I get the hint of too much cynicism. Living your life everyday with the understanding that you do make a difference, regardless of, or lack of, feedback you get.
As I said, I cannot ever compare the decisions I make regarding my patients to that of your average ER physician; however, we are both in the people business and I have learned that when you invest in people and show them compassion and care for no reason other than they are a fellow human being; that's a rewarding experience.
With that said, I look forward to applying and getting into medical school. I look forward to the adventure of long nights, of texting my girlfriend (perhaps wife some day) that I am sorry I cannot meet her for dinner tonight, I will be at the hospital much longer than I thought. Why? Because this next chapter of my life will give me the ability to have a much greater affect on peoples lives.
I'm excited.
OK Abider. I am thinking you need a nice vacation somewhere.
You are not special b/c you CHOOSE to be cynical and fatalistic. Do you really feel all "pregnant" about how hard life can be, while the rest of us flag-waving rah rahs flitter around smelling roses and licking lollipops. LOL. Really? Talk about one-dimensional thinking.
But you missed it, b/c you can't look within--only out--and with the out, you have decided to take the dark existential side of life.
I won't waste you time singing my swan song of woes, stresses, abuses, unfairnesses, trials, and tragedies. They are those that are "common to all men" (people).
It's what you do with it that counts. And enjoying the company of people that can laugh and let loose a little bit, while working in stressful situations is far from kissing butt for crying out loud. Listen. You can have the ****test work situations and experiences in the world, but working together with others in a positive and even jovial way (when possible) is simply experiencing the joie de vivre that goes along with the painful, interesting and intense, as well as the mundane things of life. We have to take life on the whole. Do you really see the world in black or white?
Listen, just b/c there is rain in my neck of the woods today, doesn't mean the sun isn't shine elsewhere, and that tomorrow the situations won't be reversed, and yes, that it indeed will rain again. Life is about taking all things together in balance. And one of the keys to joy is appreciation.
When we feel downtrodden and somehow victimizied, it's hard to feel appreciative and joyful.
The world isn't all good or all bad. It's both simultaneously, and each of us has to do her/his best to moderate and balance that reality successfully everyday. . .else, what really is the point?
And if there is no point, then nothing matters. . .and in fact we have all just wasted a huge boatload of money, time, and energy.
Really? People are healthy if they live their lives with that kind of thinking???? I don't think so.
All battles first begin within the soul and mind.
Find joy. . .and peace.
Also, I am quite happy with my vaginology.
Geez, no wonder why men tend to not live as long as women. Someone stole your joy Abider, and along with may be your soul. You better keep an eye for it before it's too late.
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Haven't you heard? The future is now.
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This is all degrees of mythology purchasing. What if, no matter how hard you tried, you had the nagging feeling that there really was no point and nothing ultimately matters. Psych. research suggests that people who are prone to depression and "existential crises" are objectively more realistic in their appraisal of situations than those who aren't. So, "happiness" seems to depend on how well or how much of an "untruth" you can swallow over a period of time.
Science and medicine especially are in the exclusive business of shattering mythologies that we typically use as strategy "everything will be OK", "it all works out in the end because it has to", "one more cheeseburger won't hurt", "my blood sugar isn't that high" et al. You start to bump up against God concepts and afterlife questions at this point because where are you supposed to put it all and where are you supposed to find peace in this morass? I am not denigrating any religious pursuit at all but theology helps a lot of people with this problem--"give it all to God" etc.
In medicine, I have met the most real but also the most secular people I know. Suicide rates among male doctors are 1.4 times higher than the national average and a staggering 2.3 times the rate for female doctors. There are obviously many factors at hand with this problem but you start to ask yourself why? Have you watched Lawrence Krauss' "A Universe From Nothing"? Have you thought about how all this hardcore physics, chemistry, biology and behavioral science study followed up by 24/7 human tragedy can make a person feel like this is just an entropic carbon merry-go-round that not only lacks ultimate meaning but will never be known or observed again as it is not even a nanosecond in an infinite and ever-expanding universe?
No?...well,
<---that's all you can do really, lolThis is all degrees of mythology purchasing. What if, no matter how hard you tried, you had the nagging feeling that there really was no point and nothing ultimately matters. Psych. research suggests that people who are prone to depression and "existential crises" are objectively more realistic in their appraisal of situations than those who aren't. So, "happiness" seems to depend on how well or how much of an "untruth" you can swallow over a period of time.
Science and medicine especially are in the exclusive business of shattering mythologies that we typically use as strategy "everything will be OK", "it all works out in the end because it has to", "one more cheeseburger won't hurt", "my blood sugar isn't that high" et al. You start to bump up against God concepts and afterlife questions at this point because where are you supposed to put it all and where are you supposed to find peace in this morass? I am not denigrating any religious pursuit at all but theology helps a lot of people with this problem--"give it all to God" etc.
In medicine, I have met the most real but also the most secular people I know. Suicide rates among male doctors are 1.4 times higher than the national average and a staggering 2.3 times the rate for female doctors. There are obviously many factors at hand with this problem but you start to ask yourself why? Have you watched Lawrence Krauss' "A Universe From Nothing"? Have you thought about how all this hardcore physics, chemistry, biology and behavioral science study followed up by 24/7 human tragedy can make a person feel like this is just an entropic carbon merry-go-round that not only lacks ultimate meaning but will never be known or observed again as it is not even a nanosecond in an infinite and ever-expanding universe?
No?...well,
We're twins separated at birth.
I love this conversation. I love how the responses don't even touch at the shades of grey and the shadows in meaning. Only a fairy tale's belief in the sanctity of our doctorly enterprise. Good guys in tall white hats taking on savages and cynics. Fighting for good and the protection of the innocent.
Any doubt. Any question immediately labeled as a "Mr Poopy Pants has a case of the Mondays!" Or some other vomitus of do-goodery.
All the great comics have a fierce impulse of cynicism. How one could live without that spark is unfathomable to me. It'd be like filling out TPS forms until the end of time.
