Dear patient......

[gasdoc77]

Take a deep breath. Try your best to persevere. Think of the plight of those that came before you. If they survived surely you will too.
After all, it's JUST A GD BLOODPRESSURE CUFF!!!!!

Now put on your big boy pants.

PS if you did anything the least bit active you wouldn't be so marshmallowie and you would have some endogenous endorphins. Perhaps you wouldn't even need this surgery to begin with.

PPS. I apologize to anyone personally offended. I am sure you are the exception and not the rule

---

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[anes]

Agreed. But the thing you have to keep in mind (I was enlightened by a vascular surgeon) is that these people tend not to be the most intelligent. Smoking, diabetes, obesity, inactivity, non compliance with medication, these all tend to occur in low socioeconomic class people. Low socioeconomic class is correlated with lower intelligence. Lower intelligence people probably process information differently than people from a higher SES.

Thinking about it this way has helped me not get angry with these patients.

 

[WholeLottaGame7]

Agreed. But the thing you have to keep in mind (I was enlightened by a vascular surgeon) is that these people tend not to be the most intelligent. Smoking, diabetes, obesity, inactivity, non compliance with medication, these all tend to occur in low socioeconomic class people. Low socioeconomic class is correlated with lower intelligence. Lower intelligence people probably process information differently than people from a higher SES.

Thinking about it this way has helped me not get angry with these patients.

I don't think it's an intelligence thing. I've taken care of some pretty simple farmers that will come in with half their arm chewed off from a farming accident and not complain about it. It's more a lifestyle/willpower issue than an intelligence issue.

 

[anes]

I don't think it's an intelligence thing. I've taken care of some pretty simple farmers that will come in with half their arm chewed off from a farming accident and not complain about it. It's more a lifestyle/willpower issue than an intelligence issue.

Farmers and other industrious/hardworking people tend to be appreciative of the care we give and not complain. I wouldn't say that farmers are less intelligent than the general public. The type of people I'm referring to are generally the govt assistance, trailer park, ghetto, etc. variety. These people are likely lower on the SE scale secondary to intelligence.

 

[BobBarker]

Yes, and farmers are not lower on the socioeconomic scale. They just value things differently. My uncle has a million dollars out in the pasture mooing.

 

[deleted171991]

I just love the kind who whines from the BP cuff or from a 22G IV, before having plastic surgery. If you think it hurts now, wait till you wake up!

 

[G0S2]

Intelligence? Just look at some of the docs around you. I know many in 50-60's with health issues such as DM2, AF, HTN and obesity.

 

[anes]

Intelligence? Just look at some of the docs around you. I know many in 50-60's with health issues such as DM2, AF, HTN and obesity.

You can't deny the evidence. These diseases occur predominantly in lower SE classes. If you compare 50-60 y/o physicians with 50-60 y/o welfare recipients who do you think will be healthier?

 

[G0S2]

I never denied the evidence that low SE status leads to more things like drug abuse and more health issues. No brainer. Intelligence is one component.

 

[kingcer0x]

Dear patient.. if you want me to understand your plight about how you could not afford your insulin/BP medicine/food other than taco bell, put the iPhone and keys to the BMW away.....

 

[WholeLottaGame7]

Farmers and other industrious/hardworking people tend to be appreciative of the care we give and not complain. I wouldn't say that farmers are less intelligent than the general public. The type of people I'm referring to are generally the govt assistance, trailer park, ghetto, etc. variety. These people are likely lower on the SE scale secondary to intelligence.

How are you defining intelligence then? There are a lot of types of intelligence, I'll give you that, but it seems like we're talking about either global intelligence or health literacy, neither of which farmers would rate particularly highly on. I'm referring to the rural, didn't finish high school, subsistence and maybe a little something extra farm. Not running one of these big industrialized farms.

Also, the sword cuts both ways. They are probably lower on the SE scale due to intelligence, but their intelligence is also probably on the lower side due to their SE status.

 

[WholeLottaGame7]

I just love the kind who whines from the BP cuff or from a 22G IV, before having plastic surgery. If you think it hurts now, wait till you wake up!

My favorite was the guy complaining of the 20g IV before his open AAA which we couldn't epiduralize for. I usually try to reassure people before surgery, but I couldn't help but tell him (paraphrased): "Sir, they are going to fillet you open from stem to stern. In a couple hours, this IV will be the very least of your problems."

 

[deleted171991]

I never denied the evidence that low SE status leads to more things like drug abuse and more health issues. No brainer. Intelligence is one component.

Un(der)diagnosed anhedonia and depression are another.

 

[anes]

How are you defining intelligence then? There are a lot of types of intelligence, I'll give you that, but it seems like we're talking about either global intelligence or health literacy, neither of which farmers would rate particularly highly on. I'm referring to the rural, didn't finish high school, subsistence and maybe a little something extra farm. Not running one of these big industrialized farms.

Also, the sword cuts both ways. They are probably lower on the SE scale due to intelligence, but their intelligence is also probably on the lower side due to their SE status.

My definition of intelligence is that which we commonly measure, meaning IQ. I'm not talking about musical intelligence or sports intelligence or anything other than straight up IQ. I would argue that farmers (albeit without any supporting) on average have higher IQs than welfare recipients (with supporting studies). I will give you that culture plays a role in how patients respond to pain/anxiety. But I would still argue that intelligence (IQ) is more important in their response. This is an extreme example, but it should illustrate my argument. Take two patients, both 15, both from the same neighborhood, parents work the same jobs. Make one of them mentally ******ed and the other a straight A student. Which one will you have more trouble placing an IV in? My argument is that the different response of the two is mostly due to a difference in intelligence, and thus processing information differently.

I would disagree with your last point though. The first part (low on SE scale due to low intelligence) is correct. But I wouldn't agree that their intelligence is low because of SE status. I would argue that intelligence is almost completely genetic with little environmental influence. People with higher intelligence will gravitate towards higher levels of education (as compared to peers in their SE class), and because of this their SES increases.

 

[deleted171991]

I would argue that intelligence is almost completely genetic with little environmental influence. People with higher intelligence will gravitate towards higher levels of education (as compared to peers in their SE class), and because of this their SES increases.

It is mostly genetic (paternal) and rarely mutates between generations (except when the father is older, hence all the famous geniuses and idiots born to fathers above 40).

 

[pgg]

Drama queen patients come from all socioeconomic strata.

SES at birth is highly predictive of SES in adulthood. The US and western Europe might have the best economic mobility in the world but it's still a very steep hill to climb out of poverty.

And I think y'all are barking up the wrong tree by bringing IQ into the discussion. Scratch the super-geniuses and the unfortunates with extra chromosomes (ie the tails of the bell curve) from consideration and I don't believe there's any correlation to a patient's pain-in-the-ass quotient to how smart they are or aren't.

 

[Random Anesthesiologist]

For sure. I've known some really smart people who whine a lot, can't handle pain well, etc.

 

[Triple AAA]

The best are the gang-bangers who act all tough on the street and then whine like little girls when they need sutures for their GSW/stab wound.

 

[anes]

Drama queen patients come from all socioeconomic strata.

SES at birth is highly predictive of SES in adulthood. The US and western Europe might have the best economic mobility in the world but it's still a very steep hill to climb out of poverty.

And I think y'all are barking up the wrong tree by bringing IQ into the discussion. Scratch the super-geniuses and the unfortunates with extra chromosomes (ie the tails of the bell curve) from consideration and I don't believe there's any correlation to a patient's pain-in-the-ass quotient to how smart they are or aren't.

The most important predictor of SES is intelligence. People from low SES tend to have lower IQs because they are genetically inclined to have lower IQs. The exception to intelligence as a predictor of SES are obviously athletes, actors, musicians etc. These people may have a different type of "intelligence", but those lessor predictors.

I'm probably overstating the impact of intelligence on emotional response. However, I've always been intrigued by the impact of culture/genetics on how people act. I tend to look at most issues in this light. Either way, thinking that a patient who is over-dramatic is dumb has helped me not get upset/angry with them. It's a coping mechanism for me.

 

[pgg]

The most important predictor of SES is intelligence.

No it's not. It's birth zip code, i.e. the SES of one's parents.

People from low SES tend to have lower IQs because they are genetically inclined to have lower IQs.

IQ is measured by exams that measure much more than whatever definition of IQ is advertised by the exam. Literacy for one, prior practice taking similar exams in the past (they are often game-like and there's a learning curve), the subject narrowness, short-term memory, on and on and on.

On this very forum, you'll find widely differing opinions with regard to whether or not the ABA's written exam adequately assess an anesthesiologist's knowledge of anesthesia; yet IQ tests are somehow reliable judges of something as complex and nebulously-defined as intelligence?

I'm probably overstating the impact of intelligence on emotional response. However, I've always been intrigued by the impact of culture/genetics on how people act. I tend to look at most issues in this light. Either way, thinking that a patient who is over-dramatic is dumb has helped me not get upset/angry with them. It's a coping mechanism for me.

Fair enough.

Whether a patient's poor behavior is a result of genetic IQ, parenting, culture ... I have to admit one of the reasons I picked anesthesiology over primary care was because in the worst case I only have to put up with bad behavior a short time, and 200 mg of propofol improves everybody's behavior.

 

[anes]

No it's not. It's birth zip code, i.e. the SES of one's parents.

IQ is measured by exams that measure much more than whatever definition of IQ is advertised by the exam. Literacy for one, prior practice taking similar exams in the past (they are often game-like and there's a learning curve), the subject narrowness, short-term memory, on and on and on.

On this very forum, you'll find widely differing opinions with regard to whether or not the ABA's written exam adequately assess an anesthesiologist's knowledge of anesthesia; yet IQ tests are somehow reliable judges of something as complex and nebulously-defined as intelligence?




Fair enough.

Whether a patient's poor behavior is a result of genetic IQ, parenting, culture ... I have to admit one of the reasons I picked anesthesiology over primary care was because in the worst case I only have to put up with bad behavior a short time, and 200 mg of propofol improves everybody's behavior.

The ABA written exam (like IQ) is definitely the best measure we have to gauge an anesthesiologist. The same way the SAT/ACT is a predictor of college success. The MCAT a predictor of medical school success. The USMLE a predictor of residency success.

Read "The Bell Curve" by Hernnstein and Murray. Read it with an open mind. The book generated unwarranted controversy for racial implications, this was not their intent.

Their whole argument is that IQ is the biggest predictor of SES. They actually place a challenge to people who don't believe the importance of IQ in predicting SES. They say "Anyone who does not like the way IQ dominates this thing called 'socioeconomic status' in producing social outcomes should come up with another way of measuring the environment".

I will quote them again ... "Among non-latino whites...bright (higher IQ) children of laborers (farmers etc) tend to do well in life, despite their humble origin". So your argument that Zip code is import is correct, but for the wrong reason. People from low SES neighborhoods tend to have lower IQs. Lower IQ is directly correlated with low SES. Low IQ and Low SES are intimately related both forwards and backwards. But, if you have a high IQ and come from a low SES, you have a great likelihood of upward mobilization.

 

[deleted171991]

That was exactly my experience living under communism (as a child) then a socialist democracy (as an adult), where education was (almost) free, so all it took to grab it was IQ and hard work. In a true democracy and market economy, I don't think anything beats good education for self-improving one's SES.

The reason why low/high SES begets low/high SES is not only the IQ, but the culture and the multigenerational experience that is being passed on. We all stand on the shoulders of giants, some of them in our own families.

 

[pgg]

I read The Bell Curve when I was an undergrad, right after it was published. I didn't really agree with it then, and at the time I was far more inclined to favor nature over nurture than I am now. It's sure sold a lot of copies, but bottom line I don't agree with its premises, data analysis, or conclusion.

"Intelligence" is very complex, multi-faceted, and hard to measure. Personal economic success, even in the most meritorious of the world's meritocracies, is heavily dependent upon one's parents ... their economic success, their non-divorced/singleness, their cultural values. Distilling socioeconomic success down to a single (ill-defined hard to measure) biologic trait is somewhere in that triangle between naivette, wishful thinking, and danger. IMO.

 

[pgg]

The reason why low/high SES begets low/high SES is not only the IQ, but the culture and the multigenerational experience that is being passed on. We all stand on the shoulders of giants, some of them in our own families.

I think IQ is far, far less important than what you call "culture and multigenerational experience" - I think it's about 96% "culture and multigenerational experience" and maybe 4% IQ. To fabricate some numbers.

Take our profession: you don't need to be very smart to be a doctor. Really, you don't. You can't be stupid, of course. The supercompetitive fields tend to be dominated by very very smart people, but that's more a function of the USMLE gateway, less a function of how smart you have to be to do those specialties. (Lookin' at you, derm. ) Mostly what you need to be a doctor is perseverence and good ass calluses to sit through lots and lots and lots of school. (It helps to have wealthy parents, too.)

The kids going to a lousy school in Detroit aren't genetically inferior to my kids in their private and public suburban whitebread schools. If the Detroit kids go to college, they'll incur high debt. My kids' tuition is already paid. Some few of the Detroitees might exit on equal academic footing with my kids, but they won't be in the same socieconomic class because they'll have debt. (And when they go job hunting, their resumes are more likely to have ethnic sounding names, which won't help.) My kids are brilliant and beautiful, but that's not why they're on the fast track to the upper class. I was born in La Jolla, and they were born in Bethesda ... not Detroit.

 

[deleted171991]

The kids going to a lousy school in Detroit aren't genetically inferior to my kids in their private and public suburban whitebread schools. If the Detroit kids go to college, they'll incur high debt. My kids' tuition is already paid. Some few of the Detroitees might exit on equal academic footing with my kids, but they won't be in the same socieconomic class because they'll have debt.

I agree. The educational-industrial complex has to go. We should be as concerned about the cost of education in the US as about the cost of healthcare. Education in public universities should be tuition-free, food and lodging offered at cost, and admission should be based exclusively on written examinations, not interviews, resumes, daddy's alumni status, race etc. That would be equal opportunity. </utopia>

Where I went to medical school, there was an anonymized multiday multidisciplinary written entrance exam, which was scored objectively. If they had X first-year spots, the first X candidates (based exclusively on the exam) would become students, the rest could keep on trying the next year, or find an unpopular major that did not fill. There were no accommodations for dyslexia and other conditions which would impact the practice of the profession; everybody ate the same ****.

As you can guess, I am a big fan of the Asian "tiger mother" way of raising kids (it works great, especially on natural born lazy whiners) and can't stand our "everybody is a winner, we cannot hurt their feelings" system.

(And when they go job hunting, their resumes are more likely to have ethnic sounding names, which won't help.)

This is so true. I am still contemplating whether it would be worth Americanizing my name.

My kids are brilliant and beautiful, but that's not why they're on the fast track to the upper class. I was born in La Jolla, and they were born in Bethesda ... not Detroit.

High SES begets high SES.

 

[nimbus]

When I was an undergrad, I started out as a biomedical engineering major. Calculus, linear algebra, organic chemistry, etc were no problem....all As. But I quickly realized it would take a LOT of work and a lot of tutoring to get through differential equations and number theory. I hit an intellectual wall. And the effort required to overcome that was not worth it to me since my primary goal was to attend medical school. I did well as a molecular biology/biochemistry major.

This is to illustrate that depending on your goals, IQ can matter. I would have been a very frustrated engineer, astrophysicist, or mathematician. And people in those professions probably can't understand why their work is difficult for somebody like me. Thankfully medicine ain't rocket science.

 

[BuzzPhreed]

Take a deep breath. Try your best to persevere. Think of the plight of those that came before you. If they survived surely you will too.
After all, it's JUST A GD BLOODPRESSURE CUFF!!!!!

This is when Dr. Buzz:
1) Checks to make sure a wrinkled cuff isn't pinching the arm and rules out Rumpel-Leede syndrome,
2) After (1) is verified, goes into "ignore mode" and just gets the job done.

 

[anes]

This is when Dr. Buzz:
1) Checks to make sure a wrinkled cuff isn't pinching the arm and rules out Rumpel-Leede syndrome,
2) After (1) is verified, goes into "ignore mode" and just gets the job done.

I learned something today. Never heard of Rumpel-Leede before. Thanks.

 

[WholeLottaGame7]

This is when Dr. Buzz:
1) Checks to make sure a wrinkled cuff isn't pinching the arm and rules out Rumpel-Leede syndrome,
2) After (1) is verified, goes into "ignore mode" and just gets the job done.

Maybe they have OI and you're shattering their humerus!

I think we're just going to have to agree to disagree on the intelligence issue.

 

[BuzzPhreed]

I think we're just going to have to agree to disagree on the intelligence issue.

Oh, I don't disagree with you. I just don't care. I've learned what to worry about and what not to worry about. If I got my panties in a bunch with every low-intelligence patient I have to treat I'd have burned out long already. Hence pushing the ignore button.

 

[Numbex]

This is when Dr. Buzz:
1) Checks to make sure a wrinkled cuff isn't pinching the arm and rules out Rumpel-Leede syndrome,
2) After (1) is verified, goes into "ignore mode" and just gets the job done.

3) Makes sure I'm not injecting propofol/roc into an IV on the same arm as the BP which is now cycling. (C'mon, hasn't everyone done this at least once?)

 

[WholeLottaGame7]

Oh, I don't disagree with you. I just don't care. I've learned what to worry about and what not to worry about. If I got my panties in a bunch with every low-intelligence patient I have to treat I'd have burned out long already. Hence pushing the ignore button.

Oh sorry I wasn't agreeing to disagree with you, that was towards anes. I agree, when they get to us, it's far too late to fix whatever psychosocial ills got them into that place. Propofol is the great equalizer.

Also a good reason I chose peds: if someone's going to have a meltdown and cry like a baby, at least it's because they ARE a baby.

 

[Foodie]

Last month, a colleague showed me a patient's arm of Rumpel-Leede phenomenon and neither of us had ever heard of this before. The case was 5 min (lesion removal from neck), under mask GA. Total of 3 BP measurements were taken throughout the whole case. It was incredible how quickly petechiae occurred in that patient.

Now that I know the name of it, I looked it up. Thanks, Buzz.

 

[Lawgiver]

Has anyone taken the LSAT here? Unlike health entrance exams that cover relevant subject matter, the LSAT is basically an iq test and has nothing to do with law, or any other subject in particular. On my first practice test I got a 136. A year and 1200 or so hours of studying, 50+ timed practice tests (actual previous lsats)and thousands of question bank questions later I was scoring in the very high 160s and low 170s, high enough to get me into Mensa.

I was fortunate enough that I had parents that took care of me. And who always encouraged me, maybe even a bit too much. I think most people sell themselves way short. They let society dictate who they are and what they can do.

Before I took the LSAT I had taken the sb5 which my psychology prof administered sophomore year. my iq came back as borderline average, not remotely Mensa material. But being stubborn (and frightened) I delayed applying to ls and decided to study like a mad men to prove to myself that I could do this.

Best part is I never applied to ls cause apparently all I really wanted was to score well on this damn test that everyone at school said was soooo hard. And given my so so gpa I prolly would have not gotten into a ls worth going to anyway.

My experience and point is for those of us in the middle It comes down to 50% hard work, 50% circumstances; because hard work is dependent upon having the freedom to engage in said hard work to begin with.

Those of u turning your noses up at other human beings make me sad.

 

[BuzzPhreed]

Those of u turning your noses up at other human beings make me sad.

To whom specifically are you addressing your comments?

The rest of your post is "feel good" gobbledegook. I took care of a very pleasant mentally-******ed patient yesterday. (Note the word pleasant.) He was also an employed dishwasher in a local restaurant, had health insurance, and was extremely grateful for the care provided to him.

Now you could put this guy through all manner of board prep courses. He probably still wouldn't be able to write his name legibly on the application form.

What we're talking about here (I think) is the self-entitled societal leech who thinks that the world owns them something and that everything in their world should always go "right" no matter what challenges they have or what obstacles they face and regardless of the actual effort they put into it. That living in a free country means you should get stuff for "free". Not people in bad circumstances who are pleasant. Regarding the former you could offer them all manner of opportunity and you know what? They're still not going to take advantage of it. Why work and contribute when you are already having all of your needs met? And nothing should ever, ever go wrong or be challenging or painful.

I'm not going to argue social bias against the poor (which I think is wrong) or racism (which I also think is wrong). What I'm talking about, and what I think others are talking about, is entitlement and acting like a complete dick or whiner to someone who is trying to help you. This is basic human interaction stuff regardless of intelligence or social standing. And that's where society is failing (or has failed). Especially when someone else is paying for your care.

Anyone who bitches that they "can't" or, more likely, "don't want to" do something should have to spend an hour with that patient.

 

[Lawgiver]

I originally included a qualifier regarding not counting extremes but I took it out. Im of course not talking about people with sub 80 iq.

And those folks u describe as leeches probably had parents you'd describe as leeches as well. Also, when someone is receiving care in a medical setting its not abnormal for him or her to be unusually whiny or demanding. Do you also constantly judge people to be of low intelligence outside your work? Id wager not nearly as much.

gooblemewhat feel good? So? My iq will never be above a 90 but I was taught never to give up. How many people out there are labeled by themselves or society as stupid and worthless because no one was there to encourage them from an early age? How many fail once and never try again because perseverance was not something they were taught?

Other than complain about it, what are you people doing to make it better?

 

[BuzzPhreed]

Do you also constantly judge people to be of low intelligence outside your work?

Are you listening? You're sure doing a lot of preaching. I already answered that question several quotations above. I don't let their gripes interfere with the job I do, AFTER I ascertain that there isn't a deeper clinical problem going on. Then I push the propofol.

Other than complain about it, what are you people doing to make it better?

I'm sorry. I wasn't aware that that was my job. Besides, the government already takes close to 40% of my paycheck. What more do you want?

 

[Random Anesthesiologist]

Has anyone taken the LSAT here? Unlike health entrance exams that cover relevant subject matter, the LSAT is basically an iq test and has nothing to do with law, or any other subject in particular. On my first practice test I got a 136. A year and 1200 or so hours of studying, 50+ timed practice tests (actual previous lsats)and thousands of question bank questions later I was scoring in the very high 160s and low 170s, high enough to get me into Mensa.

I was fortunate enough that I had parents that took care of me. And who always encouraged me, maybe even a bit too much. I think most people sell themselves way short. They let society dictate who they are and what they can do.

Before I took the LSAT I had taken the sb5 which my psychology prof administered sophomore year. my iq came back as borderline average, not remotely Mensa material. But being stubborn (and frightened) I delayed applying to ls and decided to study like a mad men to prove to myself that I could do this.

Best part is I never applied to ls cause apparently all I really wanted was to score well on this damn test that everyone at school said was soooo hard. And given my so so gpa I prolly would have not gotten into a ls worth going to anyway.

My experience and point is for those of us in the middle It comes down to 50% hard work, 50% circumstances; because hard work is dependent upon having the freedom to engage in said hard work to begin with.

Those of u turning your noses up at other human beings make me sad.

Yes. I took the LSAT once, on a whim. 163. Decided to pursue medicine instead. I think it worked out fine.

 

[pgg]

I kind of think you and I are in broad agreement that IQ tests can be learned/gamed and that IQ is an uninteresting and non-useful tool for predicting much of anything ... but this did catch my eye, and it's so weird that now I've lost track of the point I thought you were trying to make:

Has anyone taken the LSAT here? Unlike health entrance exams that cover relevant subject matter, the LSAT is basically an iq test and has nothing to do with law, or any other subject in particular. On my first practice test I got a 136. A year and 1200 or so hours of studying, 50+ timed practice tests (actual previous lsats)and thousands of question bank questions later I was scoring in the very high 160s and low 170s, high enough to get me into Mensa.

[...]

Best part is I never applied to ls cause apparently all I really wanted was to score well on this damn test that everyone at school said was soooo hard. And given my so so gpa I prolly would have not gotten into a ls worth going to anyway.

You really put in 1200 hours of studying for the LSAT over a year, ie a half time job studying about 4.5 hours/day, 5 days/week ... studying for an entrance exam, just to take the test for the sake of taking the test.

Are you certifiably insane?

Although in fairness, the last time I had that much free time to kill I was an undergrad, and I mostly spent it drinking and goofing off, not studying for the MCAT, so maybe I was the crazy one. Things worked out though.

 

[Consigliere]

Doggy style