Med students become callous?

[Bushido416]

Article came out from the Journal of Academic Medicine. I was curious as to what yall thought about it. I'm starting medical school this fall and I want to go into a procedural specialty. Do you think med schools are doing enough to prevent the callous building process? Is there anything to do or wrong with it? I've recently read the thread talking about the majority of people not finding the empathy training really helping them. Article below at that html.

http://academicmedicine.org/pt/re/a...yrG83DlxSKvQLQJf!1253064403!181195628!8091!-1

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[Ashers]

How are you supposed to teach someone to have empathy? Empathy training = waste of time. Empathy is something one has or doesn't have. Hopefully, people have it.

In med school you basically have to develop a tough skin, and there still are times you may feel hurt (within a week, I had an attending and a patient tell me I'm "not helping and go away" and that I'm "useless" -- I know this because I know hospitals function perfectly well without med students). You can't go and cry every time someone tells you something you don't like, or yells at you (I got that mostly out of my system as a phlebotomist where I basically did go home and cry every night or tried to avoid going to work). It's not that people then don't empathize with their patients, but they may be able to see the prognosis of certain situations whether it's with patients, colleagues, or wathever.

 

[SocialistMD]

One thing I noticed on surveys like this that I took as a medical student (or that I take now as a resident) is that I don't really answer far from neutral anymore. When I was younger and more idealistic, I thought everything was a matter of life or death. Now, actually knowing what is a matter of life or death, everything else doesn't seem that important. I don't think it is me becoming callous, I think it is me gaining perspective as to what is really important. I'm still nice to my patients and still have empathy, but my perspective if I were to have the disease is different, because my understanding of the range of severity of injuries is much broader now (i.e. before, I would have been like, "Oh no, I have gastric reflux! Woe is me," whereas now I know there are much worse places to be).

 

[nogolfinsnow]

On a checklist that is used to evaluate our interviewing skills there is a box for "use of empathetic statements." So students will actually make sure they say something that sounds empathetic, whether they are truly being empathetic or not just so the observer checks the box. I don't think that telling people how to feel is a good way to teach.

 

[MattD]

Preface: I didn't read the article.


As for not becoming callous... You have to develop a thickened skin. You shouldn't be rude, and you should still care for your patients, but if you "CARE" your little heart out over each and every patient, and personally identify with each of them, you're going to be crushed by an emotional steamroller. It's ok for you to not hurt when your patient is hurting. It becomes a problem when you don't even care that your patient is hurting. It's definitely a problem if you don't even care if friends and family are hurting. Thick skin is normal and necessary. Emotionally numb is not.

 

[soeagerun2or]

When will this hippie PC carebear movement realize that not everyone wants someone to hold their hand and cry with them or jump up and be a cheerleader for them reaching their D-I-A-B-E-T-E-S goal?

 

[angry energy]

this is bull****. a school can teach me how to think, how to treat, how to approach problems, but NOT how to feel.

i feel nothing but contempt for >90% of my idiot patients who can't bring themselves to eat a salad instead of a steak or take a walk instead of watching whatever gay bull**** like deal or no deal.
and in the end, the outcomes of my patients are no different than any of the other doctors, students, np's, or whatever subset you look at. i smile and grin and pretend to care about their pathetic existences, but the second i'm out of the room all that disappears

empathy is nothing. having a good relationship prevents lawsuits. don't teach feelings, teach skills to build trust. but if at this point youre 25+ years old and still can't figure out how to be personable, then ur a misanthrope or just suck at life. go be a hermit.

schools want to be idealistic. its also why all their administrators/ones-that-are-most-involved are in peds, family, general medicine.
you won't find a neurosurgeon/orthopod/ENT/general surgeon (very few, if any) falling into this hippie nonsense. let the psychiatrists deal with that; just do your job and get by whatever means necessary, but dont for a second think that bleeding for your patients helps anyone

 

[Drogba]

this is bull****. a school can teach me how to think, how to treat, how to approach problems, but NOT how to feel.

i feel nothing but contempt for >90% of my idiot patients who can't bring themselves to eat a salad instead of a steak or take a walk instead of watching whatever gay bull**** like deal or no deal.
and in the end, the outcomes of my patients are no different than any of the other doctors, students, np's, or whatever subset you look at. i smile and grin and pretend to care about their pathetic existences, but the second i'm out of the room all that disappears

empathy is nothing. having a good relationship prevents lawsuits. don't teach feelings, teach skills to build trust. but if at this point youre 25+ years old and still can't figure out how to be personable, then ur a misanthrope or just suck at life. go be a hermit.

schools want to be idealistic. its also why all their administrators/ones-that-are-most-involved are in peds, family, general medicine.
you won't find a neurosurgeon/orthopod/ENT/general surgeon (very few, if any) falling into this hippie nonsense. let the psychiatrists deal with that; just do your job and get by whatever means necessary, but dont for a second think that bleeding for your patients helps anyone

You sound like a bit of a misanthrope yourself.

 

[Tired]

You sound like a bit of a misanthrope yourself.

I disagree. He sounds like the running soundtrack in all our heads every day we spend on the wards or in clinic.

Perhaps if schools would do more to help students deal with these thoughts, there would be less callousness. Unfortunately, what they do instead is shove the touchy-feely stuff down our throats, and conveniently ignore the fact that we feel used and disgusted by many of our patients. They lose credibility when they demand genuine empathy for every patient, regardless of their behavior or circumstances of admission.

 

[Drogba]

I disagree. He sounds like the running soundtrack in all our heads every day we spend on the wards or in clinic.

Perhaps if schools would do more to help students deal with these thoughts, there would be less callousness. Unfortunately, what they do instead is shove the touchy-feely stuff down our throats, and conveniently ignore the fact that we feel used and disgusted by many of our patients. They lose credibility when they demand genuine empathy for every patient, regardless of their behavior or circumstances of admission.

I think that is a reasonable suggestion. Not having experienced this so-called "empathy training" myself I can't comment on its content, nor can I come close to fully relating to your feelings of being used or disgusted. However I can say that I have worked with many people whose careers have been dedicated to providing services for some of the most difficult imagineable populations including chronic addicts, homeless and people with personality disorders (none of which need be mutually exclusive) and still maintain an empathetic engagement with their patients. So it is possible to do so. It probably depends a great deal on your own personal moral outlook at least as much as the actual experience itself. From the outside looking it this insensitivity and relative valuation of patients seems to be a powerful defense mechanism that many physicians develop. I could be completely mistaken obviously, as my experience is rather limited.

Hey, if the buddhists can continue to feel and demonstrate compassion to those who have tried to exterminate them then doctors can maintain their empathy even for that wretched drug-seeker.

 

[smq123]

I think that is a reasonable suggestion. Not having experienced this so-called "empathy training" myself I can't comment on its content, nor can I come close to fully relating to your feelings of being used or disgusted. However I can say that I have worked with many people whose careers have been dedicated to providing services for some of the most difficult imagineable populations including chronic addicts, homeless and people with personality disorders (none of which need be mutually exclusive) and still maintain an empathetic engagement with their patients. So it is possible to do so. It probably depends a great deal on your own personal moral outlook at least as much as the actual experience itself. From the outside looking it this insensitivity and relative valuation of patients seems to be a powerful defense mechanism that many physicians develop.

I think that the people that you worked with made their careers on dealing with chronic addicts and people with personality disorders. As you said - they've dedicated their careers to these populations, probably because their personality fits this type of work. Some physicians can also deal well and compassionately with these populations - that's why they chose their field of interest. (Some psychiatrists, for instance, are wonderful at dealing with chronic drug users.)

Others, such as Tired for instance, didn't go into medicine because he wanted to work with these populations. He just has to, as an incidental part of his job. When you must work with these difficult patients out of default, and not by choice, it can make it harder to deal with them.

 

[Drogba]

I think that the people that you worked with made their careers on dealing with chronic addicts and people with personality disorders. As you said - they've dedicated their careers to these populations, probably because their personality fits this type of work. Some physicians can also deal well and compassionately with these populations - that's why they chose their field of interest. (Some psychiatrists, for instance, are wonderful at dealing with chronic drug users.)

Others, such as Tired for instance, didn't go into medicine because he wanted to work with these populations. He just has to, as an incidental part of his job. When you must work with these difficult patients out of default, and not by choice, it can make it harder to deal with them.

Thats certainly reasonable. Discontent oftem arises from being forced to do what one does not want to. Well, residency is only a few years and then these physicians can choose a practice environment that mostly excludes these difficult patients.

Medicine certainly seems to challenge much of one's perception of the world. I guess that is to be expected from a career that situates you in such an intimate way with another human being. It appears that can be both a blessing and a curse especially when considering some of the difficult populations physicians frequently care for.

 

[Arsenic]

When will this hippie PC carebear movement realize that not everyone wants someone to hold their hand and cry with them or jump up and be a cheerleader for them reaching their D-I-A-B-E-T-E-S goal?

seriously, i think its gonna have to wait until our generation takes control of medical education.

 

[PeepshowJohnny]

I disagree. He sounds like the running soundtrack in all our heads every day we spend on the wards or in clinic.

Perhaps if schools would do more to help students deal with these thoughts, there would be less callousness. Unfortunately, what they do instead is shove the touchy-feely stuff down our throats, and conveniently ignore the fact that we feel used and disgusted by many of our patients. They lose credibility when they demand genuine empathy for every patient, regardless of their behavior or circumstances of admission.

Agree, 100%.

To crib from Fight Club, schools are still pushing the "beautiful and unique snowflake" view of patients and it just doesn't work. The school should teach students that they'll be treating patients who are going to be begging for oxycodone so they can sell it to buy enough beer to get wasted, drive home drunk and beat the wife and kids. Or the G10P8 thirty year old. Help them deal with "worst case scenarios" not ones with simplistic solutions and angelic patients.

 

[ftbllstd79]

Medical student will become callous no matter what you do or how you go about teaching them. Thats just the nature of the material we have to learn. It is too much to handle in the time they expect us to learn it. That makes us callous toward the idea of medicine. I think it is inevitable, but those who are in it to help others, learn how to deal with it.

 

[Trismegistus4]

seriously, i think its gonna have to wait until our generation takes control of medical education.

Our generation? If you're at a school where you feel most of your classmates are going to get rid of the hippie PC carebear stuff when they take control, I envy you. 99% of my classmates are totally on board with it.

 

[sprinkibrio]

I think most of the professors/mentors I've come into contact with so far are pretty callous themselves at times. It doesn't mean they don't truly care for the majority of their patients but they definitely tell it like it is. As a result we take on this attitude which is amplified by the crazy lifestyle change and stress that accompanies first year.

Anyways, don't addiction medicine specialists/psychiatrists have to be the most callous/removed of them all? At the same time, however, they can truly care for their patients to be able to continue wanting to treat them. We're just being taught when to turn it on and when to turn it off, while before entering first year we were all very empathetic/idealistic because it was pretty much a requirement for acceptance.

 

[78222]

It doesn't matter how many empathy classes they force us to attend - you can't piss on our legs and tell us it's raining.

 

[Ashers]

Our generation? If you're at a school where you feel most of your classmates are going to get rid of the hippie PC carebear stuff when they take control, I envy you. 99% of my classmates are totally on board with it.

Seriously? My class tends to resent every moment of it. There are probably some exceptions which I don't know about.

 

[Dr. Dukes]

We're callous for a reason: because we have to be. When you're working your shift and a patient on your floor codes, what happens? You rush in, do all this stuff, and it probably doesn't work. You call the family, they all come in, cry, and take the next 3-4 days off to deal with it and get their "stuff" together before going back to work. What do we do? We go check the K on the guy two rooms down. Normal people don't walk from one dead guy to another dying guy and not get callous after a while.
We're in medicine, people die and are rude to us. We deal with, and guess what, stop giving a crap (and therefore, become callous) after a while.

 

[joco7788]

I did some research and shadowed some plastic surgeons this summer. They called me "Smiley" because I reminded them of a younger them. They said I still had a great outlook on the medical field.

They then told me that it would only be a matter of time before I became jaded like them.

Well it certainly has not happened yet, but I suppose I can see why they feel that way.

It is up to the individual to determine how callous they will become.

 

[Occams Razor]

Is it any wonder that most people avoid doctors until they are gravely ill and in desperate need of treatment? (I'm not talking about going to a minute clinic for the flu...I'm referring to preventative care or maintenance).

In case some of you scholars have missed class, a great number of common ailments have strong genetic predispositions, or have infectious origins. Should we blame our patients for not eating steak or not walking, and contributing to their diabetes, whereas even if they did follow your diet plan, they may still have the same disease due to genes? Is it even our job to blame?

Some of the responding Dr. House wannabes should consider how they would feel, being in their patient's shoes. The patient's fears, the patient's anxiety, the patient's pain, and keep it in mind. Or, what if this was your child? your parent? We all remember the golden rule...

2 book recommendations for those having problems with the god complex:
What Patients Taught Me-A Medical Student's Journey by Audrey Young
Singular Intimacies by Danielle Ofri

 

[Drogba]

Not all of societies' ills need be biologicized. There is an obvious and significant social component to many of the ailments that affect Americans, and this is even more true for the global poor. Geneticizing the argument removes both personal agency on the part of the patient and siociopolitical responsibility on part of the government.

 

[Maxprime]

In case some of you scholars have missed class, a great number of common ailments have strong genetic predispositions, or have infectious origins. Should we blame our patients for not eating steak or not walking, and contributing to their diabetes, whereas even if they did follow your diet plan, they may still have the same disease due to genes? Is it even our job to blame?

Thank you for solving the health crisis in the US. Apparently, Americans appeared out of thin air with magically unique and equally terrible genomes. All the places our grandparents came from don't have the same rates of obesity and diabetes as the US because they have better genes that they chose not to pass down - lifestyle has nothing to do with it.

There are obviously people with risk factors and bad genes. I know someone who's family is full of marathon runners that eat very well and they all have cholesterol problems because of a crappy gene. At the same time, they're making the best of it instead of eating McD's 3 times a day and watching American Idol as their physical exertion of the day.

How would I feel if my doc told me I'd die if I didn't lose weight? I'd probably end up admitted for exhaustion because of my silly love of being alive.

 

[MossPoh]

Thank you for solving the health crisis in the US. Apparently, Americans appeared out of thin air with magically unique and equally terrible genomes. All the places our grandparents came from don't have the same rates of obesity and diabetes as the US because they have better genes that they chose not to pass down - lifestyle has nothing to do with it.

Most of those places are catching up pretty fast. Germans and Brits in particular.

I'm not refuting the argument by the way. There are definite groups of people with very very very strong genetic components...mainly american indians.

Anyway, the callous thing. I keep reading the same "you can't teach someone how to think or feel". That is true....if you are a sociopath. Our emotions are modeled every day by what is around us. We tend to feel death is a bad thing and we mourn, cry ,etc. Is that inherent to our being or a part of our culture? Not every culture cries with death, some throw celebrations. I think the real problem with medical education, and I've heard it from the mouths of quite a few doctors, is that they don't really teach you how to handle death or bad circumstances. They throw mountains of information at you, drain your energy, and then expect you to cope with it just dandy. The natural reaction seems to involve becoming withdrawn and callous. It is easier for us. We see that person dying in the room and we say to ourselves "Oh. That is sad. I should leave the family members alone for the last moments" and we go about our business. Not many of us can testify to what those last moments are like when you don't know what the hell is going on around you. Your loved one attached to all sorts of machinery, odd sounds originating from every angle of the room, and you left there, grasping on that final hope that maybe they will come back. Now what can you do that is any different? Sometimes, it comforts people to explain what is happening as it happens. Sometimes they just need the person in the room with them. Sometime sit is right to haul *** out and do paperwork. It is a case by case thing. Doctors all like to think the handle these cases the proper way, but I highly doubt it. I once heard somewhere that the average doc(certain fields probably withstanding) sees a person die 23 times a year (give or take a few). So, roughly every 2 weeks for a large chunk of some of our lives, many of us will see a person die. Callousness almost seems inevitable when you put it on that scale doesn't it? I know I'm going to catch flak for not being a med student yet, but I have seen more people die in person and 1 in a horrendous manner. I have already gotten to the point that some old person doesn't make me feel sad at all, but that 2 yearold child? I bawled my eyes out when I saw that. All of a sudden it just isn't fair when it is a child.

Now, the run of the mill copd and refusing to quit smoking patients, drug seekers, and lazy people. I rarely, if ever, will have sympathy for them.

 

[AwesomO]

seriously, i think its gonna have to wait until our generation takes control of medical education.

The previous generation was probably more reasonable than we are. What happened is that the sane people ran screaming from academic medicine leaving the loonies in the class to teach the next generation of physicians.

As for empathy training heres a novel idea, people tend to be less callous when their lives don't suck so much. You work 80 or more hours a week, have ungrateful patients, crabby attendings, 200K in debt, medicare decreasing your reimburstment/pay a good half decade before you will even see it, the general public whinning about your salary, and then you have people within your own profession trying to tear it down from the inside. You dump that on the average American's lap and they will be screaming for some politician to save them from such an existence. For all those who are furiously typing about how we should just suck it up and we signed up for it or how so and so has it worse, you completely missed the point so don't bother.
If you want less callous physicians try making them happy. It's a novel concept I know and goes against the "Just yell at them till they become happy" dogma we currently have but perhaps worth exploring.

 

[xanthines]

Actually, it would seem they appeared out of fat air!

-X

/Thanks folks, I'll be here all night!
//Try the veal!

[SNIP] Apparently, Americans appeared out of thin air with magically unique and equally terrible genomes. [/SNIP]

 

[Occams Razor]

Americans may not have started out with "bad genes". Heard of evolutionary genetics? Mutations due to increased stress and environmental pollutants?

My post wasn't in reference to "solving the health crisis." Lets be real. My point is that there are multiple factors in any illness- genetic, environmental, as well as financial, social, and psychological factors added in. A callous physician could very well exacerbate the patient's ailments.

That being said, I agree with Moss's assertion that medical training doesn't prepare one for the emotional rollercoaster in a medical setting. Students and residents may learn how to deal with it from observing burned-out, sour attendings who are numb to the suffering of their patients.

I had the opportunity to take a Death and Dying course during my undergraduate studies, and I believe that prepared me well. I believe that medical schools should incorporate this into first semester curriculum-- doing this would ingrain empathy and coping strategies from apprehensions during gross anatomy lab to treating patients. Taught early, these strategies will carry into the field.

 

[TMP-SMX]

Trial by fire. The medical school way.

 

[Pemberley]

That entire study is based on the assumption that it is possible to measure a person's empathy by administering a multiple choice test.

If you asked me to trust a person to evaluate my capacity for empathy, based on extensive one-on-one observation, I would want an evaluator of remarkable character, experience, and perceptiveness. Otherwise how would we be able to distinguish a difference of opinion between the two of us from a defect of empathy on my part?

Aren't these guys a little arrogant (presumptuous? self-satisfied?) to claim that they can take the role of this evaluator with character, experience, and perceptiveness... but without the extensive one-on-one observation -- in fact, that they can evaluate the finer points of the characters of people that they've never even met? With a multiple choice test?

That's got to be one of the bigger loads of horse hockey that I've heard recently.

 

[Tired]

Americans may not have started out with "bad genes". Heard of evolutionary genetics? Mutations due to increased stress and environmental pollutants?

There is no f-ing way that you are in medical school.

If you were, you would recognize that:

(1) the rate of rise in obesity has occurred over the last 30 years, which is far too quick to blame either genetic evolution or even acquired mutations, which would then have to propagate through the population over a period of many generations.

(2) There is a difference between "genetic predisposition" and "genetic disease". In the latter, you get the disease because of the gene. In the former, genes predispose people to developing disease in response to environmental stresses. The thing about genetic predisposition is that, if you avoid the stressors, you are far less likely to develop the disease. So while Native Americans may be more likely to develop diabetes as a sequelae of obesity, if they avoid the obesity they probably won't get the diabetes.

Again, I call BS. You are not a medical student. You are likely a random internet user who believes that reading internet sites makes you "medically educated". But you are not. And you have no idea what you are talking about.

 

[Drogba]

Again, I call BS. You are not a medical student. You are likely a random internet user who believes that reading internet sites makes you "medically educated". But you are not. And you have no idea what you are talking about.

More than likely he is an MS0 who overexcitedly changed their status. Or, he could be completely delusional... Apparently there are many premeds who don't quite get evolution though.

 

[Occams Razor]

Actually, I am a medical student in an accredited medical school. I fully understand evolution, but thanks for the lesson. In reference to the glorified nature/nurture debate we have going, I didn't say diseases are entirely genetic. I said they are multi-factorial, and it's unfair to assume that a disease is solely caused by the patient's behavior or lifestyle, because other variables are present.

Way to take a sentence out of context, folks. Read the rest of the post before you discredit, please.

 

[Na1a]

Actually, I am a medical student in an accredited medical school. I fully understand evolution.

You just proved yourself wrong by making the following statement:

"Heard of evolutionary genetics? Mutations due to increased stress and environmental pollutants? "

Stress does not cause mutations. Let me put it this way: I can send you and five hundred of your relatives to the North Pole to live naked for a hundred years and none of you would grow furr or feathers.

 

[Tired]

I fully understand evolution. . .

Guess we'll have to agree to disagree.

 

[Occams Razor]

I can send you and five hundred of your relatives to the North Pole to live naked for a hundred years and none of you would grow furr or feathers.

We probably would grow thicker hair, however.

But I'll give my dissertation on evolution later...you callous med students have injured my self-confidence.

 

[Na1a]

We probably would grow thicker hair, however.

You just keep putting that foot further in your mouth...

 

[HEADintheCLOUDS]

You just keep putting that foot further in your mouth...

Yeah but because of all the stress your causing him he has mutated and now has a huge mouth that can hold both feet and still talk.........

 

[Tired]

We probably would grow thicker hair, however.

Lysenko lives again!

PS - you're still not a med student.

 

[Na1a]

Yeah but because of all the stress your causing him he has mutated and now has a huge mouth that can hold both feet and still talk.........

Dammit, you made me spit some of my lemonade. Too funny!

 

[da8s0859q]

You just keep putting that foot further in your mouth...

This thread was worth the read solely for the bashing.

As to the idea here: I'm not even in med school yet, and even I got irritated with some of the ridiculous things seen/said in an ED or another doc's clinic when I was shadowing there.

I'd feel bad for the young-ish woman who just received confirmation that she has Huntington's. Horrible.

The 400 lb. 35 yo who gets belligerent because she can't understand that her fat *** explains many of her health issues? Not so friggin' much.

 

[lilnoelle]

All right guys, lets try to be positive and not put anyone down.

 

[Timmythemic22]

Goddamn, Tired... I really hope I'm as on point as you when I reach residency. As it is, I agree 100% with your assesments.

Additionally, it's nice to know there are others out there that also assume a REALISTIC view on practicing medicine.

 

[da8s0859q]

Goddamn, Tired... I really hope I'm as on point as you when I reach residency. As it is, I agree 100% with your assesments.

Additionally, it's nice to know there are others out there that also assume a REALISTIC view on practicing medicine.

mm... I also like reading his posts. His, Panda Bear's, GeneralVeers over in the EM forum, docB, few others.

 

[SomeDoc]

The question is whether med students become callous, or whether medical school disproportionately attracts students with a callous propensity. The path towards getting into medical school is rife with personal sacrifices and opportunities for developing a thick skin- fertile grounds for the development of a distorted sense of entitlement and arrogance. How many of you remember passing on attending social events, etc. as an undergrad because you had to study? Perhaps a relative decrease in social interactions beginning in undergrad years can be added to the mix. By the time these students go into their third and fourth year of medical school, it may be all but too late to do a 180 in terms of personality. All hope is not lost, however, as sometimes the aforementioned may occur by a freak occurence.

 

[la petite mort]

The few times I've had to go to a hospital I've felt instant dislike for nurses and doctors who acted overly casual and "Barney" (you know what I mean) with me. And most of those times were when I was a child (although obviously pediatrics is the one specialty where empathy should be prioritized, although it seems kind of like a redundant statement because who's ever known a mean pediatrician?). Some of them even tried to hug me. Bleh.

In every single field there's a way to be appropiately formal and detached while still seeming approachable to the patient. When I say approachable, I mean someone who listens carefully and answers questions readily. I think that's all the kindness you need in the consult. You're there only to get health issues solved, not to receive a quota of niceness you bizarrely feel entitled to for some reason. I really hate that trend I'm beginning to see whenever I go to the US, from bankers to waiters.

Seriously, though. There's no way anyone can be the best possible doctor for their patients unless they remain focused and aloof.

 

[la petite mort]

this is bull****. a school can teach me how to think, how to treat, how to approach problems, but NOT how to feel.

i feel nothing but contempt for >90% of my idiot patients who can't bring themselves to eat a salad instead of a steak or take a walk instead of watching whatever gay bull**** like deal or no deal.

There's nothing I despise on this planet more than shameless self-indulgence. I imagine those you mention have been repeatedly informed of the harm they're doing to themselves, too.

 

[da8s0859q]

There's nothing I despise on this planet more than shameless self-indulgence. I imagine those you mention have been repeatedly informed of the harm they're doing to themselves, too.

Je penserais que oui...

 

[la petite mort]

Je penserais que oui...

D'accord complètement. What's worse is, those who are self-satisfiedly stupid and giggle when they hear they have to change their bad habits immediately, usually seem to be the ones that expect niceness and hugs.

America has become a nation of fat, spoiled, infantile, expectant adults.

 

[da8s0859q]

D'accord complètement. What's worse is, those who are self-satisfiedly stupid and giggle when they hear they have to change their bad habits immediately, usually seem to be the ones that expect niceness and hugs.

America has become a nation of fat, spoiled, infantile, expectant adults.

Add "stupid" to that list, and, well, you're a woman after my own heart. I really do try to keep tight reins on my cynicism these days, but I suppose we're known for such people for a reason in a sort of little-bit-of-truth-to-every-stereotype way. That expectant/entitlement part really bugs me.