Yours is a great answer.
I don't think many of us want students to be disingenuous and lie about their interests. The problem with the earlier comment was not that a student didn't like surgery but rather the way it was phrased which shows a lack of understanding about how one's comments are received.
Believe me, I KNOW a lot of surgeons have "difficult" personalities but I still think it rather rude to point that out, especially if the person with whom you are interacting might not be one of those personalities.
There is a whole unwritten protocol that involves asking medical students what they want to be when they grow up on a particular rotation. It used to be in the past (maybe still is the case) is that if you wanted surgery you had to say you wanted it to the attendings and they would grade you on a different curve: i.e. a surgical attending meets a perfectly academically qualified medical student whom is technically qualified, takes good h & p's, knows their stuff in the OR and is interested, but for some reason rubs the attending wrong they would torpedo the student in the evaluation because for some undefined reason they didn't think they were "cut-out" to be a surgeon, i.e. maybe they had to much of outside life that would thought to interfere with being a surgeon or weren't as extroverted etc . . . supposedly this is frowned on today because obviously there are many who don't fit the mold of a typical surgeon, i.e. quiet, introverted but passionately all-about-surgery and known to colleagues as an excellent surgeon i.e. one of america's best doctors . . . so I think the idea came along to judge people by their talents and more objectively, admit more women and minorities to medical school and just try to get the best people. However, from what I hear peripherally about orthopedic surgery residency is that according to myth or canon at one medical school you had to blow away the top orthopaedic surgeon i.e. department chairperson who if they think you are up to snuff will give you the "two thumbs up" and basically fast-track you to ortho i.e. you "fit" their mould of what a surgeon should be although this obviously just perpetuates a cadre of surgeons who think and act alike. However, the culture still persists in each specialty, even though today there are no/few pyramid residencies and in ways it is easier to become a surgeon once in medical school, . . . still the question of if you want to do specialty x while on rotation x is like a loaded gun in the medical student's face, personally I have known medical students who didn't do surgery because of the "personalities" in surgery (subjective at any rate) so if I was a surgeon and a medical student said that they didn't want to go into surgery because of personalities, well, that is straightforward and truthfull so I wouldn't hold it against the student, I personally know someone who thought they would hate surgery and loved it and then decided it was their calling. I think today that medical students are stereotyped on the wards as being uninterested in something if it wasn't what they were going into, personally I found all my rotations interesting, I'm not doing cartwheels in halls after a CSection, but yes I find the physiology of pregnancy extremely fascinating although I do not plan to be an ob/gyn. . . I was asked on rotation x if I wanted to do it, and rotation x was what I wanted to do and I truthfully told the attending so, but they didn't believe me initially! So, basically, I don't think that attendings should be asking nervous third years if they want to be what they are, and perhaps medical schools should ask attendings not to do this or give all the medical students instructions to answer saying that they fully hope to enjoy third year and that their dean asked them all to keep their minds open! As you can see from Dr. Cox's comments, if a student says that she doesn't want to do surgery because of the "personalities" (fair enough even the general public has a strong preconceived notion of surgeons and so do med students) what would happen is she discovers that she loves surgery?! if she stuck her foot in her mouth and offended Dr. Cox? What if they would have become a leading heart surgeon? Personally I find it offensive when an attending asks me in a low voice if I want to do x (or a resident) it serves no real educational purpose as I would ask/do more if I loved the rotation regardless of what I wanted to do but only pigeon-holes students. I try to be polite and tell people I am looking at something else but find specialty x interesting which is true! i really do find it all interesting, no harm telling that, obviously they are more tactful ways to say things, and I would never tell a surgical attendings that I didn't like the personalities of surgeons, but surgeons do expect an almost different form of english when spoken to, i.e. excessive differential cowing and a certain culture that is foreign to a third year medical student, so at times the "game" looks a little silly to outsiders
so at times the "game" looks a little silly to outsiders, here is the naive third year:
Attending: "Where is the patient for the lap chole? Where is the resident? Turns to med student, why aren't you following this patient?"
Naive 3rd:"I was just told to go to the OR for the fifth case, I haven't gotten to see the chart yet"
Attending: "Didn't we TELL you during orientation to know your patient, did you read up on the case?"
Naive 3rd: "I know that obviously, . . . I would if I knew what . . . "
Attending: "The OR list has the names of the patients AND cases if is unacceptable for you not to have read up."
Naive 3rd: Shruggs shoulders, "I don't know . . . I didn't know that . . ."
Attending walks away angry, the anger of the tardy patient/resident is displaced on student, the student in their mind just met a jerk of an attending, and during the operation berrates medical student for now knowing charcot's triangle on second day of rotation, but when you know the game:
Attending: "Where is the patient for the lap chole? Where is the resident? Turn to med student, why aren't you following this patient?"
Seasoned 4th: "Right, I had expected the patient to be down in the OR by now, the residents to me to meet him/her down here now, let me go phone the 7th floor and ask his nurse (looks very concerned)" . . . returns 10 minutes later, "I paged the resident, they are still doing the central line on the floor and the patient just left their room, . . . do you mind if I scrub in?"
Attending: "Sure, just go talk to the scrub, ah nurse . . . Where are all of the residents?!? This is no way to run a hospital, ridiculous!!"
Final Touch: Go up to 7th floor or wherever patient is and "help" get the patient down faster or push nurse to get patient down to OR faster, and then push in OR and tell attending that "We've found the patient!" grinning, attending will say "About time" but happy that you are responsive, I personally don't mind acting like the most compassionate concierge at the most expensive hotel which caters to the most obnoxious guests when i found that this what attendings respond to (surprise) normally you would be paid to act this way. I think it is helpful to look at hospital work as hotel hospitality work (close spelling eh?), if you basically cater to the guests (patients) and to the hotel managers (attendings) who fret about every little thing, the residents are just the senior bellhops, but it helps if you treat them like management too as they feel like they are close to "running the place" themselves. Here is the seasoned fourth year scenario rewritten in hotel language:
Attending (Hotel Manager): Where is the limo for Mr. X who is waiting in the lobby? Didn't I tell you to be more attentive with your guests?
Fourth year (Bell Hop): Right, let me go call for them again, they told they would be here in a minute . . . come back 10 minutes later: "I'll again for the limo, and they were delayed so they will be right over, I asked them for discount and told them they shouldn't treat our guests this way."
Attending (Hotel Manager): Oh, ok, demand the discount, this is no way to run a hotel limo service!
Fourth year (Bell Hop): I'll go tell Mr. X myself and apologize and offer him a complimentary massage downstairs.
Attending (Hotel Manger): Oh, ok good, . . .
Basically accept responsibility for everything even if you don't know what is going on, and then run around like mad to fix it! Alot of times if you are nice to patients and treat them like guests they don't want to leave the "hotel", . . . I just tell them they are going for a "CAT scan" and wheel them down to radiology and keep going to the exit.
