CRINGEPOCALYPSE: I dont want to apply for surgery if I end up like these residents

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From the same department and not cringe-y at all. These read more like thoughtful intelligent surgeons and less like testosterone fueled frat boys. In fact very well said.

"I am humbled and grateful to be a part of the Johns Hopkins legacy. Among the things that this program has taught me are, Believe in yourself; Be kind to people; Find something that you love and pour your heart into it. Our patients are at the heart of everything we do. They are why we wake up before dawn and lie awake into the night, rehearsing every operation over and over in our minds until they are fluid. They are why we strive constantly to be better, perfecting every stitch, evaluating our every decision, and sharing our knowledge with all who wish to learn. They are why we avail ourselves of every operative opportunity afforded to us in our pursuit to better ourselves and our skill set. There are sacrifices. And they are worth it. I am grateful to my co-residents and to my mentors, who have become like family over these years. It is an honor and a privilege to train alongside you."



"General Surgery residency at Johns Hopkins Hospital has been one of the most exciting periods of my life. Every day I feel honored to work alongside bright and humble professionals, who are extremely invested in both patient care and resident education, and are proud of being part of something that is bigger than themselves. Hopkins is one of the oldest residency programs in the country. While we value our traditions, we also carefully foster innovation as it is the only way through which change will come in the surgical field. This dichotomy – keeping what we have learned but allowing new ideas to flourish and be implemented – creates a dynamic atmosphere at Hopkins where you are constantly thinking: ‘How can I do this better for my patient?’ I came to Hopkins via its Preliminary Surgery program as an international medical graduate and I was given the opportunity to stay to finish my surgeon’s training. After a step-wise progression during residency – in clinical judgment, team leadership, and technical skills -- I feel comfortable treating highly complex surgical patients and to tackle my next step: Transplant fellowship. However, I could not have accomplished that without the tireless efforts of innumerable mentors that go beyond the Surgery Department and include advanced practitioners, nursing staff, technicians, other medicine specialties, and perhaps most important, my fellow residents and co-chiefs to whom I am eternally grateful."

 

[Instatewaiter]

So what? There is more to life than the prestige of your residency program: your health, your family, serving the sick, protecting the weak.

As a random aside, i have found the people in medicine who spout off the most about protecting the weak and serving the sick are also the people who are the least capable and the most likely to hurt patients. When I hear something like this it usually lets me know I shouldn't let my family within 100 yards of that person.

It's not that others don't want to help people, it's just a certain type of person that gets up on a soap box and announces they want to serve the sick .

 

[Instatewaiter]

Giving short acting metoprolol q6h to someone in decomp HF, trying to pace someone at high rates to “improve the cardiac output” (so so wrong), nitro infusion to someone on pressors due to a troponin leak (from a type 2 NSTEMI), asking for mechanical support in distributive shock, over reliance on devices like the vigileo to give hemodynamics over an actual physical exam/POC ultrasound, giving continuous fluids to everyone and wondering why the severe AS guy is having recurrent flash pulmonary edema etc. This is just a drop in the bucket. And when confronted, the response is “you think I don’t know how to manage this? How dare you” instead of gratitude. But that might just be the academic ego speaking and I’m sure it’s not like that in the real world.

Yes I get that everyone makes mistakes. But the biggest mistake is hubris - assuming you know what you’re doing when you don’t.

I think with cardiology specific issues the surgeons are especially bad. Usually though, the older ones have been burned enough they get cards involved pretty early.

As an aside, coming from a place that used swans a lot, I can tell you that most people with chronotropic incompetence in the setting of cardiogenic shock will get a marked improvement in cardiac output even in the setting of the increased dysnchrony with faster pacing. The caveat to this is those actively ischemic

 

[RNtoMD87]

Most good doctors I know as far as knowledge and skill can be jerks. All I care about is whether they can do their job. This country is too worried about having everything candy coated.


Yeaterday my patient said he didn’t want dialysis, so the renal doc comes in (love this dude. Tells it how it is).

Goes, “do you want dialysis or do you want to live?” Guy says he doesn’t want dialysis.

(Dr. To me) “okay. I’ll make him a DNR” *leaves the room*

Patient- “DNR? What does that mean?”

Me-“if your heart stops were not going to try to bring you back”

Patient-“what?! Why not! Get the doctor! Tell him to come back!”

Me- well if you don’t get dialysis you’re going to die, so what’s the point?

 

[sloop]

I don’t think these statements are at all shameful.

Also, I don’t think it’s unique to surgery necessarily. People go to top places because they want to be the best and they deserve to be proud of that.

There’s also something very humbling about these places in that you’re acutely aware that you’re standing on the shoulders of giants. I think that’s part of what the reference to Halsted is. God knows my department has its own heroes that I feel similarly about.

 

[Goro]

OP joins SDN three years ago, waits until June '18 to post, limits who can view his profile, and his only posts to date are inflammatory ones, given in a drive-by posting.

Yup:

 

[Radetzky]

trying to pace someone at high rates to “improve the cardiac output” (so so wrong).

What's wrong with that?

As an aside, coming from a place that used swans a lot, I can tell you that most people with chronotropic incompetence in the setting of cardiogenic shock will get a marked improvement in cardiac output even in the setting of the increased dysnchrony with faster pacing. The caveat to this is those actively ischemic

+1

 

[Psai]

OP joins SDN three years ago, waits until June '18 to post, limits who can view his profile, and his only posts to date are inflammatory ones, given in a drive-by posting.

Yup:

Its the long troll

 

[IMreshopeful]

I think with cardiology specific issues the surgeons are especially bad. Usually though, the older ones have been burned enough they get cards involved pretty early.

As an aside, coming from a place that used swans a lot, I can tell you that most people with chronotropic incompetence in the setting of cardiogenic shock will get a marked improvement in cardiac output even in the setting of the increased dysnchrony with faster pacing. The caveat to this is those actively ischemic

We used swans a lot as well (perhaps too much). Issue is when they pace people higher without taking into account diastolic filling.

What's wrong with that?



+1

Frank Starling curve. Relaxation also affects contractility

That’s besides the original point

 

[Raney Schauer]

The following "personal statements" were written by Chief Residents in General Surgery at Johns Hopkins. I believe that these graduating Chief Residents were instructed to summarize their experience at Johns Hopkins.

I won't name the authors, but I will give them nicknames. You can google the text to find how who they are.

PREPARE TO CRINGE...

Resident 1: No Words

"As chief resident, I am confident that I can take care of any patient in this hospital and address all of their medical and surgical needs...

...It is an incredible gift for a patient—a person—to willingly subject themselves to anesthesia and to let another person wield the knife...The legacy of Halsted is pervasive. The lessons learned from my patients are with me wherever I go—in my heart, in my head, in my Hopkins-trained hands."

Resident 2: The Terminator

"The program has such a rich history of being the nidus for surgical discovery... That having been said, it is not merely focused on past accomplishments, but rather, it is dedicated to continuing its dominance of the surgical landscape..."

... I will always remember the strong relationships that I have forged amongst my co-chiefs"

Residents 3 and 4: Team Guadalcanal

"I was asked to give much of yourself, sometimes more than I thought I could...Physically, Hopkins asks you to study the physiologic impact of every stitch you throw... I had world-class facilities, field-leading experts, and battle-tested friends...

...I wanted a glimpse of the Halsted legacy...I am fortunate to consider my 7 other co-chiefs as very close friends, ones who I can count on for anything in the future. It has been an honor to train with these bright stars ..."
______________________________

To me, the above statements reveal an approach to medicine defined entirely by arrogant, sheltered, short-sighted professional competition instead of genuine humanitarian concern.

I want to tell them to "get a life." Where is their desire to serve others? They are all about "ME ME ME"....except for some "HALSTED" guy and they are all about "dominating" other people...and they write like ****: "as that having been said has been an honor" .... Where is their active voice?

The residents above write like they just won World War 2. Surgical residency is hard --but its no D-Day , it's no Pacific Theatre. Unlike these "battle-tested co-chiefs," after their hellish experience at D-Day the marines didn't get six-figure salaries.

"Dominance of the surgical landscape"..."Hopkins trained hands"..."I can do all medicine and all surgery for anyone on the planet.."

If I go into Surgery is this what I will become?

SDN reflux is real.

 

[sloop]

As a random aside, i have found the people in medicine who spout off the most about protecting the weak and serving the sick are also the people who are the least capable and the most likely to hurt patients. When I hear something like this it usually lets me know I shouldn't let my family within 100 yards of that person.

It's not that others don't want to help people, it's just a certain type of person that gets up on a soap box and announces they want to serve the sick .

Not entirely sure about this. I think there might be some truth to it but, frankly, a lot of people in medicine (many of them very competent) do at least some of this. The degree of publicity it entails might be the difference, however.

The truth is that the actual day to day practice of medicine sucks in a lot of ways. The major problem that leads to demoralization (at least in my experience) is that medicine at its core is not really about you as the doctor and does not actually care about you at all. It is all about the patients. People sometimes go weeks or months straight surrounded by mostly hateful, ungrateful patients (this can be especially true in my field of psychiatry but was equally true at times when I was doing IM in intern year).

This job takes tremendous emotional sacrifice and the way that a lot of people cope is by reframing sacrifice as benevolence. While it might be true that the especially vocal people may have competence issues and be doing this publicly as a way to maintain their self-esteem, I actually think that the thought process is relatively normal for stressed medical professionals who entered the field for at least partially benevolent reasons.