Heart Failure - Diary of a Third Year Medical Student

[DermViser]

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Has anyone read this?
http://upalumni.org/medschool/ (esp. the Appendices section, see "Desensitized" or "Medical Student Abuse"?

Would any of you say your experiences during medical school have been similar? I thought the cover was quite eye-catching to say the least.

 

[Apoplexy__]

This is some really potent and powerful stuff, but the guy seems to clearly have psychiatric issues. His perception of certain events really appears pathological. Like yeah, it bugs me when I see patients get sub-optimal care because the doctor doesn't have enough patience to deal with them, but you just let it roll off and tell yourself you learned a lesson of what NOT to be.

Not to say the author's concerns aren't valid, but it just seems like he hasn't taken off those rosy-colored MS1 glasses and was psychologically assaulted as a result.

 

[DermViser]

This is some really potent and powerful stuff, but the guy seems to clearly have psychiatric issues. His perception of certain events really appears pathological. Like yeah, it bugs me when my attending complains about a patient for being "difficult" when it was just the doc being an a-hole inciting the patient in the first place, but you just deal with it.

Not to say the author's concerns aren't valid, but it just seems like he hasn't taken off those rosy-colored MS1 glasses and was psychologically assaulted as a result.

But one could make the claim that you're desensitized which is why you feel this way.

 

[Apoplexy__]

But one could make the claim that you're desensitized which is why you feel this way.

True...but there's a middle ground to achieve. You can get worked up all you want about world poverty, but at some point, for your own good, you just need to let it go. Doesn't mean you stopped caring about it, though.

 

[SouthernSurgeon]

This is some really potent and powerful stuff, but the guy seems to clearly have psychiatric issues. His perception of certain events really appears pathological. Like yeah, it bugs me when I see patients get sub-optimal care because the doctor doesn't have enough patience to deal with them, but you just let it roll off and tell yourself you learned a lesson of what NOT to be.

Not to say the author's concerns aren't valid, but it just seems like he hasn't taken off those rosy-colored MS1 glasses and was psychologically assaulted as a result.

He seems insufferable

 

[DermViser]

True...but there's a middle ground to achieve. You can get worked up all you want about world poverty, but at some point, for your own good, you just need to let it go. Doesn't mean you stopped caring about it, though.

I'm sure the author of it went into medicine to truly help people. So it can be quite earth shattering that everything you hear about how much medicine is a helping profession, yada, yada, isn't what it truly is. I think it truly exposes the dark underbelly of medicine.

 

[DermViser]

He seems insufferable

In what way?

 

[SouthernSurgeon]

In what way?

Mostly in that everything I've read so far is written from the perspective of someone who presumes moral superiority over their colleagues.

 

[DermViser]

Mostly in that everything I've read so far is written from the perspective of someone who presumes moral superiority over their colleagues.

I don't know about moral superiority as much as shock as to how real attendings doctors behave and treat patients and med students. Hardly the "respectful" profession that medicine makes itself out to be.

 

[username456789]

Mostly in that everything I've read so far is written from the perspective of someone who presumes moral superiority over their colleagues.

Agreed. He browbeats you with it in almost every line of every entry.

Then, of course, there's this nugget:

"I made a pact with myself. Throughout third year I was going to wear a QUESTION AUTHORITY button on my coat. And I have."

****.

 

[Apoplexy__]

I'm sure the author of it went into medicine to truly help people. So it can be quite earth shattering that everything you hear about how much medicine is a helping profession, yada, yada, isn't what it truly is. I think it truly exposes the dark underbelly of medicine.

Yeah, I get that. I have empathy for him. But to sum up my feelings on the matter: I think it's noble, but futile.

 

[username456789]

I don't know about moral superiority as much as shock as to how real attendings doctors behave and treat patients and med students. Hardly the "respectful" profession that medicine makes itself out to be.

In almost every entry, the not-at-all-subtle (and often explicit) theme is one of him watching his fellow students, the residents, and the attendings rape and pillage the hospital/patients, while he quietly stands alone as the single beacon of hope. Occasionally, a nurse will notice this and mention how he is the only one who isn't terrible.

 

[DermViser]

Agreed. He browbeats you with it in almost every line of every entry.

Then, of course, there's this nugget:

"I made a pact with myself. Throughout third year I was going to wear a QUESTION AUTHORITY button on my coat. And I have."

****.

But some of the situations he encounters are very emotionally jarring. On Surgery rotation (where else?): "A five year old girl lays naked and unconscious before us on the operating table - legs frogged open - while the doctors comment on her body. She's cute, the head surgeon says. Fourth generation Baywatch, says the anesthetist. The nurse adds knockout and heart breaker. Another surgeon: "But I'd operate on her even if she wasn't so cute, that's just the guy I am." Everyone laughs. I haven't laughed for two weeks."

 

[username456789]

But some of the situations he encounters are very emotionally jarring. On Surgery rotation (where else?): "A five year old girl lays naked and unconscious before us on the operating table - legs frogged open - while the doctors comment on her body. She's cute, the head surgeon says. Fourth generation Baywatch, says the anesthetist. The nurse adds knockout and heart breaker. Another surgeon: "But I'd operate on her even if she wasn't so cute, that's just the guy I am." Everyone laughs. I haven't laughed for two weeks."

If that even happened, yeah of course some of the stuff is obviously awful. That is an extreme example, and deviates so far from anything I have ever witnessed even on the worst days of medical training that it's difficult to use as an example of how medicine makes people horrible. Those comments come from people who were horrible well before they set foot in a classroom.

I still maintain that, although a lot of the stuff he mentions does sound familiar, I'm distracted by the overall "Me vs. The World" mentality he has.

 

[Apoplexy__]

I still maintain that, although a lot of the stuff he mentions does sound familiar, I'm distracted by the overall "Me vs. The World" mentality he has.

Exactly. He just seems to have a maladaptive perception of his life. Like with the kid who ran out of anesthetic:

I held him down on command while he screamed. We were late; the pain-killer had worn off. We gave him more, but started in long before it could have possibly taken effect. A child's suffering sacrificed for convenience. I see it routinely.


The surgeon keeps telling him to relax - to relax as they hook an endoscope into the back of his throat through his right nostril. The nurse has to keep gagging him to suction out all the blood from his mouth. A teddy bear is shoved in his face while the surgeon calls him buddy. "Relax," he said. "Relax, buddy."


And Jacob will never forget me.

I think most people would just be like "Man...that poor kid. I'm not going to let that happen again."

 

[DermViser]

If that even happened, yeah of course some of the stuff is obviously awful. That is an extreme example, and deviates so far from anything I have ever witnessed even on the worst days of medical training that it's difficult to use as an example of how medicine makes people horrible. Those comments come from people who were horrible well before they set foot in a classroom.

I still maintain that, although a lot of the stuff he mentions does sound familiar, I'm distracted by the overall "Me vs. The World" mentality he has.

Well there are other examples of course, which he mentions. I think what he's getting at is how much medical education and medical training can turn even the best people into such horrible human beings. I don't think he's saying they're inherently bad. What he's saying is that medicine essentially mutes people emotionally. Which is ironic, bc medicine talks so much on end about how empathy for the patient is so important. Forget the "Me vs. The World" mentality. There is truth to what he's saying right?

 

[SouthernSurgeon]

My other problem with it...

I mean...third year was hard. It was eye-opening for sure. I was often physically tired and emotionally exhausted due to the experiences I was having.

But at the same time...I somehow managed to miss all my regularly scheduled beatings. No one was maliciously pimping me every second of every day. No one was making me cry. I will admit I cried during third year - when a patient with biliary atresia I'd taken care of died.

I also must have missed all the horrible hateful attendings and residents who are mean and lie to their patients. The ones I knew were all genuine and caring. Overworked and tired...but for the most part good people at the heart of it.

 

[DermViser]

http://upalumni.org/medschool/appendices/appendix-16.html

Cutting Edge
Not surprisingly, studies find that the frequency of abuse was greatest during the surgical rotation.[233] In one study, eight percent of students were threatened with bodily harm, assault, or assault with a weapon.[234] Perpetrators were most often surgeons.[235]

From the trade journal Medical Economics:

For the most spectacular tantrums, it's hard to match the lords of the operating room. While most surgeons mind their manners, a minority go absolutely bonkers - flinging scalpels, threatening to throw scrub nurses against the wall, kicking equipment, fistfighting with anesthesiologists... 'The throwing of scalpels goes on, but not as much as it used to,' says... a former medical director. 'Maybe one guy out of 30 does it now. It used to be one out of 10.'[236]

In a pilot study, ten percent of students report actually being physically abused (slapped, kicked, or hit) by residents or faculty. Examples were given:

In the OR I was being taught to suture. When I held the forceps improperly I was hit on the knuckles with another instrument by my chief. When I inadvertently did it again I was hit in the same place. After the operation, my knuckles were bleeding and I now have a scar on the back of my right hand.[237]

One student reported he had been kicked in the testicular region by an attending physician and required medical attention for his injury.[238]

Medical student testimonials: "'The abuse felt like someone shoved a vacuum cleaner hose down my throat and sucked everything out of me.' As far as I'm concerned it's been three years of constant abuse and humiliation, and I view it as a time to forget - a sacrifice of 4 years of my life."[239] "My third year experience so completely soured my ideals of medicine that I am now considering becoming a malpractice consultant." Me too damn it. Maybe I'll just get a law degree and sue doctors. Watch them untouchably squirm on the stand.​

 

[DermViser]

My other problem with it...

I mean...third year was hard. It was eye-opening for sure. I was often physically tired and emotionally exhausted due to the experiences I was having.

But at the same time...I somehow managed to miss all my regularly scheduled beatings. No one was maliciously pimping me every second of every day. No one was making me cry. I will admit I cried during third year - when a patient with biliary atresia I'd taken care of died.

I also must have missed all the horrible hateful attendings and residents who are mean and lie to their patients. The ones I knew were all genuine and caring. Overworked and tired...but for the most part good people at the heart of it.

I must have missed the "lie to their patients" part. I think he's more referring to the dehumanizing. Again, I don't think he's saying they're bad people. He's saying that the dehumanizing and soul-crushing experience of medical education makes doctors something they shouldn't be.

 

[DermViser]

Yeah, I get that. I have empathy for him. But to sum up my feelings on the matter: I think it's noble, but futile.

So then you are desensitized.

 

[Mad Jack]

Third year should be a breeze!

I want to give the book a read, but I also don't want to buy a copy and feed into his delusion of importance. Wut do?

 

[DermViser]

Third year should be a breeze!

I want to give the book a read, but I also don't want to buy a copy and feed into his delusion of importance. Wut do?

You don't have to buy his book. It's online already there.

 

[Mad Jack]

You don't have to buy his book. It's online already there.

Oh it's just an online diary? Sweet. I didn't even click the link.

 

[DermViser]

Oh it's just an online diary? Sweet. I didn't even click the link.

I don't know about a diary. But yes, his book is online. You can buy it in softcover form as well.

 

[Mad Jack]

I don't know about a diary. But yes, his book is online. You can buy it in softcover form as well.

I was just assuming from the title. My eyes are probably going to roll right out of my head during this read, I can feel it already.

 

[mimelim]

Kinda outdated. Everything is ~20 years old.

You could probably collect all the negative things said/done in many work places and make something similar. Its all about selection bias.

Don't get me wrong, medicine can be malignant and surgery is still likely worse than many other areas, but this is the definition of yellow journalism.

 

[tdram]

Wow I feel like I really missed out. None of this happened in my third year. My third year was extremely normal.... even surgery. I was really hoping that something like this would happen so I could talk about it.

 

[DermViser]

Kinda outdated. Everything is ~20 years old.

You could probably collect all the negative things said/done in many work places and make something similar. Its all about selection bias.

Don't get me wrong, medicine can be malignant and surgery is still likely worse than many other areas, but this is the definition of yellow journalism.

How is it yellow journalism if it's a documenting of what happened on his clerkships? His complaints are hardly office workplace water-cooler complaints. But yes, in 20 years, the episodes of physical assault have likely changed. Mainly due to control coming from the outside and regulatory bodies, bc Medicine refuses to self-regulate (well) on the inside.

 

[DermViser]

Wow I feel like I really missed out. None of this happened in my third year. My third year was extremely normal.... even surgery. I was really hoping that something like this would happen so I could talk about it.

Mainly bc of the Internet. Where everyone would find out how badly med students are treated at that particular med school.

 

[username456789]

I don't know about a diary. But yes, his book is online. You can buy it in softcover form as well.

It is written exactly in the form of a diary. A bunch of stand-alone angsty/artsy one-liners abound, usually punctuated by a paragraph or two that drastically over sells whatever point he's trying to make.

 

[tdram]

Mainly bc of the Internet. Where everyone would find out how badly med students are treated at that particular med school.

The internet has a tendency to over dramatize things. I've learned not to take what's written on the internet so seriously.

 

[DermViser]

The internet has a tendency to over dramatize things. I've learned not to take what's written on the internet so seriously.

I'm talking about PR with respect to recruiting applicants.

 

[DermViser]

It is written exactly in the form of a diary. A bunch of stand-alone angsty/artsy one-liners abound, usually punctuated by a paragraph or two that drastically over sells whatever point he's trying to make.

With actual events of what happened on the clerkship.

 

[username456789]

With actual events of what happened on the clerkship.

In a ridiculously spun manner that would make Fox News jealous.

 

[mimelim]

How is it yellow journalism if it's a documenting of what happened on his clerkships? His complaints are hardly office workplace water-cooler complaints. But yes, in 20 years, the episodes of physical assault have likely changed. Mainly due to control coming from the outside and regulatory bodies, bc Medicine refuses to self-regulate (well) on the inside.

You really think this is documenting what is happening on his clerkships? Or is this someone writing down every negative thing they see? This person has an obvious axe to grind and the language/tone gives that away independent of the content. You think his 3rd year was this constant negative environment devoid of anything else? Does this resemble anything you've heard others describe? Never mind among current medical students, historically? Should any of this stuff that he writes about happen? No. Does it happen or did it happen? I haven't read it all, but probably. Is that any type of real representation of 3rd year at any point in the last 25 years? No.

1. Scare headlines - "Heart Failure", "Failure to Thrive", "A cut below the rest", "Miscarriage of justice"
2. Pictures - http://upalumni.org/medschool/heart-failure-cover.jpg
3. Dramatic sympathy with the "underdog" against the system

I have no way to look at "use of faked interviews, misleading headlines, pseudoscience and a parade of false learning from so-called experts.

Just missing emphasis on full-color Sunday supplements, usually with comic strips.

As previously stated, the definition of yellow journalism.

 

[DermViser]

In a ridiculously spun manner that would make Fox News jealous.

🙄

 

[username456789]

🙄

Is this your dad's blog or something?

 

[DermViser]

You really think this is documenting what is happening on his clerkships? Or is this someone writing down every negative thing they see? This person has an obvious axe to grind and the language/tone gives that away independent of the content. You think his 3rd year was this constant negative environment devoid of anything else? Does this resemble anything you've heard others describe? Never mind among current medical students, historically? Should any of this stuff that he writes about happen? No. Does it happen or did it happen? I haven't read it all, but probably. Is that any type of real representation of 3rd year at any point in the last 25 years? No.

1. Scare headlines - "Heart Failure", "Failure to Thrive", "A cut below the rest", "Miscarriage of justice"
2. Pictures - http://upalumni.org/medschool/heart-failure-cover.jpg
3. Dramatic sympathy with the "underdog" against the system

I have no way to look at "use of faked interviews, misleading headlines, pseudoscience and a parade of false learning from so-called experts.

Just missing emphasis on full-color Sunday supplements, usually with comic strips.

As previously stated, the definition of yellow journalism.

Like you said, it happened 20 years ago. And you acknowledge that it happens. You think med students actually talk about these things with eachother? Really?!?
I realize though, as a Vascular Surgeon, your bar of what constitutes mistreatment is quite high.

 

[mimelim]

But yes, in 20 years, the episodes of physical assault have likely changed. Mainly due to control coming from the outside and regulatory bodies, bc Medicine refuses to self-regulate (well) on the inside.

Is that a joke? I can no longer tell. You think lawyers, bankers, wall street, lobbyists, oil companies, rental car companies etc. self-regulate? I'd like to see a list of groups that DO self regulate well.

 

[DermViser]

Is this your dad's blog or something?

😆No it's not my Dad's blog. I'm just taken aback by your lack of compassion and empathy (although expected).

 

[operaman]

Yeah my experience has been nothing like this guy's. It's a convenient rhetorical device to portray yourself as the only enlightened being and everyone else as "desensitized," but it really doesn't reflect reality. Agreed that this book says more about the author's personal mental health than medical education. The more I think about it, there is a pervasive sense that -- at least as a student -- this guy embodied a worldview consistent with an adolescent pipe dream, that he was a great physician simply by virtue of his supreme intelligence. I'm just glad this guy wasn't ever on my team!

 

[KnuxNole]

Agreed. He browbeats you with it in almost every line of every entry.

Then, of course, there's this nugget:

"I made a pact with myself. Throughout third year I was going to wear a QUESTION AUTHORITY button on my coat. And I have."

****.

I hope he didn't question authority, and instead tried to be a good student.

 

[username456789]

I'd like to see a list of groups that DO self regulate well.

Mount up.

 

[DermViser]

Is that a joke? I can no longer tell. You think lawyers, bankers, wall street, lobbyists, oil companies, rental car companies etc. self-regulate? I'd like to see a list of groups that DO self regulate well.

My point is that Medicine has been thoroughly warned about the way it conducts itself. It had a chance to do that on its own with GME. They refused to do so. So what happened? The Libby Zion case, which spun things out of control to where people OUTSIDE of the profession said that action needed to be taken (i.e. 80 hour work weeks by the ACGME) which if it hadn't happened Congress would have passed a law.

You can't get away with things by saying Medicine is a "calling" and thus say it doesn't have to follow any rules. It does.

 

[mimelim]

Like you said, it happened 20 years ago. And you acknowledge that it happens. You think med students actually talk about these things with eachother? Really?!?
I realize though, as a Vascular Surgeon, your bar of what constitutes mistreatment is quite high.

This isn't about my "bar of what constitutes mistreatment" or anyone's "lack of compassion and empathy", good ad hominem. This is about the lack of credibility/relevance of this book. As previously stated, this guy advertises that he has an axe to grind, openly states that his entire purpose is to challenge people he sees as authority. Never mind that it is 20+ years old and fits the definition of yellow journalism.

 

[DermViser]

I hope he didn't question authority, and instead tried to be a good student.

Apparently he did, as he graduated from Tufts with Honors, according to the preface.

 

[DermViser]

This isn't about my "bar of what constitutes mistreatment" or anyone's "lack of compassion and empathy", good ad hominem. This is about the lack of credibility/relevance of this book. As previously stated, this guy advertises that he has an axe to grind, openly states that his entire purpose is to challenge people he sees as authority. Never mind that it is 20+ years old and fits the definition of yellow journalism.

My second quote was hardly an ad hominem. I don't see how the 20+ years old thing is relevant bc you even acknowledged that it happens.

 

[DermViser]

Mount up.

Who is that?

 

[mimelim]

Hey look, at the author a little bit more...

Professor Joe Schwarcz of McGill University recommends Greger's videos but says they contain "cherry-picking of data. Of course that doesn’t mean the cherries he picks are rotten; they’re fine." and that Greger has swallowed veganism "hook, line, and sinker; not that there’s anything wrong with that."[4] Sceptic and physician Harriet A. Hall has also criticized Greger's video Uprooting the Leading Causes of Death, saying his videos are part of a genre featuring "a charismatic scientist with an agenda who makes sweeping statements that go beyond the evidence, makes unwarranted assumptions about the meaning of studies, and omits any reference to contradictory evidence".[5]

Hey look, his primary media outlets for his stuff are Oprah Winfrey, Colbert Report and Dr. Oz Show....

 

[DermViser]

Hey look, at the author a little bit more...



Hey look, his primary media outlets for his stuff are Oprah Winfrey, Colbert Report and Dr. Oz Show....

He also works on food safety issues, such as bovine spongiform encephalopathy (mad cow disease). He appeared as an expert witness to testify about mad-cow diseasewhen cattle producers sued Oprah Winfrey for libel.[3]

Dr. Greger has been an invited lecturer at universities, medical schools, and conferences worldwide.[where?] He has lectured at the Conference of World Affairs, theNational Institutes of Health, and the International Bird Flu Summit, among countless other symposia and institutions, testified before Congress, has appeared on shows such as The Colbert Report and The Dr. Oz Show, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

Yeah, what a bad guy. 🙄