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Indoctrination in Medicine

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slowthai

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I was curious. Most fields that require very intense amounts of training require some form of indoctrination or programming. I assume that's true for the field of medicine. What are some examples of this?

As a result of being molded into an instrument of death, (I meant healing, I joke) I've heard that a loss of compassion and empathy is common. But doesn't that sound like a killer though? Lol. Why exactly is this true? Also, how has this affected your interactions with people inside and outside of medicine? I know it's a lot of questions, but it's just very interesting.
 
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FrkyBgStok

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Personally, I think the biggest indoctrination type thing in medicine is the push for evidence based medicine, but I don’t think that is a bad thing.

The loss of empathy can be seen in two ways. It is common in people who don’t choose medicine for the right reasons and it isn’t that common amongst all providers. But there is also an ability to disconnect from patients which can also be a good thing depending on the specialty. Dying kids just becomes more common than outside of medicine, so it affects you less. Things getting better and then taking an unexpected turn is more common so it affects you less.

As far as affecting my relationships, it hasn’t really, other than I notice when people I know die, it doesn’t affect me as much. That’s the only thing I can see.
 
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Crayola227

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the indoctrination starts with matriculation and the Oath

then there's typically some sort of humanities course about being a physician that covers ethics, professionalism, etc
the whole "professionalism" thing is a big deal, and rightly so, I think, but it can get taken to ridiculous levels

the next thing that sort of tears you down is being a big fish in a big pond, meaning you go from the top of your college classes to a mediocre med student, "average" in a class of above average people

moments of supreme boredom during orientation and lectures

feeling the breakdown of 4-8 hour exams every few weeks, like finals week every other week, that are very difficult, the price of failure is high

it's competitive and you start to feel not good enough on many levels, especially as you compare yourself to your peers and those above you in the hierarchy
then of course is the extremely hierarchical nature of not only medical education but general practice as well

next comes the ultimate med student Rite of Passage, the Step 1 exam
basically how "good" you are gets reduced to a number that you can use to adjust your self esteem
it also determines so much more of your life

after that begins the constant uncertainty of rotations - uncertain locations, times, you often don't know even until Friday before Monday where/when to be, or even what days off you might have for the next 4 weeks

everyone around you is overworked, has different expectations, and who you work with can change even on a daily basis, those grading you might only meet you 2 or 3 times

you are pushed to the limits of your endurance regarding how much you can study, how long you can stand, how long you can go without food, without urinating, how little sleep, how long a shift

on top of this, you can "expect" to be randomly quizzed on all sorts of bits of knowledge that you maybe couldn't possibly be expected to know

some people will go out of their way to throw you under the bus or humiliate you

the deprivation and the random nature of punishment that you don't feel you have control over - has been done in experiments to dogs, and basically is the recipe for trauma, indoctrination, learned helplessness

at the same time that your soul is taking this beating from those you work with, you are thrust, rather unprepared (no one could really be prepared) to watching the modern medical for profit establishment treat human beings like meat for the gristmill

you watch people who have been worn down and possibly lost some of their empathy and compassion, struggle to cut the "right" corners (after you've been taught the "proper" way in your humanities course) and juggle a million demands

you watch a lot of the worst of human suffering, and watch them treated by some who have lost something of themselves

one way of dealing with this is to emulate it

there's a psych term for this, I think reaction formation or something, like blaming the victim, sort of

it also goes to some Milton experiments about obedience to authority

at some point, you can feel like so many things are hopeless - the ability to give patients the care they need, the time, the handholding, for them to change, lose weight, stop doing drugs, for the waste in healthcare to be avoided
 
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Crayola227

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also what a killer and doctor have in common, the distancing, the dampening down of empathy - is essential for both to act

when I was learning from a physiatrist (rehabilitation doctor, often a focus on musculoskeletal health) that when you do a musculoskeletal exam, on say a knee or shoulder bugging someone, you have to recreate the pain with your exam. You need the data from the physical exam maneuvers and what recreates the pain to diagnose what's wrong. This is pretty common for a lot of your other diagnostic moves.

surgeons sometimes say they are unlike other specialties in that moreso or more dramatically than others, they harm to heal

cutting someone open and shoving your hand in someone is.... pretty extreme and it's hard-pressing to call it anything other than a major insult to the body, at the time
of course the end result is mostly that the patient is better off than before when it's all said and done

very often, in the carrying out of your duties, you have to set aside the patient's discomfort AND your own sense of discomfort that comes from theirs, from your mirror neurons

you have to learn to touch people, have them experience pain, even struggle (they have consented first, still, this is difficult), and yet persist in what you are doing
you have to learn to touch people who are asleep, are disoriented, don't know where they are or who you are
you have to learn to interrupt people mid-sentence, and to ask the most personal questions that you might otherwise never even imagine asking a stranger
you have to learn to touch people in their most private places, some places that no one else has ever touched, that people would never let touched otherwise

so yeah, there's a lot you have to learn to turn off to be effective

the key thing is that there is a focus on results

and therein lies the difference between the killer and the healer
 
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slowthai

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so yeah, there's a lot you have to learn to turn off to be effective

the key thing is that there is a focus on results

and therein lies the difference between the killer and the healer

Wow, that's so heavy.
 
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Goro

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I was curious. Most fields that require very intense amounts of training require some form of indoctrination or programming. I assume that's true for the field of medicine. What are some examples of this?

As a result of being molded into an instrument of death, (I meant healing, I joke) I've heard that a loss of compassion and empathy is common. But doesn't that sound like a killer though? Lol. Why exactly is this true? Also, how has this affected your interactions with people inside and outside of medicine? I know it's a lot of questions, but it's just very interesting.
One of the things that I have seen is dogma. Skeptical thinking, critical analysis and requirements for EBM are one thing, but sometimes things get so embedded tat it's outright heresy to come up with a finding that contradict the status quo. An example was the finding that lumpectomies had the same outcomes as radical mastectomies.

Sometimes even the normal requirements for EBM can go a tad overboard. It took about a decade for people to accepts that gastric ulcers had a bacterial cause. Another paradigm shift that met with a lot of resistance was the finding that CNS neurons can regenerate.
 
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slowthai

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It leads me to wonder...are there any doctors that have developed DID (dissociative identity disorder) as a coping mechanism? I know, a bit extreme, but think about it, in the worst cases, emotional trauma, constant sleep deprivation, and extreme stress...these are like the ingredients for personality splitting, lol.

I feel like if anyone had it, there would be a higher frequency before duty hours were limited.
 
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Noisewater-TDX

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It leads me to wonder...are there any doctors that have developed DID (dissociative identity disorder) as a coping mechanism? I know, a bit extreme, but think about it, in the worst cases, emotional trauma, constant sleep deprivation, and extreme stress...these are like the ingredients for personality splitting, lol.

I feel like if anyone had it, it would be have a higher frequency before duty hours were limited.

I got burnt as a nurse. Completely shut down about half way though a 12 hour shift. Mostly due to the typical lunacy of ER abusers and such, not the sick patients who needed us. I've struggled to "come back to baseline" in med school. All the professors expect you to be highly empathetic as a "newbie" in medicine.

So, my struggle currently is attempting to wash away all the negativity of real world healthcare and attempt to learn medicine in the cushy bubble of med school. So, i am hoping to be re-indoctrinated in a positive manor.
 
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Coupd'Cat

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Seeing how imperfect the delivery of medicine is and laughing at the most egregious examples of inefficiency to keep from crying. Then thinking to yourself that you'll try to change it when you have more power than a medical student, only to gradually realize the chain of command just keeps on going and everyone answers to someone else even more resistant to change.
 
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WhiteCoatWonder

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the indoctrination starts with matriculation and the Oath

i agree with 99% of this, especially the above.

to expand on this idea, consider the fact that in addition to being taught how to assess and repair, we are also "instructed" on how to console. for example, during my prep for CS, i remember reading about safe locations on the patients body to touch. it struck me as odd, in doing something so natural as comforting a person, that it would be considered inappropriate to touch them in a way that seemed natural. im not much of a hugger, but you better believe if somebody is crying or dying, my first inclination is not pat them in a way that is socially acceptably on a distal extremity.

as a student of the discipline, i agree with the necessity for standardization of practice within medicine in general, but i dont like being taught a format in which to do human things like express care/concern freely or hold a conversation. i guess i have to remember that not everyone has a natural knack for these things and personal touch/personal ideas could derail a patient-provider interaction very quickly.

i try to stay within the realm of the rules but go with my instinct.
 
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infectiousdisease101

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"Loss of empathy" may actually simply be the physician having to make a hard decision and they may shut down their emotions until they get home, then let it out so it does not affect their work. I know of pediatric EM doctor who said he has been to accident sites in which he could clearly tell there was no saving that child and transporting them to the hospital was a waste of money and resources that could be spent on saving another child. If he wasted money and other resources transporting a child that was beyond saving, they may have to resort to budget cuts and lay off nurses, which would do more harm than good.

I also attended a seminar from a general ED doctor and he said ED doctors are constantly criticized by other fields for not giving the "proper" treatment because they don't understand ED doctors do not have the luxury of knowing the patient for years like a family doctor and they must make a decision in a short period of time. Again, the "loss of empathy" could just be them hardening themselves for the rough sides of their individual fields.
 
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One of the things that I have seen is dogma. Skeptical thinking, critical analysis and requirements for EBM are one thing, but sometimes things get so embedded tat it's outright heresy to come up with a finding that contradict the status quo. An example was the finding that lumpectomies had the same outcomes as radical mastectomies.

Sometimes even the normal requirements for EBM can go a tad overboard. It took about a decade for people to accepts that gastric ulcers had a bacterial cause. Another paradigm shift that met with a lot of resistance was the finding that CNS neurons can regenerate.
Another problem that strict adherence to EBM poses is that it can cause some people to be inflexible and loose site of the nuance necessary to practice medicine in a humanistic way that acknowledges that individual patients don’t embody averages.
 
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sloop

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Sometimes people imprecisely use loss of empathy and loss of sympathy interchangeably.

Empathy is the ability to understand what another person is experiencing. This is essential to the diagnostic process, since if you can't understand a patient's symptoms, you can't hope to know what is causing them.

Sympathy is subjectively feeling what the patient is feeling, for instance feeling bad for the patient who is going through a difficult illness. This is not a necessary part of being a physician. It is often how laypeople show one another they care but the way kind physicians should professionally show that they care is by making objective assessments, accurate diagnoses and appropriate treatment plans.

Loss of empathy is a sign of professional demoralization, or physician burnout. Loss of sympathy is generally an appropriate adaptive response to the requirements to maintain objectivity, produce an accurate diagnosis with appropriate treatment plan, and interact with many people with heartbreaking stories every day.
 
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Crayola227

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Sometimes people imprecisely use loss of empathy and loss of sympathy interchangeably.

Empathy is the ability to understand what another person is experiencing. This is essential to the diagnostic process, since if you can't understand a patient's symptoms, you can't hope to know what is causing them.

Sympathy is subjectively feeling what the patient is feeling, for instance feeling bad for the patient who is going through a difficult illness. This is not a necessary part of being a physician. It is often how laypeople show one another they care but the way kind physicians should professionally show that they care is by making objective assessments, accurate diagnoses and appropriate treatment plans.

Loss of empathy is a sign of professional demoralization, or physician burnout. Loss of sympathy is generally an appropriate adaptive response to the requirements to maintain objectivity, produce an accurate diagnosis with appropriate treatment plan, and interact with many people with heartbreaking stories every day.

I disagree. There have been studies that suggest that treatment adherence and hard outcome measures like HA1C are affected by the therapeutic alliance. Studies have also suggested that this is in turn affected by how the patient feels the physician feels about them. While studies support that people are not good at picking out liars, we are actually good at identifying how someone feels about us.

In short, patients can sniff out these sort of robot doctors, as can colleagues. There is more to being a good physician than pure objectivity, diagnosis, and treatment plans.

Your point about the use of the term empathy vs sympathy is well taken.
 

sloop

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I disagree. There have been studies that suggest that treatment adherence and hard outcome measures like HA1C are affected by the therapeutic alliance. Studies have also suggested that this is in turn affected by how the patient feels the physician feels about them. While studies support that people are not good at picking out liars, we are actually good at identifying how someone feels about us.

In short, patients can sniff out these sort of robot doctors, as can colleagues. There is more to being a good physician than pure objectivity, diagnosis, and treatment plans.

Your point about the use of the term empathy vs sympathy is well taken.

One can form a therapeutic alliance without sympathy. You can show you care without subjecting yourself to the patient's emotions.

In fact, I tend to think that sympathy often comes off as disingenuous, even when actually sincere.

I'm a psychiatry resident and I probably come off as colder than average for my field. Not everyone responds well to my professional demeanor but I will say that I think most people do indeed do well with it. I express that I care and that I want to work with them to make their lives better, but I don't pity them or put on a show about how sorry I am for them. I expect them to put in the work and as long as they're invested in themselves, I will be invested in them (of course this does not apply to people who are psychotic or for whatever reason can't be invested in themselves).
 
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Psych_hopeful

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the indoctrination starts with matriculation and the Oath

then there's typically some sort of humanities course about being a physician that covers ethics, professionalism, etc
the whole "professionalism" thing is a big deal, and rightly so, I think, but it can get taken to ridiculous levels

the next thing that sort of tears you down is being a big fish in a big pond, meaning you go from the top of your college classes to a mediocre med student, "average" in a class of above average people

moments of supreme boredom during orientation and lectures

feeling the breakdown of 4-8 hour exams every few weeks, like finals week every other week, that are very difficult, the price of failure is high

it's competitive and you start to feel not good enough on many levels, especially as you compare yourself to your peers and those above you in the hierarchy
then of course is the extremely hierarchical nature of not only medical education but general practice as well

next comes the ultimate med student Rite of Passage, the Step 1 exam
basically how "good" you are gets reduced to a number that you can use to adjust your self esteem
it also determines so much more of your life

after that begins the constant uncertainty of rotations - uncertain locations, times, you often don't know even until Friday before Monday where/when to be, or even what days off you might have for the next 4 weeks

everyone around you is overworked, has different expectations, and who you work with can change even on a daily basis, those grading you might only meet you 2 or 3 times

you are pushed to the limits of your endurance regarding how much you can study, how long you can stand, how long you can go without food, without urinating, how little sleep, how long a shift

on top of this, you can "expect" to be randomly quizzed on all sorts of bits of knowledge that you maybe couldn't possibly be expected to know

some people will go out of their way to throw you under the bus or humiliate you

the deprivation and the random nature of punishment that you don't feel you have control over - has been done in experiments to dogs, and basically is the recipe for trauma, indoctrination, learned helplessness

at the same time that your soul is taking this beating from those you work with, you are thrust, rather unprepared (no one could really be prepared) to watching the modern medical for profit establishment treat human beings like meat for the gristmill

you watch people who have been worn down and possibly lost some of their empathy and compassion, struggle to cut the "right" corners (after you've been taught the "proper" way in your humanities course) and juggle a million demands

you watch a lot of the worst of human suffering, and watch them treated by some who have lost something of themselves

one way of dealing with this is to emulate it

there's a psych term for this, I think reaction formation or something, like blaming the victim, sort of

it also goes to some Milton experiments about obedience to authority

at some point, you can feel like so many things are hopeless - the ability to give patients the care they need, the time, the handholding, for them to change, lose weight, stop doing drugs, for the waste in healthcare to be avoided

I love these points. It right on the money when it comes to medicine. Completely.

Liberal ideas are indoctrinated everywhere. You would think if liberalism is such a good idea we wouldn't be required to be force fed.

I'm sorry, but what does liberalism have to do with anything here?
 
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Roxas

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We had an hour long ethics lecture that could be summed up as "if you accept pharm rep lunches you are a bad person and will die alone"

I felt it was a little over the top, imho
 
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AlbinoHawk DO

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I love these points. It right on the money when it comes to medicine. Completely.



I'm sorry, but what does liberalism have to do with anything here?
It influences the way you practice. My colleague couldn't admit a patient looked like a recovering Meth addict because that was just an assumption. It wasn't until even the medical assistants agreed that she started to accept it, so imagine how because of liberal indoctrination she would never screen for drug abuse unless the patient told her directly
 

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It influences the way you practice. My colleague couldn't admit a patient looked like a recovering Meth addict because that was just an assumption. It wasn't until even the medical assistants agreed that she started to accept it, so imagine how because of liberal indoctrination she would never screen for drug abuse unless the patient told her directly

Why would liberal indoctrination mean that you don't screen for drug abuse? The platform of both parties is that some drugs are harmful and worth screening for as far as I'm aware.
 
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Crayola227

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Right or left as physicians we are taught to challenge our perceptions of all of our patients. Preconceived notions don't catch less obvious signs of different pathologies - avoiding premature closure.
 
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psychMDhopefully

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Medicine is a racket, I just want the money. I use to be nice wtf happened to me.
 
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AlbinoHawk DO

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Why would liberal indoctrination mean that you don't screen for drug abuse? The platform of both parties is that some drugs are harmful and worth screening for as far as I'm aware.
Platforms are meaningless. When you try to be too politically correct then you let your ideology and feelings get in the way of rational thinking.

"I don't want to say anything about her being fat because it might offend her. Better just refill that insulin!"
 
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Psych_hopeful

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Platforms are meaningless. When you try to be too politically correct then you let your ideology and feelings get in the way of rational thinking.

"I don't want to say anything about her being fat because it might offend her. Better just refill that insulin!"

I feel like this is generalizing all liberals into politically correct folk. Of course you need to counsel and warn the patient of the complications, but I would stop at fat shaming as the literature has demonstrated that that is counterproductive.

But I know of no liberal doctor that wouldnt counsel a patient to lose weight. I know one who actually makes his patients go on a no carb diet all the time and tells it like it is.
 
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AlbinoHawk DO

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I feel like this is generalizing all liberals into politically correct folk. Of course you need to counsel and warn the patient of the complications, but I would stop at fat shaming as the literature has demonstrated that that is counterproductive.

But I know of no liberal doctor that wouldnt counsel a patient to lose weight. I know one who actually makes his patients go on a no carb diet all the time and tells it like it is.
And I know doctors that won't counsel on that. The problem is that it then seeds into the population of doctors where even ones that want to won't because they don't want to deal with some whiny patient.

I didn't think I needed to say that, but of course "not all" liberals and I'm not suggesting fat shaming is good.
 

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It influences the way you practice. My colleague couldn't admit a patient looked like a recovering Meth addict because that was just an assumption. It wasn't until even the medical assistants agreed that she started to accept it, so imagine how because of liberal indoctrination she would never screen for drug abuse unless the patient told her directly

I mean, you were the one on here saying a student potentially getting in trouble holding a cadaver head up like a trophy was because "SJWs" had taken over medicine, so you may just be talking out of your ass.
 
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Mad Jack

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It leads me to wonder...are there any doctors that have developed DID (dissociative identity disorder) as a coping mechanism? I know, a bit extreme, but think about it, in the worst cases, emotional trauma, constant sleep deprivation, and extreme stress...these are like the ingredients for personality splitting, lol.

I feel like if anyone had it, there would be a higher frequency before duty hours were limited.
Dissociative identity disorder is basically BS in 99% of cases. What doctors do is compartmentalize, which is healthy.
 
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Psych_hopeful

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@Mad Jack In the spirit of staying on topic and not going off into the unknown, what does the latin in your signature mean? :p

"Nimis fatum vivere et mori etiam rara ad mortem."
 
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AlbinoHawk DO

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I mean, you were the one on here saying a student potentially getting in trouble holding a cadaver head up like a trophy was because "SJWs" had taken over medicine, so you may just be talking out of your ass.
What are you talking about? That's exactly the type of people that are messing up medicine and they have been indoctrinated since before medical school. They then influence those around them. I don't know how I'm talking out of my ass by being consistent.
 

WingedOx

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What are you talking about? That's exactly the type of people that are messing up medicine and they have been indoctrinated since before medical school. They then influence those around them. I don't know how I'm talking out of my ass by being consistent.
You are indeed consistent. I'll give you that.
 
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AlbinoHawk DO

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You are indeed consistent. I'll give you that.
I'm the most consistent of all. Always consistent. People say "look at that guy, he's consistenting all the time." Tremendously consistent!
 
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WingedOx

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Some of them do. But others manage to post stupid things every time the show up here.

Plus when you post something THAT dumb, it's pretty memorable.
 
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