Is thick skin a requirement?

[NalaLucy]

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Sooo....been making baby steps towards a career switch for many years (going on 5). Pretty much back and forth between nursing, PA, medicine. I was premed as an undergrad but switched to business and have really been bored with my work/the thought of doing something similar to what i currently do for the next 40 years. I finally found a doctor nice enough to let me go on rounds with him as a hospitalist this past weekend. I have zero clinical experience, I plan on getting plenty more before taking the plunge, but am also trying to balance getting started on the pre-reqs (which means quitting my job because i am a consultant that travels 100%-another reason why its hard to get clinical time) and applying to med school as soon as i can. However, my first shadowing experience was this weekend (10 hours), and I did pretty well for the most part. I was a little worried that I might pass out from the blood/wounds, etc going into the day, but wasnt really exposed to much. However...I almost passed out twice while in patient rooms just from the emotional aspect of what was going on (many young (18-25) alcoholic patients, repeat drug seekers/addicts, etc. that just really got to me). I wonder if that is normal for the first time, or if that is a bad sign that I might not be tough enough? I am hoping that you eventually learn to manage the gross and gory and upsetting and develop thicker skin? Anyone else start out similar to me and able to get over it? Any advice/thoughts would be appreciated.

 

[StIGMA]

What you are experiencing is certainly normal. You will see these things and you will get used to it. Hopefully, you will become understanding of the situations these people are in, how they got there, and what you can do to help them (and what you cannot do). You will likely have classes in medical school where you discuss these emotional aspects of patient interaction, and there are numerous other ways to commiserate and talk to others about these things. You will get accustomed to it - no doubt. The thing you need to keep in check is becoming de-sensitized to it though, which in my opinion is one of the worst aspects of the medical process; right now you care too much- you do not want to overshoot and care too little. The blood/etc aspect is a gradual process (doing first physical exams, rectals, anatomy etc.), and you will become accustomed to that as well.

 

[familyaerospace]

Having a thick skin is a requirement, but probably 90% of people don't have that thick skin at first. I'm more likely to get ill on smells and sights than emotions personally.

 

[The right Path]

Like others have said, it is completely normal (and not an indicator of unsuitability) to have strong reactions to physically and emotionally unpleasant circumstances. Over time, the shock value wears off and you unconsciously develop various coping strategies. For the most part, especially with emotional issues, your natural feelings regarding the situation are still there, but they don't interfere so much with taking care of what needs to be taken care of.

If you can manage it, try to spend more time getting clinical exposure- and not so much for the purpose of becoming "desensitized" but so that you can get to the point where you see beyond the shock factor stuff and really get a better idea of the bigger picture of what medicine is about.

 

[ArkansasRanger]

However...I almost passed out twice while in patient rooms just from the emotional aspect of what was going on (many young (18-25) alcoholic patients, repeat drug seekers/addicts, etc. that just really got to me). I wonder if that is normal for the first time, or if that is a bad sign that I might not be tough enough?

That's not a good sign, and I think it points more to nursing than anything else since their profession's stance on healthcare seems geared more towards caring and hospitality rather than treatment and science.

I can't imagine that having any emotional toll on anyone. I'm not negating your emotions or criticizing you. I know I'm also pretty calluous after years in law enforcement and EMS, but even early into those fields what you listed above wouldn't have made me miss a step. Everyone is different, but just because someone is alcoholic or just because someone is a drug seeker shouldn't even make you skip a beat.

This weekend, one of the doctors I know had a drug seeker come in and demand pain meds. He told her he wouldn't see her because she had no insurance and refused to pay up front. She shouted "You took an oath to help everybody" to which he replied "Not for you I didn't" and walked away. The only reason he even had that much communication with her was because she was giving the clerk problems. These are the doctors I know, and I'd say they're pretty skilled clinicians, collectively. Maybe I shouldn't share their mentality (cynicism), but I do. I've yet to meet a resident, med student, or attending that was just eager to get out there and save their world. Even going into that type of thing I never got wide-eyed about any of it.

Anyway, I really don't think what I quoted should have bothered you in the least. Again, just my tarnished $0.02.

 

[QofQuimica]

That's not a good sign, and I think it points more to nursing than anything else since their profession's stance on healthcare seems geared more towards caring and hospitality rather than treatment and science.

I can't imagine that having any emotional toll on anyone. I'm not negating your emotions or criticizing you. I know I'm also pretty calluous after years in law enforcement and EMS, but even early into those fields what you listed above wouldn't have made me miss a step. Everyone is different, but just because someone is alcoholic or just because someone is a drug seeker shouldn't even make you skip a beat.

This weekend, one of the doctors I know had a drug seeker come in and demand pain meds. He told her he wouldn't see her because she had no insurance and refused to pay up front. She shouted "You took an oath to help everybody" to which he replied "Not for you I didn't" and walked away. The only reason he even had that much communication with her was because she was giving the clerk problems. These are the doctors I know, and I'd say they're pretty skilled clinicians, collectively. Maybe I shouldn't share their mentality (cynicism), but I do. I've yet to meet a resident, med student, or attending that was just eager to get out there and save their world. Even going into that type of thing I never got wide-eyed about any of it.

Anyway, I really don't think what I quoted should have bothered you in the least. Again, just my tarnished $0.02.

I couldn't possibly disagree more with your "two cents" more. Medicine is *not* solely about treatment and science, and physicians are not merely technicians. You do not have to be a nurse to have empathy for patients, even drug seekers.

OP, it is completely normal for people to start out being a little overwhelmed emotionally and even physically by what they see and do in medicine, but as others have said, you will learn to adjust and cope with it over time. Some people have a harder time with it than others, but even people who wear their hearts on their sleeves (and I'm definitely one of them) learn to behave professionally when they feel a little torn up inside. Part of it is recognizing that you can't be more hysterical than your patients, because you won't be able to help them like that! But my experience has been that patients in emotionally charged contexts do appreciate knowing that you feel bad too. So it's ok to be a little choked up sometimes, especially if a patient you've become close to isn't doing well.

As far as the physical exposure to blood and guts goes, you may feel a little sick at the beginning, but again, you learn to adjust. My first week in anatomy, I had to go out in the hallway and sit down a few times. I also walked out of one of my first year lectures where the speaker was graphically describing some (in my opinion) unwarrantedly cruel physiology experiments that had been done on dogs. But by the time I reached my surgery rotation, I was fine seeing the blood and guts. I was even able to witness some autopsies last summer without getting sick--there is no way I could have done that as a first year student, let alone as a premed. (It still bothers me to hear about cruel experiments being done to dogs though.)

Feeling sick or faint is nothing to be ashamed of. Sometimes even third year med students faint or feel sick in surgery, and if you do feel sick while you're shadowing in the OR, don't be proud: go sit down until you feel better. You'll probably get some ribbing for it, but it's loads better than falling face-first into the field. 😉

Also, I agree with StIGMA that you don't want to go too far the other way and become indifferent to your patients' suffering. Some of the worst experiences I've had on the wards or in clinics have been situations where a physician was completely focused on "treatment and science" while ignoring the patient's or family's emotions entirely. I actually thought about dropping out of medical school early in my third year over one of these types of situations, because I felt like if that was the kind of person I was going to have to become, then being a doctor just wasn't worth it. Fortunately, I have also had the opportunity to work with some absolutely phenomenal and caring clinicians, one of whom was my surgery attending of all people. As you go through your training, you will find the role models that you admire, and even the ones you don't admire can still teach you something about who you don't want to be.

Hope this helps, and best of luck. 🙂

 

[glamqueen]

I couldn't possibly disagree more with your "two cents" more. Medicine is *not* solely about treatment and science, and physicians are not merely technicians. You do not have to be a nurse to have empathy for patients, even drug seekers.

OP, it is completely normal for people to start out being a little overwhelmed emotionally and even physically by what they see and do in medicine, but as others have said, you will learn to adjust and cope with it over time. Some people have a harder time with it than others, but even people who wear their hearts on their sleeves (and I'm definitely one of them) learn to behave professionally when they feel a little torn up inside. Part of it is recognizing that you can't be more hysterical than your patients, because you won't be able to help them like that! But my experience has been that patients in emotionally charged contexts do appreciate knowing that you feel bad too. So it's ok to be a little choked up sometimes, especially if a patient you've become close to isn't doing well.

As far as the physical exposure to blood and guts goes, you may feel a little sick at the beginning, but again, you learn to adjust. My first week in anatomy, I had to go out in the hallway and sit down a few times. I also walked out of one of my first year lectures where the speaker was graphically describing some (in my opinion) unwarrantedly cruel physiology experiments that had been done on dogs. But by the time I reached my surgery rotation, I was fine seeing the blood and guts. I was even able to witness some autopsies last summer without getting sick--there is no way I could have done that as a first year student, let alone as a premed. (It still bothers me to hear about cruel experiments being done to dogs though.)

Feeling sick or faint is nothing to be ashamed of. Sometimes even third year med students faint or feel sick in surgery, and if you do feel sick while you're shadowing in the OR, don't be proud: go sit down until you feel better. You'll probably get some ribbing for it, but it's loads better than falling face-first into the field. 😉

Also, I agree with StIGMA that you don't want to go too far the other way and become indifferent to your patients' suffering. Some of the worst experiences I've had on the wards or in clinics have been situations where a physician was completely focused on "treatment and science" while ignoring the patient's or family's emotions entirely. I actually thought about dropping out of medical school early in my third year over one of these types of situations, because I felt like if that was the kind of person I was going to have to become, then being a doctor just wasn't worth it. Fortunately, I have also had the opportunity to work with some absolutely phenomenal and caring clinicians, one of whom was my surgery attending of all people. As you go through your training, you will find the role models that you admire, and even the ones you don't admire can still teach you something about who you don't want to be.

Hope this helps, and best of luck. 🙂

Agree 100 percent with QofQuimica and with the above her poster (disagree) also 100 percent like she said.

Echo her reasons, plus, you definitely get used to smells and sights. You really do. Before I went into medicine, I shadowed a vet and nearly passed out from sight of blood. Worried about it a lot. Now as a med student, my pregnant self can handle nasty decomposing cadavers that weren't prepped properly, as well as experiences in the OR as first-assist (yeah, I was pretty lucky to have an amazing preceptor on a comm med rotation) and delivered numerous placentas or "red babies" myself. Talk about blood, sights and smells!

Trust me - you'll adjust.

And really, can't repeat anything better than what Q said on the empathy thing. Please listen to her above pre-meds. She is in med school, ahead of me in her years there, and she knows what she is talking about.

 

[ArkansasRanger]

I couldn't possibly disagree more with your "two cents" more. Medicine is *not* solely about treatment and science, and physicians are not merely technicians. You do not have to be a nurse to have empathy for patients, even drug seekers.

OP, it is completely normal for people to start out being a little overwhelmed emotionally and even physically by what they see and do in medicine, but as others have said, you will learn to adjust and cope with it over time. Some people have a harder time with it than others, but even people who wear their hearts on their sleeves (and I'm definitely one of them) learn to behave professionally when they feel a little torn up inside. Part of it is recognizing that you can't be more hysterical than your patients, because you won't be able to help them like that! But my experience has been that patients in emotionally charged contexts do appreciate knowing that you feel bad too. So it's ok to be a little choked up sometimes, especially if a patient you've become close to isn't doing well.

As far as the physical exposure to blood and guts goes, you may feel a little sick at the beginning, but again, you learn to adjust. My first week in anatomy, I had to go out in the hallway and sit down a few times. I also walked out of one of my first year lectures where the speaker was graphically describing some (in my opinion) unwarrantedly cruel physiology experiments that had been done on dogs. But by the time I reached my surgery rotation, I was fine seeing the blood and guts. I was even able to witness some autopsies last summer without getting sick--there is no way I could have done that as a first year student, let alone as a premed. (It still bothers me to hear about cruel experiments being done to dogs though.)

Feeling sick or faint is nothing to be ashamed of. Sometimes even third year med students faint or feel sick in surgery, and if you do feel sick while you're shadowing in the OR, don't be proud: go sit down until you feel better. You'll probably get some ribbing for it, but it's loads better than falling face-first into the field. 😉

Also, I agree with StIGMA that you don't want to go too far the other way and become indifferent to your patients' suffering. Some of the worst experiences I've had on the wards or in clinics have been situations where a physician was completely focused on "treatment and science" while ignoring the patient's or family's emotions entirely. I actually thought about dropping out of medical school early in my third year over one of these types of situations, because I felt like if that was the kind of person I was going to have to become, then being a doctor just wasn't worth it. Fortunately, I have also had the opportunity to work with some absolutely phenomenal and caring clinicians, one of whom was my surgery attending of all people. As you go through your training, you will find the role models that you admire, and even the ones you don't admire can still teach you something about who you don't want to be.

Hope this helps, and best of luck. 🙂

Hmmmm

Let me see. One can care. Hell, I've cried in my police car. I can't stand watching movies anymore where innocent people are killed and raped. However, when I'm around people like drug seekers I have no sympathy. Medicine isn't all about treatment and science, but that's your foremost responsibility. The doctor I related in my original statement is a great, friendly guy. Many of them are. His regular patients like him. He's an FP. After seeing people like that drug seeker though there's no more compassion. For him, that was either never there or died decades ago.

 

[NalaLucy]

Hmmmm

Let me see. One can care. Hell, I've cried in my police car. I can't stand watching movies anymore where innocent people are killed and raped. However, when I'm around people like drug seekers I have no sympathy. Medicine isn't all about treatment and science, but that's your foremost responsibility. The doctor I related in my original statement is a great, friendly guy. Many of them are. His regular patients like him. He's an FP. After seeing people like that drug seeker though there's no more compassion. For him, that was either never there or died decades ago.

Thank you all for your responses. Arkansas - I really am surprised at the response you mentioned the doctor you know provided to the drug seeker. The doctor I was shadowing had the complete OPPOSITE response (this was prior to my mini emotional meltdown too!) I had said wow...it must get a little annoying treating people that are repeat addicts and come in without any insurance AND lie to you over & over, leave AMA. His response was not at all, those people are sick just like any other variety of patients. True, they may be causing their own sickness, but the withdrawal symptoms are real, the pain they feel is real (even if only psychological), and I need to do my best to treat them. That doesn't necessarily mean writing scripts, but more so protecting them during withdrawal, making it not so painful (i.e. prescribing an anti-depressant in place of oxycodone, providing small amounts of rx's while going through withdrawl), and encouraging them to seek therapy. I was shocked that after 25+ years of practicing he wasn't cynical, wasn't jaded, wasn't hateful/disgusted towards these people. He truly wanted to help them. The doctors that turn these people away may be justified in some right, but I believe this doctor's approach is truly what medicine is about. The doctors that continue to write scripts at the pain clinics because it's easier than dealing with potential liability and/or hassle is not right. (and just an fyi...one of the "drug addicts" was a young man who had gone through brain surgery and became addicted to the med's prescribed to him...he had been living a normal life contributing to society prior to his brain cancer diagnosis - honor roll student, student-athlete, etc...I dont know how one can not feel empathy and understand that horrible addictions can happen to "good" people, not just lazy bums like we sometimes conveniently like to think).

 

[eablackwell]

Thank you all for your responses. Arkansas - I really am surprised at the response you mentioned the doctor you know provided to the drug seeker. The doctor I was shadowing had the complete OPPOSITE response (this was prior to my mini emotional meltdown too!) I had said wow...it must get a little annoying treating people that are repeat addicts and come in without any insurance AND lie to you over & over, leave AMA. His response was not at all, those people are sick just like any other variety of patients. True, they may be causing their own sickness, but the withdrawal symptoms are real, the pain they feel is real (even if only psychological), and I need to do my best to treat them. That doesn't necessarily mean writing scripts, but more so protecting them during withdrawal, making it not so painful (i.e. prescribing an anti-depressant in place of oxycodone, providing small amounts of rx's while going through withdrawl), and encouraging them to seek therapy. I was shocked that after 25+ years of practicing he wasn't cynical, wasn't jaded, wasn't hateful/disgusted towards these people. He truly wanted to help them. The doctors that turn these people away may be justified in some right, but I believe this doctor's approach is truly what medicine is about. The doctors that continue to write scripts at the pain clinics because it's easier than dealing with potential liability and/or hassle is not right. (and just an fyi...one of the "drug addicts" was a young man who had gone through brain surgery and became addicted to the med's prescribed to him...he had been living a normal life contributing to society prior to his brain cancer diagnosis - honor roll student, student-athlete, etc...I dont know how one can not feel empathy and understand that horrible addictions can happen to "good" people, not just lazy bums like we sometimes conveniently like to think).

👍 I've known many people with drug addictions, several in my family.

One thing I've learned as a teacher is that you never know what another person comes from, what they've been through, or the baggage they carry with them from day to day.

My friends would tell you that I'm one of the most cynical people they know, but I think in regards to professional etiquette, be it in teaching or medicine, we should try our best to put cynicism aside. I'm not saying you have to break down crying every time you see someone in a bad way, but I think remarks like the doctor in the above post made are crass and uncalled for.

 

[EdLongshanks]

Here's one of those cases where the opinions of pre-meds are not very valuable, although they are quite revealing.

 

[QofQuimica]

Hmmmm

Let me see. One can care. Hell, I've cried in my police car. I can't stand watching movies anymore where innocent people are killed and raped. However, when I'm around people like drug seekers I have no sympathy. Medicine isn't all about treatment and science, but that's your foremost responsibility. The doctor I related in my original statement is a great, friendly guy. Many of them are. His regular patients like him. He's an FP. After seeing people like that drug seeker though there's no more compassion. For him, that was either never there or died decades ago.

Again, treatment and science is *not* a physician's "foremost responsibility." A physician's foremost responsibility is healing. Sometimes that involves treatment, and other times it involves helping a patient accept that there is no known treatment, and sometimes it involves telling patients that you can't give them what they want and having them tell you what to go do with your mother (which sometimes occurs with drug seeking patients). As for science, science is not so central to the average practicing physician. Most physicians are not scientists, and the role of science in their "foremost responsibility" is relatively limited.

There is also a difference between sympathy and empathy. I don't have sympathy for all of my patients either, but I do my best to have empathy for all of them, and to treat them all professionally. That is my job, regardless of what I perceive as the patients' roles in bringing about their own problems. There have definitely been patients who have told me and showed me things that utterly disgusted me, and there have been many patients who have frustrated me. I've gotten plenty of practice at keeping my poker face in medical school. But I still try to be as professional as I can be, even when the patient is not being professional with us, because that patient is still a human being.

The doctors that turn these people away may be justified in some right, but I believe this doctor's approach is truly what medicine is about.

As do I.

Here's one of those cases where the opinions of pre-meds are not very valuable, although they are quite revealing.

I think what really raised my dander was the sheer hubris of telling someone that she should be a nurse and not a doctor just because she got a little emotional while shadowing!

 

[ArkansasRanger]

Again, treatment and science is *not* a physician's "foremost responsibility." A physician's foremost responsibility is healing. Sometimes that involves treatment, and other times it involves helping a patient accept that there is no known treatment, and sometimes it involves telling patients that you can't give them what they want and having them tell you what to go do with your mother (which sometimes occurs with drug seeking patients). As for science, science is not so central to the average practicing physician. Most physicians are not scientists, and the role of science in their "foremost responsibility" is relatively limited.

There is also a difference between sympathy and empathy. I don't have sympathy for all of my patients either, but I do my best to have empathy for all of them, and to treat them all professionally. That is my job, regardless of what I perceive as the patients' roles in bringing about their own problems. There have definitely been patients who have told me and showed me things that utterly disgusted me, and there have been many patients who have frustrated me. I've gotten plenty of practice at keeping my poker face in medical school. But I still try to be as professional as I can be, even when the patient is not being professional with us, because that patient is still a human being.


As do I.


I think what really raised my dander was the sheer hubris of telling someone that she should be a nurse and not a doctor just because she got a little emotional while shadowing!

Despite being a premed 🙄 which has nothing to do with my opinions and observations, I know of the difference between empahty and sympathy, but I still think there are certain things (alcoholics and drug seekers make a good example) that in and of themselves shouldn't evoke either. Any professional needs to be empathetic to the public he serves. Even a maximum security correctional officer dealing with some of the worst trash ever spit out into the world needs to have some empathy if not at least do a good job of feigning it. I also know "science" is not so central to most doctors. I know they don't collectively sit around thinking about electrons to arrive at a diagnosis. I think we also know that a lof of things cannot be treated, and it's to be expected that there are just some people who can't be or won't be helped.

Nurses are involved in healing.
Physicians are involved in healing.
They both have a basis in science.
They both have provide treatment.
They are both professions.

However, a nursing education program will be quick to point out that their profession is one of caring while I think we'd all agree that medicine is one of...well...medicine, usually defined as the art and science of healing which I guess is really just a return to homeostasis. The "art" part is what I dubbed "treatment." This isn't to suggest that physicians don't care.

I'm not being defensive, but as you know I do like to emphasize my point.

There's nothing wrong with being emotional. Plenty of people are. I'm not one of them be that fortunate or not. However, I pointed out nursing because the OP came across to me as one who is ultimately more of a nurturer than anything else. To feel some emotional strain, on a personal level, after having only shadowed some type of clinician working around the above clinetele leads me to think that she would probably be happier in a role where one gets to spend more time around and caring for the patients. It was not a jab at anyone nor any profession.

🙂

 

[deleted92121]

Different people respond in different ways. There are some folks that are extremely empathetic and emotional while others are more stoic and distant. Just do what is best for the patient and remember they are human.

But for the record, working in EMS for the past 5 years has definitely jaded me. I am not nice to the drug seekers or system abusers. I am merely indifferent. But I do care about patients that are truly sick and in need. In fact my favorite experiences are usually hospice patients.

Good luck with whatever you choose.

 

[EdLongshanks]

... I still think there are certain things (alcoholics and drug seekers make a good example) that in and of themselves shouldn't evoke either

🙂

One thing that this thread has done for me is to remind me to drive VERY carefully through Arkansas.

 

[ArkansasRanger]

One thing that this thread has done for me is to remind me to drive VERY carefully through Arkansas.

You know it, lol. 😉

 

[QofQuimica]

Despite being a premed 🙄 which has nothing to do with my opinions and observations, I know of the difference between empahty and sympathy, but I still think there are certain things (alcoholics and drug seekers make a good example) that in and of themselves shouldn't evoke either.

If you knew the difference, then why were you talking about not having sympathy for drug seekers? And for the record, I wasn't trying to pull rank on you just because I'm a (gasp) Medical Student. Evidently, I was much less well-informed as a premed than you are, because I *didn't* know the difference between sympathy and empathy at that point. Sorry for mistakenly assuming that someone who talked about sympathy in response to my description of empathy also might not have known.

 

[ArkansasRanger]

If you knew the difference, then why were you talking about not having sympathy for drug seekers? And for the record, I wasn't trying to pull rank on you just because I'm a (gasp) Medical Student. Evidently, I was much less well-informed as a premed than you are, because I *didn't* know the difference between sympathy and empathy at that point. Sorry for mistakenly assuming that someone who talked about sympathy in response to my description of empathy also might not have known.

I probably misread it or mistyped. Either way I know the difference. There was a lesson on it at police academy, lol. Until I sat through that PowerPoint I, like most people, didn't know.

 

[The right Path]

In healthcare, the role of physicians is to diagnose and treat patients, for nurses to take care of patients- not judge them. OF COURSE, we have personal feelings and opinions and internal judgements about them. However, a true professional develops the ability to self-identify these feelings and cope with them appropriately so that they don't interfere one way or another in providing care.

No one will tell you it's easy or perfect.

A separate but related example comes to mind when I've observed differences in how forensic patients are treated by the custodial officers. Most are very professional, but there have been some that have actually taunted patients, including making comments about their mother! Now being that these patients include murderers, rapists, etc., I'm not about to shed any tears for them, but seriously, who does that? It shows a disgraceful lack of pride in your own profession and yourself to sink to that level.

 

[wagmanager]

What I do not understand is why more and more people are saying medicine or the practice of it is not science. it is science through and through. There are 2 parts to being a good MD, one the ability to diagnose and formulate an appropriate treatment plan and 2) the manner in which you relay such info to the patient.There is so much talk of well roundedness, empathy, sympathyetc and why all these are very important I do not think that the place of science in medicne should be underplayed. even if you are not pushing electrons while examing a patient it is still science.

 

[QofQuimica]

What I do not understand is why more and more people are saying medicine or the practice of it is not science. it is science through and through. There are 2 parts to being a good MD, one the ability to diagnose and formulate an appropriate treatment plan and 2) the manner in which you relay such info to the patient.There is so much talk of well roundedness, empathy, sympathyetc and why all these are very important I do not think that the place of science in medicne should be underplayed. even if you are not pushing electrons while examing a patient it is still science.

Examining patients, diagnosing diseases, and formulating a treatment plan is not as scientific as you might think it is. Even people's anatomy has significant variation, never mind their physiology and pathology or their responses to treatment. And if the person is morbidly obese enough, forget finding much of anything on physical exam or even on imaging. Plus, plenty of patients somehow don't seem to read the textbooks before going to the doctor's office or the hospital.

It's also not uncommon for treatment regimens to consist of "let's try this and see if it works." Or, when you ask your attending why we're doing X instead of Y, for him to tell you that it's because that's how he learned to do it when he was a resident--but no, actually, there aren't any studies showing that it works. We just think it should work. Or, the patient with a cold insists on getting an antibiotic, and the doctor gives it to them.

Even take something as simple as getting doctors to foam in and foam out every time they enter or leave a patient's room. There is substantial evidence in favor of using the foam to decrease the spread of infections from patient to patient by health care staff going room to room. The hospital has installed two foam containers in every room: one right outside the door, and another by the patient's bed. But in spite of heavy campaigning to educate the entire hospital, every time they publish the compliance results, doctors, who have the most science education, are always at the bottom.

One of the most shocking things to me has been how *unscientific* much of what we do in medicine is. If a science lab were run analogously to a doctor's office, no one would ever believe in their results.

 

[riverjib]

I spent years working in the OR. Almost every medical student reacted to surgery...not when they walked in when the patient was open, but when they spoke to the patient pre-op, witnessed the onset of anesthesia, and saw the initial cut. It's not the surgery people react to...it's the humanness of the surgery...the reality that you're cutting into a REAL person.

That's how medicine goes. I worry more about the future MDs who DO NOT react than those that do. And it's not specific to surgery...that's just the perfect analogy for making a major decision that impacts a patient. You should have some visceral reaction to it all, initially.

 

[EdLongshanks]

I spent years working in the OR. Almost every medical student reacted to surgery...not when they walked in when the patient was open, but when they spoke to the patient pre-op, witnessed the onset of anesthesia, and saw the initial cut. It's not the surgery people react to...it's the humanness of the surgery...the reality that you're cutting into a REAL person.

That's how medicine goes. I worry more about the future MDs who DO NOT react than those that do. And it's not specific to surgery...that's just the perfect analogy for making a major decision that impacts a patient. You should have some visceral reaction to it all, initially.

A decade or so ago, my daughter was getting a surgical procedure and I, of course, stayed with her all the way into the OR where they put her under the anesthesia. The habit of medical people to use euphemisms like "onset of anesthesia" is interesting. A psychologist might theorize that they are trying to distance themselves from the patient. That might be a good thing.