So happy to be finished with IM clerkship (vent)

[ainsky]

Is anyone else finishing / recently finished Internal Medicine and just so glad to be done with it? I couldn't tell if it was the patients, the type of med students who go for IM, the pseudo-intellectual approach to having long notes just like you were supposed to fill out the entire SAT essay even if it was pointless drivel, the philosophical arguments to Lasix dosing, families dropping grandma off on a Friday so they could get the weekend free while Medicare paid a few dozen grand for her stay.. I think overall just the inefficiency of everything drove me nuts.

I think what I took away the most from IM is that inpatient medicine's goal is not primarily to heal patients.. but to cover the hospital and doctors' liability while milking as much $$$ out of insurance or Medicare as possible.. and if the patient gets better during that process, that was a positive side effect of the process

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[sanfran256]

I was in the opposite field for my first rotation.. surgery but was also super frustrated with inefficiency

The OR turnover start/turn over times were a nightmare. Took the staff almost an hour between cases to turn over the room . In addition the cases would always take longer than scheduled. The only case that ever started on time was the first.. If a case was supposed to start at 2pm it would not go until at least 4.. Words cannot express how infuritating it was to have to wait around doing nothing until your 3 hour case finally started at 4:30 .

No wonder all surgeons seem to hate their lives
I have zero idea why anyone would go into surgery.

 

[Osteoth]

I was in the opposite field for my first rotation.. surgery but was also super frustrated with inefficiency

The OR turnover start/turn over times were a nightmare. Took the staff almost an hour between cases to turn over the room . In addition the cases would always take longer than scheduled. The only case that ever started on time was the first.. If a case was supposed to start at 2pm it would not go until at least 4.. Words cannot express how infuritating it was to have to wait around doing nothing until your 3 hour case finally started at 4:30 .

No wonder all surgeons seem to hate their lives
I have zero idea why anyone would go into surgery.

Oh my god I know. That literally turned me away from surgery. I had a 12PM surgery take till 4 to go back on a Friday and and not finish till 9PM. Literally lost my mind.

 

[ainsky]

Oh my god I know. That literally turned me away from surgery. I had a 12PM surgery take till 4 to go back on a Friday and and not finish till 9PM. Literally lost my mind.

I was in the opposite field for my first rotation.. surgery but was also super frustrated with inefficiency

The OR turnover start/turn over times were a nightmare. Took the staff almost an hour between cases to turn over the room . In addition the cases would always take longer than scheduled. The only case that ever started on time was the first.. If a case was supposed to start at 2pm it would not go until at least 4.. Words cannot express how infuritating it was to have to wait around doing nothing until your 3 hour case finally started at 4:30 .

No wonder all surgeons seem to hate their lives
I have zero idea why anyone would go into surgery.

Haven't done surgery yet , IM has made me look forward to it.. This sounds more like a hospital problem than something inherent to the field. Whereas being pathologically risk averse and essentially experts at keeping your patient in a holding pattern while specialists peck away at your patient's payor seems to be part and parcel of Internal (or as i like to call it, eternal) medicine

 

[Osteoth]

Haven't done surgery yet , IM has made me look forward to it.. This sounds more like a hospital problem than something inherent to the field. Whereas being pathologically risk averse and essentially experts at keeping your patient in a holding pattern while specialists peck away at your patient's payor seems to be part and parcel of Internal (or as i like to call it, eternal) medicine

That's true but from what I've heard basically the only places that don't run into this problem are surgical centers, which make up a minority of surgical experiences nationwide.

It's also pretty hard to mentally prepare yourself for the day when you get pushed back randomly 4 hours. You can't really "relax" for that time but you are stuck in the hospital with nothing to do. I hate studying while I'm working...

 

[ainsky]

That's true but from what I've heard basically the only places that don't run into this problem are surgical centers, which make up a minority of surgical experiences nationwide.

It's also pretty hard to mentally prepare yourself for the day when you get pushed back randomly 4 hours. You can't really "relax" for that time but you are stuck in the hospital with nothing to do. I hate studying while I'm working...

yeah I can see that. i also could not really do much UWorld or shelf prep while sitting around waiting on IM.

from what I read on Surgery forum, more and more the shift is going towards surgical centers, with a surgeon not having any scheduled cases on call day, thereby giving his/her partners a more "normal" life

did you enjoy the actual OR and floor management part of your surgery rotation?

 

[Goro]

Is anyone else finishing / recently finished Internal Medicine and just so glad to be done with it? I couldn't tell if it was the patients, the type of med students who go for IM, the pseudo-intellectual approach to having long notes just like you were supposed to fill out the entire SAT essay even if it was pointless drivel, the philosophical arguments to Lasix dosing, families dropping grandma off on a Friday so they could get the weekend free while Medicare paid a few dozen grand for her stay.. I think overall just the inefficiency of everything drove me nuts.

I think what I took away the most from IM is that inpatient medicine's goal is not primarily to heal patients.. but to cover the hospital and doctors' liability while milking as much $$$ out of insurance or Medicare as possible.. and if the patient gets better during that process, that was a positive side effect of the process

Where's @W19 when you need him?

 

[mw18]

All start times for anything but first cases are nonsense. I get that that looks like what you all are saying, but what I'm saying is you never should have looked at it with the expectation of it being an actual schedule. That's not really what it's meant to be. It's just a guide of what cases are being done in what order. Usually room specific but that can change based on case length/room availability. Many surgeries are listed as "x with possible y, possible z." So it's not really possible to accurately estimate the time, plus complications and so forth. They just ballpark it because it's not supposed to be real life.

I'm with you on turnover time, though. That's frustrating. It's a shift work vs. case work problem.

 

[sanfran256]

yeah I can see that. i also could not really do much UWorld or shelf prep while sitting around waiting on IM.

from what I read on Surgery forum, more and more the shift is going towards surgical centers, with a surgeon not having any scheduled cases on call day, thereby giving his/her partners a more "normal" life

did you enjoy the actual OR and floor management part of your surgery rotation?

I did not enjoy the OR a lot of the time but a lot of it had to do with the teams I was working with. A lot of teams were too busy/frustrated to teach or engage med students in cases. Its hard to pay attention when you don't know whats going on. There were some that were great though and it made a big difference.

Truthfully, I am honestly too impatient to be a surgeon , I wouldn't be able to spend hours lysing adhesions or putting sutures in delicate structures.

I enjoyed talking with patients/ floor care a lot more, so I'm hoping ill like IM!

 

[W19]

Where's @W19 when you need him?

Well, the poster is right on the money...

Argument b/t LR and NS can last an entire 4-5 hr rounding...

 

[ainsky]

Well, the poster is right on the money...

Argument b/t LR and NS can last an entire 4-5 hr rounding...

Did you enjoy any other rotations?

I want to rotate in neuro but not if its anythign like IM

 

[W19]

Did you enjoy any other rotations?

I want to rotate in neuro but not if its anythign like IM

I did enjoy Neurology but it was too late. My school has a 2 wks outpatient neuro rotation embedded into IM rotation and I did not like that neuro rotation. It was until I did an elective neuro rotation in 4th year at a big academic center that found out I loved neuro, but it was already in the middle of the interview season...

 

[ainsky]

I hated all sorts of hospital medicine. The grossly inefficient system. Endless notes. Running around not really knowing what to do as an M3. It's not great. The most disappointing thing I discovered though were the patient interactions. Some patients are awesomely pleasant, engaged in their care and give you great satisfaction in helping treat them. All too often however I found that many patients were overtly unpleasant or downright rude to work with, didn't really give a damn about their health, and had unrealistic expectations. On my last day of my ortho sub-I this came to a head when I was helping change a lady's dressing for her thigh shooter's abscess debridement at the safety net hospital. It was early in the morning before rounds and she was vehement that I had to wake her, rudely complaining and making a fuss. I grabbed a nurse to help roll her and while we are doing our work she purposefully defecates and urinates all over the bed and near her wound, chuckling while we scramble to keep the wound clean and get new supplies. This felt like a summary of my year and cancelling my next ortho away, I took a radiology elective and will now be pursuing that instead. Clinical medicine is just not for everyone. It was a very disappointing reality to face but I write this to let you know that: many people share your sentiments; private practice or other settings can be drastically different even in the same fields; and that there are plenty of non-hospital or even non-clinical options as a physician if you desire.

thanks for this post. your description of patients (a few a pleasure to work with, most difficult and entitled) is spot on. before IM i would have laughed at disbelief at your ortho patient but now i fully can picture it happening. patients know our hands are tied and they take every advantage of it.

i enjoyed my trips to the reading room but what holds me back is 1) being a support service leaves less bargaining chips 2) the fear of AI gets brushed aside a little too easily by those in rads

 

[takeurmeds02]

Not saying any of it is right, but everything that's being discussed is the US healthcare system and it's way less glamorous than advertised. The inefficiency, medico-legal ass covering, and overly-entitled patients are part and parcel of the system and it's not specific to any one team or place. There will rarely be a specialty that's not without it's faults (daily logistics, patient panel, etc) but you just have to find that one thing about medicine that supersedes it all. Hate that some folks' reality checks are during 3rd but oh well, I guess that's partly what it's for.

In reference to patients, you also have to understand that many of these people are chronically ill whether they did it to themselves or not. A good number are going to have attitudes. Imagine if you couldn't breathe 80% of your day, lose autonomy to care for yourself, or had some other debilitating issue - I'd be pissed off most of the time too. In terms of unrealistic expectations, patients (and families) are working with not even 10% of the knowledge you have, health literacy has never been high in our society. And to the COPD'ers requiring O2 at home but still light up like a chimney, those are the ones who you could take the most issue with but you shoulder the attitude and move on.

I'm not the biggest fan of IM but I also hate that OP had such a poor experience haha.

 

[Moose A Moose]

My favorite part of IM is running the list...










.. for the seventh and final time of the day.

 

[IMreshopeful]

Eh, I sympathize as someone who has gone through medicine residency.

As a medical student it can be godawful annoying being on rounds for hours and feeling like nothing is accomplished. Rounds should be efficient and teaching/decision making should be geared around medical issues. The problems usually arise when some nephro attending starts waxing poetic about using NS vs 1/2 NS for someone’s AKI and mild hypernatremia. Trust me... no medicine resident likes that BS. On the other hand, if a patient presents with fever of unknown origin and going down the differential, reviewing labs, and using it as a teaching opportunity, this can be a great use of time both from a diagnostic standpoint and teaching the medical students. That’s point one.

Point two - medicolegal stuff is a part and parcel of practicing medicine in the United States. That’s why sometimes the unnecessary stress test gets done, the guy with a low Wells score and atypical chest pain might still get the triple rule out CT, the dude with fever that’s probably due to sinus infection but a little nauseous still gets IV antibiotics and admitted instead, etc etc. it exists in EVERY specialty of medicine. You think it’s bad in IM, rotate in the ED at some point. Even surgeons have their fair share of crap they need to deal with. Radiologists have to be conservative in their reads otherwise they get sued. The list goes on and on and on.

Take the positives from the rotation and move on. Hopefully you’ll find something you like. I didn’t love internal medicine, and 80% of folks going into IM (at least American grads) usually end up either as subspecialists or hospitalists, who have a much different experience.

 

[ainsky]

\On the other hand, if a patient presents with fever of unknown origin and going down the differential, reviewing labs, and using it as a teaching opportunity, this can be a great use of time both from a diagnostic standpoint and teaching the medical students. That’s point one.
\

thanks for your post. appreciate the insight.

part of the problem is i found myself disliking patients and their problems. i am so sick of reading uworld questions / clinical vignettes about the 100th COPD patient. or as in your example, a FUO brings literally 0 interest or excitement to me. i was reading in the House of God that Potts gave one of his ED admissions $5 to leave, and the patient did. i can see myself being like that

 

[IMreshopeful]

thanks for your post. appreciate the insight.

part of the problem is i found myself disliking patients and their problems. i am so sick of reading uworld questions / clinical vignettes about the 100th COPD patient. or as in your example, a FUO brings literally 0 interest or excitement to me. i was reading in the House of God that Potts gave one of his ED admissions $5 to leave, and the patient did. i can see myself being like that

Fair. Not everyone enjoys clinical medicine.

FWIW I don’t love every part of internal medicine. Endocrine, nephro, and GI bore me. But I loved critical care, cardiology, etc so that helped inform my career decision. I was willing to tolerate the rest.

 

[atomi]

Wait until you are an intern and have to deal with the pointless AM labs and pointless and wasteful electrolyte repletions. It’s criminal to give someone a bag of K without telling them it’s going to cost a few hundred bucks and getting their consent. Let alone the expensive lab draw in the first place. Sofa king dumb.

 

[IMreshopeful]

Slightly tangential, but I also love cardiology and critical care. I have tons of time to decide, but why did you choose cards over the latter? Curious about your reasoning.

I’ll PM you

 

[atomi]

I know med oncs making 700k working 4 days a week. If you get stuck in IM that’s the way to go imo. The number of systemic therapies coming out are mind boggling.

 

[IMreshopeful]

Lol the funny thing is one of my last senior months as an IM resident I basically told everyone I want succinct notes and by no means will we ever get out after sign out unless there’s a very good medical reason.

One of the med students who wanted to do IM said I created a hostile work environemnt and wrote in my eval that I never wanted to be at work (I guess because I encouraged us to leave work and have a life). I also gave the student honors.

IM just attracts very weird and eccentric people. Stay away unless you really want to do cards or GI.

There’s definitely some weirdos in the field but I would say I have seen those types in every medical field. I think some medicine residencies are a little odd and do encourage this martyr attitude (a program I know of calls their interns “marines”... three guesses as to who that is) but luckily most of my coresidents were pretty chill

 

[Kgizzle]

UTSW Dallas is my guess.

It’s honestly a silly joke

Say it isn't so

 

[Lnsean]

Honestly, it's because there is a lack of personal responsibility in our society...this has been going on for a few decades now...the deterioration of one's own accountability for one's own actions. Everyone likes to point the finger at doctors and healthcare providers, but when are patients also held responsible for their own health. The reason the system is so inefficient is because we run it like a hotel service.

 

[ainsky]

Honestly, it's because there is a lack of personal responsibility in our society...this has been going on for a few decades now...the deterioration of one's own accountability for one's own actions. Everyone likes to point the finger at doctors and healthcare providers, but when are patients also held responsible for their own health. The reason the system is so inefficient is because we run it like a hotel service.

its laughable how much effort med schools put into "wellbeing" and "not losing your empathy" in the first 2 years then they throw you into the pit and you see it for what it is

 

[IMreshopeful]

UTSW Dallas is my guess.

It’s honestly a silly joke

Not what I was thinking of. Although possible

 

[libertyyne]

Honestly, it's because there is a lack of personal responsibility in our society...this has been going on for a few decades now...the deterioration of one's own accountability for one's own actions. Everyone likes to point the finger at doctors and healthcare providers, but when are patients also held responsible for their own health. The reason the system is so inefficient is because we run it like a hotel service.

is our society special in terms of lack of personal responsibility? Is this decline measured in any way which would indicate that it has objectively declined? What about other developed nations? are they facing the same problem in personal accountability? by all measures people smoke less, have unprotected sex less, drive with seat belts more, complete college at a higher percent. It doesn't necessarily seem like personal responsibility went missing all of a sudden in Americans that is causing this.

I dont think that Doctors are to blame for our predicament , but patients also are not.

 

[ainsky]

^classic arguing for the sake of arguing. of course the majority of IM patients are responsible for their COPD, CHF, and T2DM.

 

[Matthew9Thirtyfive]

is our society special in terms of lack of personal responsibility? Is this decline measured in any way which would indicate that it has objectively declined? What about other developed nations? are they facing the same problem in personal accountability? by all measures people smoke less, have unprotected sex less, drive with seat belts more, complete college at a higher percent. It doesn't necessarily seem like personal responsibility went missing all of a sudden in Americans that is causing this.

I dont think that Doctors are to blame for our predicament , but patients also are not.

My anecdotal experience taking care of people who have preventable issues says otherwise.

 

[libertyyne]

Just wait until your third year IM/ general surgery rotations. Willing to bet this outlook goes out the window.

Ive spent plenty of time in urban hospitals and ERs. I know there are bunch of patients that are train wrecks. Thats not the point, for every train wreck patient you remember how many grandma's that are compliant with medical advice do you remember? American exceptionalism is a terrible argument for the situation of healthcare. Somehow every other industrialized country in the world doesnt have the waste of dollars, time , and human life that ours does.


What is even funnier about the personal responsibility argument is that old people that were supposedly more responsible compared to younger generations are the people in the hospitals using resources more heavily .

 

[Matthew9Thirtyfive]

Somehow every other industrialized country in the world doesnt have the waste of dollars, time , and human life that ours does.

That doesn’t really argue against a lack of personal responsibility though. There could be (and are) a number of reasons for that.

 

[libertyyne]

That doesn’t really argue against a lack of personal responsibility though. There could be (and are) a number of reasons for that.

So let me get this straight. Other industrialized nations spend half of what we do , have better outcomes, and access, and personal responsibility is the cause of our healthcare woes? Even after you adjust for obesity, or other chronic conditions we still spend more and get less. I fail to see how personal responsibility is sole driver of that difference.

Plus the older generations cost the most in terms of care, last six months of life, werent they somehow more personally responsible, compared to the population of today?

 

[Dro133]

^classic arguing for the sake of arguing. of course the majority of IM patients are responsible for their COPD, CHF, and T2DM.

What % of your COPD, CHF, T2DM patients are low SES? I think there are a lot of societal factors that go into it, and the blame can't be 100% put on patients.

 

[Matthew9Thirtyfive]

So let me get this straight. Other industrialized nations spend half of what we do , have better outcomes, and access, and personal responsibility is the cause of our healthcare woes? Even after you adjust for obesity, or other chronic conditions we still spend more and get less. I fail to see how personal responsibility is sole driver of that difference.

Did I miss the part where anyone said personal responsibility is the sole driver of our healthcare problems? The post you quoted seemed to be referring to the inefficiencies on an inpatient medicine service, but maybe I misunderstood.

There are a number of reasons that we have the problems we have. I’m not an expert and won’t pretend to know them all, but that there are multiple reasons doesn’t mean that a lack of personal responsibility is not a factor in the frustrations of medicine.

Plus the older generations cost the most in terms of care, last six months of life, werent they somehow more responsible?

Again this seems like a straw man, but maybe you aren’t meaning it to be or maybe I just read that post wrong.

 

[Matthew9Thirtyfive]

What % of your COPD, CHF, T2DM patients are low SES? I think there are a lot of societal factors that go into it, and the blame can't be 100% put on patients.

You definitely can’t put 100% of the blame on patients, but there are absolutely patients (and a number of them) who absolutely cause their own problems by their refusal to make lifestyle changes. I think it’s a bit hyperbolic to say that it’s the vast majority of patients though. @libertyyne definitely hit it when he said we tend toward extremism.

 

[libertyyne]

Did I miss the part where anyone said personal responsibility is the sole driver of our healthcare problems? The post you quoted seemed to be referring to the inefficiencies on an inpatient medicine service, but maybe I misunderstood.

There are a number of reasons that we have the problems we have. I’m not an expert and won’t pretend to know them all, but that there are multiple reasons doesn’t mean that a lack of personal responsibility is not a factor in the frustrations of medicine.



Again this seems like a straw man, but maybe you aren’t meaning it to be or maybe I just read that post wrong.

which makes it even more ridiculous that personal responsibility is brought out as the reason for inefficiences in our healthcare system. Healthcare system is broken because it is poorly designed. We can talk about preventable disease prevelances related to personal responsibility all day.

 

[Matthew9Thirtyfive]

which makes it even more ridiculous that personal responsibility is brought out as the reason for inefficiences in our healthcare system.

I agree that it’s certainly not the sole reason or even a major contributor. I think it’s easy to blame because when you’re in the trenches trying to care for people who want to get better, it is super frustrating to deal with people who expect you to fix everything while they are eating at McDonald’s every night or smoking like a chimney and then yelling at you when their necrosis continues to creep up their leg. That **** eats up a lot of time and money it might not if they were more compliant, so it probably feels like that’s the main cause.

 

[Psai]

What % of your COPD, CHF, T2DM patients are low SES? I think there are a lot of societal factors that go into it, and the blame can't be 100% put on patients.

Have you ever met a patient before? You'll look back in a few years and cringe at the tommyrot you posted.

 

[Dro133]

You definitely can’t put 100% of the blame on patients, but there are absolutely patients (and a number of them) who absolutely cause their own problems by their refusal to make lifestyle changes. I think it’s a bit hyperbolic to say that it’s the vast majority of patients though. @libertyyne definitely hit it when he said we tend toward extremism.

I agree that there are patients who refuse to make lifestyle changes, but again, I'd ask the question what % of these patients are low SES? Are they really *refusing* to make lifestyle changes, or are there factors in their lives that make it more difficult for them to make these changes vs. your middle to upper-middle class person? Yeah, I try to exercise and eat healthy, and not drink too much or do drugs that are harmful to me, but I'm also able to shop at Trader Joe's every weekend and have access to an exercise room in my apartment, and my (highly educated) parents taught me that healthy habits are important. I think a lot of our patients are missing these things, and we're quick to jump to labeling it as a "lack of personal responsibility" instead of acknowledging that a large portion of the problem has to do with their environment which is a result of the tremendous income inequality in this country. Hell, I'm sure some of us would probably not do much better than them if put in a similar situation (read: some, not all).

 

[Matthew9Thirtyfive]

I agree that there are patients who refuse to make lifestyle changes, but again, I'd ask the question what % of these patients are low SES? Are they really *refusing* to make lifestyle changes, or are there factors in their lives that make it more difficult for them to make these changes vs. your middle to upper-middle class person? Yeah, I try to exercise and eat healthy, and not drink too much or do drugs that are harmful to me, but I'm also able to shop at Trader Joe's every weekend and have access to an exercise room in my apartment, and my (highly educated) parents taught me that healthy habits are important. I think a lot of our patients are missing these things, and we're quick to jump to labeling it as a "lack of personal responsibility" instead of acknowledging that a large portion of the problem has to do with their environment which is a result of the tremendous income inequality in this country. Hell, I'm sure some of us would probably not do much better than them if put in a similar situation (read: some, not all).

Having been one of those people who can't make those changes due to SES issues and having worked in healthcare for a while, to me they are separate issues. There are patients who absolutely would make changes if they could, but they can't, and they really need someone to work with them to figure out a way to live as healthy as possible with the options they have (assuming it's not too late). Then, there are patients who would be self destructive if they were Steve Jobs. A lot of these people don't accept the connection between their behavior and their long-term health. They've been eating ****ty foods for decades and haven't started to feel bad until now, so clearly it can't be their diet. Or their uncle smoked for 50 years without getting cancer or any health problems (never mind that he died of a stroke), so any issues they have now would have happened anyway because cigarettes obviously aren't that bad. Etc.

I do think that some people will lump the former in with the latter, but the self-destructive patient with the means to change who won't definitely exists in non-trivial numbers.

 

[Dro133]

Have you ever met a patient before? You'll look back in a few years and cringe at the tommyrot you posted.

I'm a 3rd year, so admittedly, I haven't seen a whole lot. I'm sure it must be frustrating as hell being a sleep-deprived intern admitting a patient for their umpteenth COPD exacerbation, and I might reach that point myself where it's tempting to blame the patient. Why don't they quit smoking? Hell, why did they start smoking in the first place? Don't they know how bad it is for them? How many doctors have counseled them on quitting? It's their fault.

But wait, according to the CDC (CDC - Tobacco-Related Disparities - African Americans and Tobacco Use - Smoking & Tobacco Use)...

• People living in poverty smoke cigarettes for a duration of nearly twice as many years as people with a family income of three times the poverty rate.
• People with a high school education smoke cigarettes for a duration of more than twice as many years as people with at least a bachelor’s degree.
• Blue-collar workers are more likely to start smoking cigarettes at a younger age and to smoke more heavily than white-collar workers.

Armed with this knowledge, how could one POSSIBLY argue that there aren't systemic factors at play in regards to patients' destructive health habits? Based on this information, I don't see how anyone could possibly say that patients' problems are solely due to a "lack of personal responsibility".

 

[Dro133]

Having been one of those people who can't make those changes due to SES issues and having worked in healthcare for a while, to me they are separate issues. There are patients who absolutely would make changes if they could, but they can't, and they really need someone to work with them to figure out a way to live as healthy as possible with the options they have (assuming it's not too late). Then, there are patients who would be self destructive if they were Steve Jobs. A lot of these people don't accept the connection between their behavior and their long-term health. They've been eating ****ty foods for decades and haven't started to feel bad until now, so clearly it can't be their diet. Or their uncle smoked for 50 years without getting cancer or any health problems (never mind that he died of a stroke), so any issues they have now would have happened anyway because cigarettes obviously aren't that bad. Etc.

I do think that some people will lump the former in with the latter, but the self-destructive patient with the means to change who won't definitely exists in non-trivial numbers.

That's fair, and I'm probably way too early to have seen a lot of these things. I would play devil's advocate for a second though and wonder how much of these things can be attributed to a lack of healthcare literacy, but I digress, and I do see your point.

 

[Psai]

I'm a 3rd year, so admittedly, I haven't seen a whole lot. I'm sure it must be frustrating as hell being a sleep-deprived intern admitting a patient for their umpteenth COPD exacerbation, and I might reach that point myself where it's tempting to blame the patient. Why don't they quit smoking? Hell, why did they start smoking in the first place? Don't they know how bad it is for them? How many doctors have counseled them on quitting? It's their fault.

But wait, according to the CDC (CDC - Tobacco-Related Disparities - African Americans and Tobacco Use - Smoking & Tobacco Use)...

• People living in poverty smoke cigarettes for a duration of nearly twice as many years as people with a family income of three times the poverty rate.
• People with a high school education smoke cigarettes for a duration of more than twice as many years as people with at least a bachelor’s degree.
• Blue-collar workers are more likely to start smoking cigarettes at a younger age and to smoke more heavily than white-collar workers.

Armed with this knowledge, how could one POSSIBLY argue that there aren't systemic factors at play in regards to patients' destructive health habits? Based on this information, I don't see how anyone could possibly say that patients' problems are solely due to a "lack of personal responsibility".

Right the system forced them to go buy a pack of lucky strikes. Don't worry, you'll get over your idealistic phase soon.

 

[The Knife & Gun Club]

Right the system forced them to go buy a pack of lucky strikes. Don't worry, you'll get over your idealistic phase soon.

Idk man it’s not really an idealistic thing - I just feel like it’s gotta suck more to be the COPD patient than the M3/intern/attending admitting them.

I don’t expect my patients to have any health literacy or agency in their own conditions. More often than not, the people we see in the hospital are there BECAUSE they lack literacy and self control. In my mind that’s part of the disease.

 

[Psai]

People should take responsibility for their own decisions. This bizarre unwillingness to have people accept responsibility for their own foolish actions is why our malpractice system is so out of whack and responsible for the huge burden on our healthcare system.

 

[deleted938090]

Which specialties do you feel were the most efficient/meaningful?

 

[NicMouse64]

People should take responsibility for their own decisions. This bizarre unwillingness to have people accept responsibility for their own foolish actions is why our malpractice system is so out of whack and responsible for the huge burden on our healthcare system.

Looking at your posts as a premed, I always thought this guy is kinda d***. Only 2 weeks in and I already am becoming jaded by the constant push for "SES determinants of health" and other agendas that seems to be a part of all of our classes. I asked one of our speakers what we, as clinicians, can do about the economic factors that burden our low SES patients. After a few seconds of blank stares, she then replied something along the lines of "advocate for political movements that help low SES patients.

 

[Psai]

Looking at your posts as a premed, I always thought this guy is kinda d***. Only 2 weeks in and I already am becoming jaded by the constant push for "SES determinants of health" and other agendas that seems to be a part of all of our classes. I asked one of our speakers what we, as clinicians, can do about the economic factors that burden our low SES patients. After a few seconds of blank stares, she then replied something along the lines of "advocate for political movements that help low SES patients.

 

[Dro133]

Looking at your posts as a premed, I always thought this guy is kinda d***. Only 2 weeks in and I already am becoming jaded by the constant push for "SES determinants of health" and other agendas that seems to be a part of all of our classes. I asked one of our speakers what we, as clinicians, can do about the economic factors that burden our low SES patients. After a few seconds of blank stares, she then replied something along the lines of "advocate for political movements that help low SES patients.

I don't understand, what exactly are you becoming jaded by? The truth that low SES is a determinant of poorer outcomes? Or the fact that many clinicians choose to ignore that fact and appease their cognitive dissonance by saying it's the patient's fault?

 

[takeurmeds02]

I walked past a guy smoking a cigarette with an IV pole just the other day lol - I agree that there is a certain lack of personal responsibility in our society and it's a big driver of healthcare spending.