So happy to be finished with IM clerkship (vent)

[Goro]

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.

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[mrbreakfast]

Did you enjoy any other rotations?

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

IM was one of my least favorite rotations, and I am going into neurology. Outside of both having long rounds, they are less similar fields than they may seem.

 

[UnoMas]

Treat them and street them.

 

[ainsky]

Its sad how so many students seem to pander to low SES patients and treat them like they are imbeciles who "have no health literacy".. youre basically calling them stupid. trust me, they know that fried foods and smoking are not good for their beetus and blood pressure and coughing

 

[Money Moniker]

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".

You're just not seeing the obvious, are you? If you're a ***** who's too stupid or lazy to finish high school or aim for a higher status than "welfare recipient" you're also probably too stupid or lazy to not smoke, drink, and eat yourself into an early grave. That people who are losers in terms of their health are also losers in matters unrelated to health just proves that losers gonna lose and it's more often than not their own damn fault, not "the system's".

 

[akuko2]

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.

My fave example:
Patient: 'I'm supposed to see a psychiatrist once a week but I've just been way too busy at work to get to the appointments.'
Me: 'That sounds tough, what do you do for work?'
Patient:'I'm on disability.'

 

[Dro133]

You're just not seeing the obvious, are you? If you're a ***** who's too stupid or lazy to finish high school or aim for a higher status than "welfare recipient" you're also probably too stupid or lazy to not smoke, drink, and eat yourself into an early grave. That people who are losers in terms of their health are also losers in matters unrelated to health just proves that losers gonna lose and it's more often than not their own damn fault, not "the system's".

I can't even...

The error in your thinking is that you believe low SES to be directly related to your intelligence or ability/willingness to work hard. Newsflash: it's not. The world, and especially the United States, does NOT function as a meritocracy. People born into low SES environments are more likely to remain in the low SES strata, and vice versa. Yes, there are success stories of people who climb the economic ladder from low to middle/upper class, but these are the exception, not the rule. If you can't see that people born into the upper-middle class and up have built-in advantages to succeeding in life, then there really is no hope for you.

Source: http://www.pewtrusts.org/~/media/assets/2015/07/fsm-irs-report_artfinal.pdf

 

[sunshinefl]

1-non-compliance isn’t a thing because you are supposed to partner with your patient not dictate a plan.

2-even if 100% of the cause of 100% of their problems IS their fault, you should still desire to help them.

 

[Psai]

Thank god we have the medical students here to tell us how to practice medicine lmao

Maybe take step 1 first before you think about lecturing others

 

[Ho0v-man]

Wow. You can clearly see who in this thread has worked with actual patients. Let me know empathetic y’all feel when you’re readmitting the same pt for the same self-induced exacerbations of a chronic dz every week.

FFS just take the medicine and stop drinking!

But that’s how things go. Can’t take a pill twice a day to save my life. Too complicated. Nah, but I can drink 24 beers a day.

 

[sunshinefl]

I am 100% sure I will continue to be empathetic after I graduate. I was an RN before medical school so while not the same capacity yes I do in fact have extensive experience with patients. If I had lost any empathy for patients by working in healthcare I never would have committed myself to advancing to physician status.

 

[Iz_FtB]

Thank god we have the medical students here to tell us how to practice medicine lmao

Maybe take step 1 first before you think about lecturing others

You're on the "medical student" subforum of student doctor network in a thread started by a med student. Why you're wasting your time with we ignorant masses, oh great anesthesia resident, is beyond me.

On topic, you can only help people help themselves. An entire lifetime of poor decisions, whether entirely under the agency of the patient or not, isn't likely to be overcome by the limited time spent under the care of a physician. People lose nothing by routinely taking their htn meds, but that is still a bridge too far for some.

Medicine is the penultimate stop of a lifetime of poor living while screaming toward an early and plus sized grave. I always thought it was unfair to expect medicine to undo all the damage a person could do to themselves. Any meaningful changes will need to be directed at the beginning of this destructive process and not the end.

 

[mcat_taker]

I also just finished my IM clerkship and don't really know what to think. I always just assumed I would go into IM because I didn't have a strong preference for anything

For example, Psych was chill but I don't want to lose my overall medical knowledge and I disliked managing drug addicted patients and crazies and figuring out who was actually crazy and who was just pretending on inpatient, and evaluating suicide risk on consults every day on the floor, I mean duh they are in the hospital with a bunch of problems of course they are kind of depressed.

I thought peds was fine, but I really disliked outpatient peds because the well checks and milestone checks were just boring and most pediatricians do outpatient.

I have been told IM opens the most doors, the hospitalist schedule also seems nice, but the residency seems absolutely brutal and miserable. And managing a dozen problems on the floor was not fun. So many phone calls constantly from every specialist, tying up everyone else loose ends.

Sorry this message is very disjointed but I'm also having a lot of career angst over IM. Part of it is that as 3rd year students we get a very cursory view of the main specialties, are expected to make a career defining decision on that experience, and don't get exposed to a lot of other specialities.

At least w peds kids come in with like 1 problem and they usually get better, unlike with IM.

 

[IMreshopeful]

What? Why are you arguing things were not arguing? Who said it’s worse to be the attending than the patient?

Honestly your second paragraph is offensive to the patients. You really think these people are so dumb they don’t know their smoking is causing their lung problems? Or eating fast food everyday is not good for their weak heart? It’s the first thing you tell these people when you diagnose them and when you admit them for the 10th time.

I would agree - sometimes people just don’t want to give up the salt, sugar, cigs, drugs, alcohol, etc. however it is naive to think that there isn’t a huge amount of harm done up front by someone’s socioeconomic status. That’s just ridiculous

I also just finished my IM clerkship and don't really know what to think. I always just assumed I would go into IM because I didn't have a strong preference for anything

For example, Psych was chill but I don't want to lose my overall medical knowledge and I disliked managing drug addicted patients and crazies and figuring out who was actually crazy and who was just pretending on inpatient, and evaluating suicide risk on consults every day on the floor, I mean duh they are in the hospital with a bunch of problems of course they are kind of depressed.

I thought peds was fine, but I really disliked outpatient peds because the well checks and milestone checks were just boring and most pediatricians do outpatient.

I have been told IM opens the most doors, the hospitalist schedule also seems nice, but the residency seems absolutely brutal and miserable. And managing a dozen problems on the floor was not fun. So many phone calls constantly from every specialist, tying up everyone else loose ends.

Sorry this message is very disjointed but I'm also having a lot of career angst over IM. Part of it is that as 3rd year students we get a very cursory view of the main specialties, are expected to make a career defining decision on that experience, and don't get exposed to a lot of other specialities.

At least w peds kids come in with like 1 problem and they usually get better, unlike with IM.

IM does involve a lot of care coordination if you’re a PCP or hospitalist. It isn’t the career for you if you want to do tons of procedures and take care of one specific thing. FWIW being a hospitalist can be a much more chill job than being a resident - but depends on your practice model. And you get paid plenty more of course.

Also via IM you have exposure to subspecialty medicine - GI, cards are some of the most competitive specialties and are very popular for obvious reasons.

 

[mcat_taker]

I would agree - sometimes people just don’t want to give up the salt, sugar, cigs, drugs, alcohol, etc. however it is naive to think that there isn’t a huge amount of harm done up front by someone’s socioeconomic status. That’s just ridiculous



IM does involve a lot of care coordination if you’re a PCP or hospitalist. It isn’t the career for you if you want to do tons of procedures and take care of one specific thing. FWIW being a hospitalist can be a much more chill job than being a resident - but depends on your practice model. And you get paid plenty more of course.

Also via IM you have exposure to subspecialty medicine - GI, cards are some of the most competitive specialties and are very popular for obvious reasons.

Hey thanks for the reply, Yea, I don't think procedures are my thing. Disliked surgery, etc. Also GI and cards are extremely competitive fellowships cant bank on those. Hospitalist schedule seems chill with the 26 weeks on and 26 weeks off model, but when you see first hand how hard they work and how many hours they put in when they are "on" you think twice.

 

[Staphylococcus Aureus]

My peers that make the helpless victim arguments like @Dro133 are the ones that never had friends/relatives in poor health and low SES.

 

[Dro133]

My peers that make the helpless victim arguments like @Dro133 are the ones that never had friends/relatives in poor health and low SES.

I'm not making a "helpless victim" argument -- I'm simply pointing out the facts that there are more factors than just "lack of personal responsibility" that go into health outcomes. Is lack of personable responsibility some component of it? Sure, probably. But for now it's impossible to tease out when we know, for a fact, that other factors are at play, and thus it is irresponsible and not factual to blame it all on a lack of personal responsibility.

I also find it surprising that you know, for a fact, that these peers of yours have no friends/family in low SES/poor health. I know that that's definitely not the case for me.

 

[ainsky]

Hey thanks for the reply, Yea, I don't think procedures are my thing. Disliked surgery, etc. Also GI and cards are extremely competitive fellowships cant bank on those. Hospitalist schedule seems chill with the 26 weeks on and 26 weeks off model, but when you see first hand how hard they work and how many hours they put in when they are "on" you think twice.

hospitalist is 7 on 7 off because you deal with the most insufferable medically complex patients all day and keep them in holding patterns. you would go crazy if you had to work a regular 5 day on 2 off like everyone else does. and a lot of hospitalists dont have residents and med students to do their scut.

 

[ainsky]

SDN literally teeming with goodie two shoes cookie cutters who only parrot what they think adcoms want to hear

 

[sunshinefl]

Non-compliance isn't a thing? I can't tell if you're serious. Maybe you worked as an RN in an affluent area. Cause I can't even count the number of people I encountered on IM who literally didn't give two ****s about their disease process and, as an example, just "didn't like" taking their diabetes meds, despite already missing toes do to it

I’m serious. As I said, you’re not supposed to just unilaterally dictate a plan. So in response to your example I would say that if a patient isn’t taking their diabetes meds due to side effect, or cost, or taste, or whatever other reason they don’t like it, try something else! Work with them. Don’t just keep repeating/prescribing the same thing over and over that you know they aren’t going to take.

 

[sunshinefl]

SDN literally teeming with goodie two shoes cookie cutters who only parrot what they think adcoms want to hear

I’m not parroting anything. What I’m saying is intrinsic for me. Seems more like other people got in by “only parroting what they think adcoms want to hear.”

 

[Mad Jack]

I was in the opposite field for mostly 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.

I did my surgery rotation in a community hospital and damn was I grateful. There was no inefficiency and no waste- turnover times were 20-30 minutes at most and factored in when scheduling cases. Academic centers tend to have maximal inefficiency for various reasons.

 

[mrbreakfast]

I also just finished my IM clerkship and don't really know what to think. I always just assumed I would go into IM because I didn't have a strong preference for anything

For example, Psych was chill but I don't want to lose my overall medical knowledge and I disliked managing drug addicted patients and crazies and figuring out who was actually crazy and who was just pretending on inpatient, and evaluating suicide risk on consults every day on the floor, I mean duh they are in the hospital with a bunch of problems of course they are kind of depressed.

I thought peds was fine, but I really disliked outpatient peds because the well checks and milestone checks were just boring and most pediatricians do outpatient.

I have been told IM opens the most doors, the hospitalist schedule also seems nice, but the residency seems absolutely brutal and miserable. And managing a dozen problems on the floor was not fun. So many phone calls constantly from every specialist, tying up everyone else loose ends.

Sorry this message is very disjointed but I'm also having a lot of career angst over IM. Part of it is that as 3rd year students we get a very cursory view of the main specialties, are expected to make a career defining decision on that experience, and don't get exposed to a lot of other specialities.

At least w peds kids come in with like 1 problem and they usually get better, unlike with IM.

You've also just started. Even a single year of experience will help things come together. I thought residency looked like a nightmare as an M3, but as an M4, it doesn't look like a walk in the park but certainly seems doable.

You can always shadow on your (very limited) free time; just maybe 5 or 6 half-days of shadowing during M3 helped me make my career decision.

Also, elective time is really helpful. You're right that you get a very limited snapshot during M3, but being able to explore more deeply, especially without a shelf looming over you, is great.

It'll come together.

 

[Weirdy]

I can't even...

The error in your thinking is that you believe low SES to be directly related to your intelligence or ability/willingness to work hard. Newsflash: it's not. The world, and especially the United States, does NOT function as a meritocracy. People born into low SES environments are more likely to remain in the low SES strata, and vice versa. Yes, there are success stories of people who climb the economic ladder from low to middle/upper class, but these are the exception, not the rule. If you can't see that people born into the upper-middle class and up have built-in advantages to succeeding in life, then there really is no hope for you.

Source: http://www.pewtrusts.org/~/media/assets/2015/07/fsm-irs-report_artfinal.pdf

You push these ideas with the huge assumption that:
1) Given a chance to succeed, these types of patients will take it.

Worked in an IM clinic before in a low SES and I used to think the system was flawed. Plenty of bad patients put in these situations who seemed to have no control. Could not understand why the docs were so mean and jaded and had their game face on 110% of the time every time these patients walked in. Then I realized a majority of them (yes, personal anecdote take it as you will) were out to get what they can and were less innocent than they seemed. A few of many examples:

Getting a call from the pharmacy asking why your patient has a prescription for a drug you are not allowed to refill-- when you explicitly told them in your office 10 minutes ago that their prescription wasn't supposed to be out yet and under law, you were not allowed to prescribe anymore.

Having a patient cause a scene in the checkout room because you switched their medications to a cheaper one upon their request and they are still giving you **** for having to pay for it.

Patients who come in and look sorry but give you a fake urine sample and make a scene when you tell them to either come back or go again.


You give them an inch as a doctor, they will eat you alive. I firmly believe this is not a result of "the system".

 

[DrMcCoyDO]

1-non-compliance isn’t a thing because you are supposed to partner with your patient not dictate a plan.

2-even if 100% of the cause of 100% of their problems IS their fault, you should still desire to help them.

LOL, non-compliance is 100% a thing. This doesn’t mean that we don’t desire to help people. You have to recognize that not everyone can be saved and a large chunk of your efforts to do so are futile; if you don’t, it will drive you insane.

 

[sunshinefl]

All of that was done, in almost every case I was involved in during my rotation. These patients cared more about getting some "free" hospital food and watching tv over their health. If it cost money, they had no interest in doing it.

Okay that’s fair. But to that I would say that you should remember that you are in a tertiary setting, thus seeing the ones who weren’t managed by primary care. Also, you can keep just doing the best you can for them while under your care, without despising them. Wanting better for them is good and appropriate even if they don’t for themselves—which means continuing to try to educate and give your very best without judging them.

 

[Ho0v-man]

I’m serious. As I said, you’re not supposed to just unilaterally dictate a plan. So in response to your example I would say that if a patient isn’t taking their diabetes meds due to side effect, or cost, or taste, or whatever other reason they don’t like it, try something else! Work with them. Don’t just keep repeating/prescribing the same thing over and over that you know they aren’t going to take.

Think these frequent fliers never get better bc their docs won’t work with them? They’d freaking peel their own flesh off if it meant not seeing these people sicker next week than last week. Multiple med changes, dietitian referrals, addiction counseling, it goes on forever.

I don’t care what the side effects are, if a med keeps my legs attached then it’s all good. But some people would rather live in the hospital and play the victim.

 

[sunshinefl]

Think these frequent fliers never get better bc their docs won’t work with them? They’d freaking peel their own flesh off if it meant not seeing these people sicker next week than last week. Multiple med changes, dietitian referrals, addiction counseling, it goes on forever.

I don’t care what the side effects are, if a med keeps my legs attached then it’s all good. But some people would rather live in the hospital and play the victim.

I am definitely not saying that everyone can be saved. My points are:

1: you should take into account what the patient wants/prefers/is willing to do
2: you should offer alternatives/be creative
3: if none of the above solves the problem, continue to do what you can, even if imperfect.
4: while doing that, do it without hate/despise/resentment

 

[Instatewaiter]

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".

The argument is an easy and straightforward one . For the same reason people make bad decisions that leave them in poverty, they make bad decisions that affect their health. Those who make good decisions rarely remain in poverty. This is well documented by the left of center think tank the Brookings institute.

Realize there aren't walls preventing mobility and unlike what is popular to espouse today, the data supports there is a lot of upward (and downward) mobily. When you meet someone in the hospital you are getting a crosssection of their life. That white collar worker might not have always been at the top. Same for the blue collar worker. My wife is a prime example of this. She grew up in a single parent household and her mother worked in a factory and later cleaned houses. They grew up exceptionally poor . However if you met her in the hospital you'd assume she must have grown up rich since she is a well spoken professional with an advanced degree .

The same reason that white collar worker was able to climb out of poverty is the same reason she doesn't smoke.

 

[NicMouse64]

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?

The idea was drilled into our brains from the moment psych/soc was put on the MCAT. Yes I am aware of these issues, and whose fault it is really isn't important. I went to medical school to be a physician who knows how to take care of patients through my scientific and medical knowledge to make accurate diagnoses and treatment plans. I didn't go to medical school to pander to all of the issues that patients have that aren't medically related. Medical school should be teaching me how to be an effective clinician, not a community organizer.

 

[Instatewaiter]

I can't even...

The error in your thinking is that you believe low SES to be directly related to your intelligence or ability/willingness to work hard. Newsflash: it's not. The world, and especially the United States, does NOT function as a meritocracy. People born into low SES environments are more likely to remain in the low SES strata, and vice versa. Yes, there are success stories of people who climb the economic ladder from low to middle/upper class, but these are the exception, not the rule. If you can't see that people born into the upper-middle class and up have built-in advantages to succeeding in life, then there really is no hope for you.

Source: http://www.pewtrusts.org/~/media/assets/2015/07/fsm-irs-report_artfinal.pdf

You can't even do what?

Just like every social science article, this is a univariate analysis . They have the data and an appropriate number of outcomes to actually do a multivariate analysis. Think about why they wouldn't do this... Perhaps because the univariate analysis is salacious and multivariate analysis isn't. Suspect, no?

There are a tremendous amount of confounders that they do not address in a multivariate analysis (and are never addressed in these types of publications) like education level, hours worked, intelligence, marriage status, kids or not, geographic area, city vs rural vs suburban. This would never fly in a medical journal

As I alluded to above, the Brookings Institute published an article years ago that to escape poverty you had to do 3 things: finish high school, get a job and don't have kids before you're married. If you do these 3 things you have a 2% chance of ending up below the poverty line and a 75% chance of making $55,000 per year and joining the middle class. You do none of those things and you have 76% chance of being poor and a 93% chance of being poor or in the lower middle class. The truth is likely some combination of factors. What is clear are univariate analyses are not helpful if we actually want to fight poverty.

 

[GadRads]

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.

Strange med student. I suspect that medical student will change tunes when residency beats him/her up.

 

[Ho0v-man]

I am definitely not saying that everyone can be saved. My points are:

1: you should take into account what the patient wants/prefers/is willing to do
2: you should offer alternatives/be creative
3: if none of the above solves the problem, continue to do what you can, even if imperfect.
4: while doing that, do it without hate/despise/resentment

Absolutely agree, especially with number 4, despite how easy it is to fall into that pattern. My counterpoint is that your previous posts imply that 1-3 aren’t being done already which isn’t the case.

 

[bonemann]

You can't even do what?

Just like every social science article, this is a univariate analysis . They have the data and an appropriate number of outcomes to actually do a multivariate analysis. Think about why they wouldn't do this... Perhaps because the univariate analysis is salacious and multivariate analysis isn't. Suspect, no?

There are a tremendous amount of confounders that they do not address in a multivariate analysis (and are never addressed in these types of publications) like education level, hours worked, intelligence, marriage status, kids or not, geographic area, city vs rural vs suburban. This would never fly in a medical journal

As I alluded to above, the Brookings Institute published an article years ago that to escape poverty you had to do 3 things: finish high school, get a job and don't have kids before you're married. If you do these 3 things you have a 2% chance of ending up below the poverty line and a 75% chance of making $55,000 per year and joining the middle class. You do none of those things and you have 76% chance of being poor and a 93% chance of being poor or in the lower middle class. The truth is likely some combination of factors. What is clear are univariate analyses are not helpful if we actually want to fight poverty.

so much this (speaking as someone who is clawing his way out of low SES)

can yah link the Brookings study to spread this inconvenient truth?

 

[nimbus]

Today is Labor Day. I got off a night of call. The vast majority of people I see working are low SES people working their jobs in restaurants, landscaping, retail, and my cleaning lady. So who is lazy? What’s the average SDN’er doing today?

 

[nimbus]

The idea was drilled into our brains from the moment psych/soc was put on the MCAT. Yes I am aware of these issues, and whose fault it is really isn't important. I went to medical school to be a physician who knows how to take care of patients through my scientific and medical knowledge to make accurate diagnoses and treatment plans. I didn't go to medical school to pander to all of the issues that patients have that aren't medically related. Medical school should be teaching me how to be an effective clinician, not a community organizer.

I’m glad you know what medical schools “should be teaching” you. When you grow up perhaps you can start your own. For now, medical schools have an agenda greater than yours. We are here to serve people. All people.....lazy ones, dumb ones, poor ones, and noncompliant ones. Perhaps you should have done more research before embarking on this career. You can post in the premed forums to warn off like minded premeds.

 

[NicMouse64]

I’m glad you know what medical schools “should be teaching” you. When you grow up perhaps you can start your own. For now, medical schools have an agenda greater than yours. We are here to serve people. All people.....lazy ones, dumb ones, poor ones, and noncompliant ones. Perhaps you should have done more research before embarking on this career. You can post in the premed forums to warn off like minded premeds.

Did I ever argue that we shouldn't treat these people with the best ability and the empathy they expect from us? no. Also nice ad-hominem. I am merely stating that the goal of a medical school should be to give an education which makes their students good...physicians. Some physicians may take up leadership roles or start a community based non-profit, or free clinic, but that is their choice. My medical education should give me the toolbox to deliver good care, not deliver community initiatives.

 

[Instatewaiter]

Today is Labor Day. I got off a night of call. The vast majority of people I see working are low SES people working their jobs in restaurants, landscaping, retail, and my cleaning lady. So who is lazy? What’s the average SDN’er doing today?

Well I'm working. And actually looking at the hours worked- the higher you move up the SES ladder, the more hours you work on average. So, that argument is not supported by data (How Many Hours a Week Do You Work? Why More Hours Means More Money in America. – DQYDJ).


As to a prior poster who asked for the Brookings institute data, it comes from a book by one of its senior fellows Ron Haskins which I cannot link. However I have included 2 links which cover similar data: the first link below covers many of the same points and is shorter. The second link gives a better overview which includes many of the points I have not discussed.

https://www.brookings.edu/wp-content/uploads/2016/06/pb28.pdf

Poverty and Opportunity: Begin with Facts

 

[nimbus]

Did I ever argue that we shouldn't treat these people with the best ability and the empathy they expect from us? no. Also nice ad-hominem. I am merely stating that the goal of a medical school should be to give an education which makes their students good...physicians. Some physicians may take up leadership roles or start a community based non-profit, or free clinic, but that is their choice. My medical education should give me the toolbox to deliver good care, not deliver community initiatives.

Service to community is an explicit mission of many medical schools. It was at mine. If it’s going to be an issue for a premed, they probably should not apply to that school.

 

[nimbus]

Well I'm working. And actually looking at the hours worked- the higher you move up the SES ladder, the more hours you work on average. So, that argument is not supported by data (How Many Hours a Week Do You Work? Why More Hours Means More Money in America. – DQYDJ).


As to a prior poster who asked for the Brookings institute data, it comes from a book by one of its senior fellows Ron Haskins which I cannot link. However I have included 2 links which cover similar data: the first link below covers many of the same points and is shorter. The second link gives a better overview which includes many of the points I have not discussed.

https://www.brookings.edu/wp-content/uploads/2016/06/pb28.pdf

Poverty and Opportunity: Begin with Facts

I agree that generally more hours worked means more income. That is certainly true in my case. However, there are people who will never earn what I earn and frankly never had a chance to earn what I earn. For example my parents and even my siblings. Some things came very easy for me that did not for them. In my youth I drank nothing but soda and rarely studied even in med school until it was time to prepare for boards. Luck played a LARGE part in my life. I don’t think it should be entirely discounted. That said, I never had a shot at the NBA.

 

[Staphylococcus Aureus]

Misapplication/comprehension of statistics by the social sciences can really fuel any viewpoint of the researcher/reader.

 

[DrMcCoyDO]

Did I ever argue that we shouldn't treat these people with the best ability and the empathy they expect from us? no. Also nice ad-hominem. I am merely stating that the goal of a medical school should be to give an education which makes their students good...physicians. Some physicians may take up leadership roles or start a community based non-profit, or free clinic, but that is their choice. My medical education should give me the toolbox to deliver good care, not deliver community initiatives.

Sorry to break it to you, but the social aspect of medicine also falls under the purview of the physician, especially with areas of medicine like family, generalist IM, and emergency. Guess what, if a social issue affects a patient’s ability to be compliant, it is a medically related problem. You may not be the one to solve it, but it’s definitely your responsibility to at least try to connect patient with the right resources.

 

[Dro133]

Well I'm working. And actually looking at the hours worked- the higher you move up the SES ladder, the more hours you work on average. So, that argument is not supported by data (How Many Hours a Week Do You Work? Why More Hours Means More Money in America. – DQYDJ).


As to a prior poster who asked for the Brookings institute data, it comes from a book by one of its senior fellows Ron Haskins which I cannot link. However I have included 2 links which cover similar data: the first link below covers many of the same points and is shorter. The second link gives a better overview which includes many of the points I have not discussed.

https://www.brookings.edu/wp-content/uploads/2016/06/pb28.pdf

Poverty and Opportunity: Begin with Facts

Your say that all you have to do to escape poverty is finish high school, get a job and don't have kids before you get married. The hole in your argument is that you make the assumption that people of all socioeconomic classes have an equal chance at accomplishing these things. Allow me to cite the article you posted:

"The U.S. has less income mobility that many European nations, but mobility has remained constant over the past four decades or so; nonetheless, children whose parents were in the bottom 20 percent of the income distribution have more than a 40 percent chance of staying in the bottom themselves."

Furthermore,

"Hardly anyone thinks we should be satisfied with the opportunities we offer to poor children when they are twice as likely to wind up at the bottom of the income distribution as children from more affluent families and when many other nations with advanced economies have more economic mobility than we do."

This is another data point that corroborates what I posted earlier; people born into low SES are more likely to remain in it. Thus, there MUST exist contributing factors to being low SES that are structural in nature. As an extremely obvious example, take the child in poverty who attends an inner city public school versus a middle or high SES child who attends a good public school or even a private school; which child has a better chance of graduating high school, and for that matter, college? One would have to either be completely dense or willfully ignorant to not see the structural barriers that exist for low SES people to move upward in society. Does that mean it's impossible? Certainly not, but the fact is that the playing ground is not level, and the same extends to the healthcare of low SES people. This is something that we must, at the very least, recognize as healthcare professionals.

P.S. if you're going to disparage legitimate studies posted by social scientists out of Stanford, it's probably not a good idea to cite a "study" from someone's personal blog (DQYDJ).

 

[Instatewaiter]

Your say that all you have to do to escape poverty is finish high school, get a job and don't have kids before you get married. The hole in your argument is that you make the assumption that people of all socioeconomic classes have an equal chance at accomplishing these things.

This is another data point that corroborates what I posted earlier; people born into low SES are more likely to remain in it. Thus, there MUST exist contributing factors to being low SES that are structural in nature. As an extremely obvious example, take the child in poverty who attends an inner city public school versus a middle or high SES child who attends a good public school or even a private school; which child has a better chance of graduating high school, and for that matter, college? One would have to either be completely dense or willfully ignorant to not see the structural barriers that exist for low SES people to move upward in society. Does that mean it's impossible? Certainly not, but the fact is that the playing ground is not level, and the same extends to the healthcare of low SES people. This is something that we must, at the very least, recognize as healthcare professionals.
.

So your first argument is really that people of low SES are unable to not have kids out of wedlock or finish high school or get a job... Ok.

Also, you clearly don't understand the idea of a confounder. Let's use an analogy:

kids of NBA players are more likely to make it to the NBA than jewish kids therefore there MUST be existing structural issues which prevent Jewish kids from excelling in the NBA.

Which child has a better chance of making their high school team or going to college and playing ball. One would have to either be completely dense or willfully ignorant to not see the structural barriers that exist for Jewish people to move upward in basketball society. Does that mean it's impossible? Certainly not, but the fact is that the playing ground is not level.

Notice that I basically used all of your own words

 

[nimbus]

So your first argument is really that people of low SES are unable to not have kids out of wedlock or finish high school or get a job... Ok.

Also, you clearly don't understand the idea of a confounder. Let's use an analogy:

kids of NBA players are more likely to make it to the NBA than jewish kids therefore there MUST be existing structural issues which prevent Jewish kids from excelling in the NBA.

Which child has a better chance of making their high school team or going to college and playing ball. One would have to either be completely dense or willfully ignorant to not see the structural barriers that exist for Jewish people to move upward in basketball society. Does that mean it's impossible? Certainly not, but the fact is that the playing ground is not level.

Notice that I basically used all of your own words

That is a wonderful treatise. We can all agree that the playing ground is not level and some people have many advantages while others have many disadvantages. But what does that have to do with SERVING patients? They don’t come to us to be judged. They come to us for help. Patients are the only reason that doctors and medical schools exist. We are here to serve THEM. If you prefer to be a judge, go to law school.

 

[mistafab]

Wow, pages 2-3 can be described as a crap fest on top of a pissing contest. We must be in Allo.

OP - your venting is welcome here! Rag on the rotations you hate and revel in the ones you love. This is third year, baby! Enjoy the RUUUUUUUUUSH.

I hope my enthusiasm and zest for all things has added some spice to your life. IM doesn’t sound like it is for you. Which is good, you can now successfully scratch that ugly duckling off of your list of potential life roads.

 

[Goro]

Note that OP was Banhammer smacked??

Kudos to the mods.

App season is troll season, alas

 

[Instatewaiter]

That is a wonderful treatise. We can all agree that the playing ground is not level and some people have many advantages while others have many disadvantages. But what does that have to do with SERVING patients? They don’t come to us to be judged. They come to us for help. Patients are the only reason that doctors and medical schools exist. We are here to serve THEM. If you prefer to be a judge, go to law school.

That's a pretty high horse for someone who doesn't have to deal with non-compliance or conscious patients for that matter. Perhaps a pathologist will next treach me about displaying compassion with patients in clinic...

Look, if you don't go after the root of the cause you're not fixing anything and you're not " serving" patients anything but what they want to hear. If you don't call patients out on their bull**** they won't change. My job is to judge their poor decisions, point those poor decisions out to them, and get them to change. And it works because it's refreshing but there's an art to it.

 

[nimbus]

That's a pretty high horse for someone who doesn't have to deal with non-compliance or conscious patients for that matter. Perhaps a pathologist will next treach me about displaying compassion with patients in clinic...

Look, if you don't go after the root of the cause you're not fixing anything and you're not " serving" patients anything but what they want to hear. If you don't call patients out on their bull**** they won't change. My job is to judge their poor decisions, point those poor decisions out to them, and get them to change. And it works because it's refreshing but there's an art to it.

I agree noncompliance can be frustrating and also agree with your point about counseling patients. But it needs to come from a place of goodwill and not anger or resentment or disdain. So much of what I see from both seasoned doctors and young medical students is disdain. I’ve been working in a safety net hospital for a long time and many of my patients are afflicted by homelessness, mental illness and drug addiction. The last thing they need from me is judgement.

 

[Lawpy]

Note that OP was Banhammer smacked??

Kudos to the mods.

App season is troll season, alas

No surprise there:

Don't waste your breath. That's the same clown who started this thread: Is milmed good if you want to be a lazy doctor?

:troll:

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