The "Hidden Curriculum"

[surftheiop]

Awhile ago we had some lectures about the "hidden curriculum" of the medical profession where physicians perpetuate an attitude where altruism is considered childish. It sort of becomes a coming of age, where medstudents feel like they need to look down on patients/altruism/the profession, in order to be considered someone who "gets it". I found the lectures really interesting and it completely aligns with things I've read on SDN. Nobody comes into medicine wanting to fall victim to the hidden curriculum, but sadly its happens to so many folks.

But what I find so interesting is that there are a subset of physicians who it doesn't seem to get to. If you look at the specialty forums here, on each forum there is always one or two attending who you can tell doesn't buy into it and still are overtly altruistic. These lectures were given by attendings of various specialties, so obviously there are MD's out there trying to stop the trend.

What do you think allows some people to stay above the "hidden curriculum"? What are you doing to try to prevent yourself from going down that road (assuming you think its a road you would rather not travel)?

Edit: If it wasn't obvious, the lectures were not endorsing the "hidden curriculum", they were warning us that it exists and hoping to encourage us to avoid its effects.

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[Marcus Brody]

Funny, I think it is the total opposite....If there is any agenda it's to actively promote and even require altruism (as if such a thing is still altruistic), whether through the admissions process, mandatory "volunteer" work, biased speakers or silly ethics classes. For whatever reason, a lot of professors and administrators are the type that refuse to acknowledge any societal benefit to profit-motivated "selfish" behavior.

Realizing that altruism is childish isn't some sort of evil brainwashing, it's just waking up to reality. It is hard to go through this process without ever facing reality.

 

[surftheiop]

Funny, I think it is the total opposite....If there is any agenda it's to actively promote and even require altruism (as if such a thing is still altruistic), whether through the admissions process, mandatory "volunteer" work, biased speakers or silly ethics classes. For whatever reason, a lot of professors and administrators are the type that refuse to acknowledge any societal benefit to profit-motivated "selfish" behavior.

Realizing that altruism is childish isn't some sort of evil brainwashing, it's just waking up to reality. It is hard to go through this process without ever facing reality.

🙄

I would hate to live in your reality, but I do respect that your reality is that of many people, of which many still do very beneficial things for society.


Also if it wasn't obvious from the OP, the lectures were not endorsing the "hidden curriculum", they were warning us that it exists.

 

[DrBowtie]

🙄

I would hate to live in your reality, but I do respect that your reality is that of many people, of which many still do very beneficial things for society.


Also if it wasn't obvious from the OP, the lectures were not endorsing the "hidden curriculum", they were warning us that it exists.

IIRC you are an M1. I think this lecture is totally lost on you guys. The real hidden curriculum occurs during M3. You're in the trenches and get to see all the BS that goes on in medicine. Its easy to get jaded.

 

[surftheiop]

IIRC you are an M1. I think this lecture is totally lost on you guys. The real hidden curriculum occurs during M3. You're in the trenches and get to see all the BS that goes on in medicine. Its easy to get jaded.

I think thats their point, I think they spend a few minutes talking about this every semester so that once we get to M3 we aren't surprised. They did mention if they waited until M3 to start having these discussions it would be too late.

 

[DrBowtie]

I think thats their point, I think they spend a few minutes talking about this every semester so that once we get to M3 we aren't surprised. They did mention if they waited until M3 to start having these discussions it would be too late.

But its the same thing like talking about how medical school is without having gone through it. You don't have the context (and going to see a few patients once a week doesn't give it to you either).

 

[BigRedBeta]

I think a lot of it comes down to how you define being altruistic. There's this belief that is common among pre-meds that patients are grateful for your services, that they are respectful to you and will say thank you for what you've done for them. I think there's certainly a form of altruism that fits this definition.

On the other hand, there are other forms that perhaps aren't as "pure" - where selfish actions have the enviable byproduct of helping patients in extreme need. I'm a 3rd year pediatrics resident interviewing for pediatric critical care fellowships. I want to take care of the kids that are the sickest of the sick, the ones that need the most help. I will have to deal with the tragedy of a child dying on a regular basis. Absolutely I DO want to help those kids. I want other doctors to call me for help. The hours I'll work, even as an attending, will be significant - Peds CCM will never be considered a "lifestyle" specialty, and I'm happy to work those as needed. Does that fit a definition of altruism? Perhaps. Do I feel more altruistic than my colleagues? No. While I do want to help the sickest children, my main motivations are purely selfish - I need the adrenaline rush, I love the variety of the PICU, I hate being in clinic, the physiology fascinates me, there are plenty of procedures, the cases are intellectually stimulating and the combination of those things excites me and makes me happy. If my passions weren't raised, I wouldn't be going in this direction. I'm not going into Peds CCM so that I can do the most good. If another field ignited my interests and made me as happy as the PICU does, I'd be doing something else. While I personally can't understand the appeal of things like derm or rads, I understand that people can find aspects of those fields that make them happy. I can't judge them for trying to be happy, and I'm not more altruistic simply because I want to deal with patients who are extremely sick.

It's nice to be aware of the "hidden curriculum", at least so if nothing else, you're not surprised when patients are rude to you, you get buried under paperwork and insurance companies are *******s towards you, and it won't ruin your motivation to be a physician.

 

[Bartelby]

Most people have an attitude shift toward 'selfish' considerations like their future lifestyle, pay, ability to raise a family, etc. That probably isn't bad. Others push it further and become contemptuous of their patients and bitter. The latter is what you have to really guard against.

So basically don't think every person saying something like "I want to be paid for what I do" has lost their motivation to do good, but don't end up being the attitude-exuding doc constantly making fun of patients in the resident room either.

 

[Bacchus]

I think a lot of it comes down to how you define being altruistic. There's this belief that is common among pre-meds that patients are grateful for your services, that they are respectful to you and will say thank you for what you've done for them. I think there's certainly a form of altruism that fits this definition. (But it doesn't always happen)

The sooner students lose this notion, or at least know its not always the case the better for them.

Case in point:
IM consult in the ED for a ~55y/o female who was feeling SOB and having chest discomfort. Pt doesn't have insurance and uses the free clinic across the driveway on hospital grounds. All meds are provided by the hospital through various funding. I go in, get the CC, take a detailed history, do a detailed physical on a patient that probably hasn't had one in many years. Pt admits to using crack 2 weeks ago and "occasionally" uses various other drugs including cocaine, heroin, marijuana and LSD. The pt had a tobacco history of 80 pack years. "Never" touched alcohol.

When asked if she had tried anything to relieve the chest discomfort or get rid of the congestion causing her SOB, I was told without a drop of the hat "I don't have any money to buy anything over the counter."

😕 Really, maam? You just bought some rocks 2 weeks ago and have a 2ppd smoking history and you have no money? I felt bad she had to be admitted to the hospital d/t COPD exacerbation, but she was not my highest priority in the least. I dreaded seeing her everyday because she always asked for something but never mentioned being thankful for her care.

As I was leaving her room in the ED, I never got a thank-you but was told to have the nurse get her a sandwich. Are you ****ing kidding me? We just wasted $1000s of dollars on you and you can't say in the least you're thankful.

 

[Morsetlis]

You should thank her cause she went away for the day. 🙂

 

[Kaustikos]

The sooner students lose this notion, or at least know its not always the case the better for them.

Case in point:
IM consult in the ED for a ~55y/o female who was feeling SOB and having chest discomfort. Pt doesn't have insurance and uses the free clinic across the driveway on hospital grounds. All meds are provided by the hospital through various funding. I go in, get the CC, take a detailed history, do a detailed physical on a patient that probably hasn't had one in many years. Pt admits to using crack 2 weeks ago and "occasionally" uses various other drugs including cocaine, heroin, marijuana and LSD. The pt had a tobacco history of 80 pack years. "Never" touched alcohol.

When asked if she had tried anything to relieve the chest discomfort or get rid of the congestion causing her SOB, I was told without a drop of the hat "I don't have any money to buy anything over the counter."

😕 Really, maam? You just bought some rocks 2 weeks ago and have a 2ppd smoking history and you have no money? I felt bad she had to be admitted to the hospital d/t COPD exacerbation, but she was not my highest priority in the least. I dreaded seeing her everyday because she always asked for something but never mentioned being thankful for her care.

As I was leaving her room in the ED, I never got a thank-you but was told to have the nurse get her a sandwich. Are you ****ing kidding me? We just wasted $1000s of dollars on you and you can't say in the least you're thankful.

Maybe it's because I've worked in etail, mabye it's cause I'm arrogant/egotistical, but I can't ellp but feel that I'd enjoy that experience. I find hmor in these ironic situations. Especially when she can't afford a ****ing medincation cause he needs crack.

In ethe end, Id' laguh about it after levaging her room. Or laugh to mylsef. Yes, I'm na MS1, but I think my retail experience has helped me retain the idea tha I'm better than them. And THAT helps.

 

[DrBowtie]

Maybe it's because I've worked in etail, mabye it's cause I'm arrogant/egotistical, but I can't ellp but feel that I'd enjoy that experience. I find hmor in these ironic situations. Especially when she can't afford a ****ing medincation cause he needs crack.

In ethe end, Id' laguh about it after levaging her room. Or laugh to mylsef. Yes, I'm na MS1, but I think my retail experience has helped me retain the idea tha I'm better than them. And THAT helps.

It would be funny if it wasn't every single patient. Society is in bad shape.

 

[surftheiop]

Maybe it's because I've worked in etail, mabye it's cause I'm arrogant/egotistical, but I can't ellp but feel that I'd enjoy that experience. I find hmor in these ironic situations. Especially when she can't afford a ****ing medincation cause he needs crack.

In ethe end, Id' laguh about it after levaging her room. Or laugh to mylsef. Yes, I'm na MS1, but I think my retail experience has helped me retain the idea tha I'm better than them. And THAT helps.

Are you drunk?

 

[jdh71]

Funny, I think it is the total opposite....If there is any agenda it's to actively promote and even require altruism (as if such a thing is still altruistic), whether through the admissions process, mandatory "volunteer" work, biased speakers or silly ethics classes. For whatever reason, a lot of professors and administrators are the type that refuse to acknowledge any societal benefit to profit-motivated "selfish" behavior.

Realizing that altruism is childish isn't some sort of evil brainwashing, it's just waking up to reality. It is hard to go through this process without ever facing reality.

I agree. There is a good amount of social engineering that comes down from the Ivory Towers that "we" should do medicine for purely altruistic reasons. The powers that be find themselves confused that they cannot convince everyone that "the reality of the medical world is pure altruism". Mostly this flies in the face of what natural man knows to be true at a gut level - that is that a man should do what he likes, be fairly compensated for hard work and specialized knowledge providing a service that no one else can. Thinking you can save the world is naive, and a recipe for disillusionment and burnout. This "hidden curriculum" is there to try help you, not hurt you. If you piss on my back and someone tries to tell me it's urine and not rain, I should be upset by this? "Know this class, in your third year people will try and tell you about reality. We tell you this now so that that you'll know to resist these messages and continue to play ball"

I'd bet that all of the bleeding heart altruists represent a small percentage of personality types that this kind of thing jives with. God bless them. The rest of us don't get it, and it not that we're bad or evil, we just see the world much different and no amount of social engineering will change that.

I do get to "help people" in my job, but mostly I like my job for personal reasons - nothing wrong with that.

 

[Bacchus]

Are you drunk?

*like*

 

[NickNaylor]

Are you drunk?

First thing I thought too.

 

[DeadCactus]

I think physicians just convince themselves that going to work everyday is their own personal blessing on humanity and negates any need for charitable work...

 

[jdh71]

I think physicians just convince themselves that going to work everyday is their own personal blessing on humanity and negates any need for charitable work...

We ALL (almost all anyway) end up doing charitable work anyway. You can't very easily get away with it in our system, especially if you're doing any hospital based medicine

 

[DeadCactus]

Care to elaborate?

I don't consider having uninsured customers who don't pay their bills the same as providing a charitable service any more than I consider a credit card company a charitable organization.

Financial losses incurred as an unavoidable aspect of being in business are not the same thing as purposefully accepting a financial loss to help someone...

 

[jdh71]

Care to elaborate?

I don't consider having uninsured customers who don't pay their bills the same as providing a charitable service any more than I consider a credit card company a charitable organization.

Financial losses incurred as an unavoidable aspect of being in business are not the same thing as purposefully accepting a financial loss to help someone...

It ends up being the same thing for the provider. If there is no practical difference, there is no difference.

 

[MilkmanAl]

Financial losses incurred as an unavoidable aspect of being in business are not the same thing as purposefully accepting a financial loss to help someone...

On a macro scale, they're basically the same thing. You just accept that 30% (or whatever the real number is) of patients will never pay you a dime when you go into it.

edit: Bah, ninja'd.

 

[Gut Shot]

Awhile ago we had some lectures about the "hidden curriculum" of the medical profession where physicians perpetuate an attitude where altruism is considered childish. It sort of becomes a coming of age, where medstudents feel like they need to look down on patients/altruism/the profession, in order to be considered someone who "gets it". I found the lectures really interesting and it completely aligns with things I've read on SDN. Nobody comes into medicine wanting to fall victim to the hidden curriculum, but sadly its happens to so many folks.

But what I find so interesting is that there are a subset of physicians who it doesn't seem to get to. If you look at the specialty forums here, on each forum there is always one or two attending who you can tell doesn't buy into it and still are overtly altruistic. These lectures were given by attendings of various specialties, so obviously there are MD's out there trying to stop the trend.

What do you think allows some people to stay above the "hidden curriculum"? What are you doing to try to prevent yourself from going down that road (assuming you think its a road you would rather not travel)?

Edit: If it wasn't obvious, the lectures were not endorsing the "hidden curriculum", they were warning us that it exists and hoping to encourage us to avoid its effects.

Before I started medical school a very wise, very successful academic attending told me "Medicine is fantastic, the worst thing about it will be your colleagues." That was over eleven years ago, and his observation has stuck with me.

When you hit the wards you will find yourself under pressure, from both the nature of the work and from your peers, to become jaded. I think a lot of this stems from the defense mechanisms people employ in order to cope, with perhaps a sprinkle of mob mentality.

In my opinion, the only important thing to remember with regards to the hidden curriculum is that you should make up your own mind, and not be led too much by how other people choose to relate to the profession.

 

[DeadCactus]

From the provider's perspective, there's no difference between sitting at home watching TV and doing charitable work. Neither pays anything. Who cares about the provider's perspective?

There's a big difference between being invited to come receive free care because you can't afford it and having a bill from the hospital that you can refuse to pay at the expense of your credit rating and the occasional collection call...

 

[MilkmanAl]

Who cares about the provider's perspective?

Uh...the providers, maybe? This is a med school forum, right? Did I come to the wrong website?

 

[jdh71]

From the provider's perspective, there's no difference between sitting at home watching TV and doing charitable work. Neither pays anything. Who cares about the provider's perspective?

There's a big difference between being invited to come receive free care because you can't afford it and having a bill from the hospital that you can refuse to pay at the expense of your credit rating and the occasional collection call...

Perhaps I should have been more clear. The context here was obvious to me, but perhaps not so obvious to you - or perhaps you're trying to be intentionally obtuse because you're starting to find yourself in a very hard to defend position? The context here, and I apparently need to spell this out for you, is there is no difference from the providers perspective as it relates to the free work they do for the patient. And I personally care about my prospective. It's MY work. I'm not owned by someone else, nor am I slave. If my work gets done for free because I do not bill, or simply if someone doesn't pay, that person is still getting free work.

 

[DeadCactus]

Yea, it's a medical school forum. The topic being discussed is that many medical providers think just going into work every day is charity. Questioning the relevance of the provider's perspective versus the supposed recipient's perspective seems pretty damn valid.

I'm sitting here posting my thoughts for free. That's charity if my perspective is the end-all-be-all. Somehow I doubt you're going to run out and nominate me for a Nobel prize, though. Why? Because from your perspective, my actions are for my own ego rather than for your benefit.

The patient with thousands in hospital bills and shot credit doesn't care if you didn't technically get paid. You provided the service as an essential evil to maintaining a practice for paying clients. That's hardly a charitable act...

Edit: Free in the context of not being charged and free in the context of assuming other consequences for not having to pay are not the same thing. Go tell the HPSP kids how lucky they are that the government was charitable enough to give them a free medical education. I'm sure it will go over great.

 

[jdh71]

Yea, it's a medical school forum. The topic being discussed is that many medical providers think just going into work every day is charity. Questioning the relevance of the provider's perspective versus the supposed recipient's perspective seems pretty damn valid.

I'm sitting here posting my thoughts for free. That's charity if my perspective is the end-all-be-all. Somehow I doubt you're going to run out and nominate me for a Nobel prize, though. Why? Because from your perspective, my actions are for my own ego rather than for your benefit.

The patient with thousands in hospital bills and shot credit doesn't care if you didn't technically get paid. You provided the service as an essential evil to maintaining a practice for paying clients. That's hardly a charitable act...

Edit: Free in the context of not being charged and free in the context of assuming other consequences for not having to pay are not the same thing. Go tell the HPSP kids how lucky they are that the government was charitable enough to give them a free medical education. I'm sure it will go over great.

Does work get done without it being paid for? This is a yes or no question.

And the HPSP folks know they owe their soul to the company store when they sign on the line. No one would accuse them of a free education because we know it's not. Your analogy might be more appropriate if the HPSP folks could simply decide NOT to do their military obligation following their school being paid.

 

[DeadCactus]

Please tell me you see the irony in vehemently arguing to stretch the definition of charitable work to the broadest possible meaning rather then just admitting to not really doing any charitable work.

You can't just say "We do enough even if it's not charitable work." You have to argue and convince yourself that it somehow is charity to send someone a bill and have them not pay it.

Charity is offering to work for free, not getting cheated out of your payment...

 

[DeadCactus]

While we're on the subject of how altruistic the medical profession is: please explain why a women with a crack-addiction, declining health, and an apartment in the middle of some ghetto none of us even want to drive through should get down on her knees and felate us for the Tylenol and sandwich we provide her but the physician making 6-figures whining about reimbursements and some loans is just being realistic...

 

[jdh71]

Please tell me you see the irony in vehemently arguing to stretch the definition of charitable work to the broadest possible meaning rather then just admitting to not really doing any charitable work.

You can't just say "We do enough even if it's not charitable work." You have to argue and convince yourself that it somehow is charity to send someone a bill and have them not pay it.

Charity is offering to work for free, not getting cheated out of your payment...

If half my patient population already isn't paying me, how much more of my time should be spent not getting paid do you think? Give me a figure.

 

[thepoopologist]

While we're on the subject of how altruistic the medical profession is: please explain why a women with a crack-addiction, declining health, and an apartment in the middle of some ghetto none of us even want to drive through should get down on her knees and felate us for the Tylenol and sandwich we provide her but the physician making 6-figures whining about reimbursements and some loans is just being realistic...

Because 90% of the time that woman is an ungrateful bitch. I'd have no problem giving a Tylenol and a sandwich if it didn't lead to more demands for drugs/food she wants but doesn't need. The problem with altruism is that the majority of people who benefit from it take advantage of it. It's not an argument to stop handouts, because there are people who need it and are grateful for it, but ****, if I'm giving you something for free you can at least do me a favor by treading lightly.

 

[MilkmanAl]

While we're on the subject of how altruistic the medical profession is: please explain why a women with a crack-addiction, declining health, and an apartment in the middle of some ghetto none of us even want to drive through should get down on her knees and felate us for the Tylenol and sandwich we provide her but the physician making 6-figures whining about reimbursements and some loans is just being realistic...

I don't know about you, but I've worked my butt off to get where I am. I feel I'm entitled to appropriate compensation for my time and abilities. The crack addict can make no such claim.

if I'm giving you something for free you can at least do me a favor by treading lightly.

Or, you know, put forth a little effort of your own to get healthy.

 

[oldbearprofessor]

What do you think allows some people to stay above the "hidden curriculum"? What are you doing to try to prevent yourself from going down that road (assuming you think its a road you would rather not travel)?

At every level of training and work, including attending-land, there are situations and patients that lead to extreme frustration and ultimately to this sense of anger at patients and medicine. It happens to everyone. Your question, which I don't really see addressed in all of the posts, is what to do about this IF you wish to avoid this type of frustration and upset about your job and your patients. Read Melvin Konner's book on this.

There is no simple answer. My suggestion is to do the best you can to focus forward on the patients you like. For me, I couldn't stand most forms of adult medicine and would be very jaded about many of them. This didn't occur for me with pediatrics. Therefore, I avoided every elective, etc I could in adult medicine and even created one at a special needs school.

Even as an attending neonatologist, there are families and situations that are difficult from this perspective. Hopeless care situations, angry parents and other situations can be an issue even in pediatrics. Again, my solution is to do a range of things with my time (research, teaching, administration, SDN) in medicine so that I can see beyond those situations.

There are some who do things like spend a couple of years treating HIV positive children in southern Africa. This is one response but still has its own frustrations. Although I tremendously respect these people, they have not solved the dilemma of burnout and frustration just through this experience. It is, however, a start for some of them.

Best of luck as you consider your own pathway to avoid an attitude you wish to avoid. Those who don't wish to avoid it don't need to be concerned, but that wasn't what you asked.

 

[DeadCactus]

I don't know about you, but I've worked my butt off to get where I am. I feel I'm entitled to appropriate compensation for my time and abilities. The crack addict can make no such claim.

What did you do that was so hard? Be born into the right situation with the right genetics? Suffer the horrors of sitting in a classroom, studying in a library, and taking an exam? The amount of self-righteous masturbation in medicine is nauseating. No, it's not the easiest path through life but it sure as hell is a privileged route.

Entitled to appropriate compensation for your time and abilities? Don't throw appropriate on there like you would refuse to work for more than that. You feel entitled to making the most money you can, just like everyone else.

Your "appropriate compensation" is an artificial construct based on the current legal and economic framework of medical care. The crackhead is entitled to a sandwich, Tylenol, and medical care by the same kind of artificial frameworks that entitle physicians to a six-figure salary.

We're a profession of some of the most privileged people in existence. That doesn't mean we don't have a right to complain. It doesn't mean we don't have a right to earn income or try to grow our wealth. It's just pathetic when we start believing our own hype and painting ourselves as some sort of martyr for society...

 

[410322]

What did you do that was so hard? Be born into the right situation with the right genetics? Suffer the horrors of sitting in a classroom, studying in a library, and taking an exam? The amount of self-righteous masturbation in medicine is nauseating. No, it's not the easiest path through life but it sure as hell is a privileged route.

Your bleeding heart liberalism shines through this paragraph. Not everybody, and not even the majority, of people in medicine were born into wealth. Every class is going to have its trust fund babies and parents who were fathers that pulled strings. Similarly, every class is going to have the kid that lived on $10 a day. Nobody chooses their genetics and their family, so arguing about that is inane. Every wealth group will have people that work hard and people that succumb to laziness.

Let's look at some facts, though: 2008 poll by Gallup shows poor people smoke more and 2009 gallup poll shows poor people worried about money. Quitting smoking isn't easy, but doing so reaps literally thousands of dollars of monetary benefits, not including health-related benefits. It might not be enough to move out of the inner city, but it's definitely enough to relocate to a neighborhood that isn't crime ridden. But let me guess, them po' people waz tricked into the cigarette adikshun!!11

If people want help, they should start by helping themselves. There are literally millions of scholarships and opportunities for underserved populations to get into college. Unfortunately, most people lack the self-discipline to remove themselves from the allure of drugs and violence.

 

[Kaustikos]

Are you drunk?

At that moment in time, yes.

 

[DeadCactus]

Your bleeding heart liberalism shines through this paragraph. Not everybody, and not even the majority, of people in medicine were born into wealth. Every class is going to have its trust fund babies and parents who were fathers that pulled strings. Similarly, every class is going to have the kid that lived on $10 a day. Nobody chooses their genetics and their family, so arguing about that is inane. Every wealth group will have people that work hard and people that succumb to laziness.

Let's look at some facts, though: 2008 poll by Gallup shows poor people smoke more and 2009 gallup poll shows poor people worried about money. Quitting smoking isn't easy, but doing so reaps literally thousands of dollars of monetary benefits, not including health-related benefits. It might not be enough to move out of the inner city, but it's definitely enough to relocate to a neighborhood that isn't crime ridden. But let me guess, them po' people waz tricked into the cigarette adikshun!!11

If people want help, they should start by helping themselves. There are literally millions of scholarships and opportunities for underserved populations to get into college. Unfortunately, most people lack the self-discipline to remove themselves from the allure of drugs and violence.

How am I liberal? Where did I argue that poor people deserve free care? Where did I argue that physicians have an obligation to do charitable work? I've argued against some of the stupid self-felating beliefs dominant in medicine. Ignoring that, labels are pretty low-brow as far as debates go. Why not just call my mom fat?

And where did I argue that everyone in medicine has a trust fund? I argued that anyone in medicine was obviously born with the tools and opportunities they needed to meet that goal. The end. It doesn't matter if you're an orphan in Harlem and made it to Harvard; you were gifted with the genetics and opportunities to make it. The end.

You're right. Many people lack self-discipline, intelligence, and the other traits necessary for success in life. Others have them. The end. No one chooses to have any of those traits. No one decides to be stupid or lack drive. I'm sorry you need to comfort yourself with the ridiculous belief that people choose to be failures and you're allowed to succeed by some divine, judicious act. Life is not fair. The crackhead's fate is no more fair than the kid with a trisomy. I'm sorry that's so hard for you to accept...

 

[DeadCactus]

Wrong.

How about we split the difference? How about we agree that the crackhead should work at least as hard for her medical care as she does for her next rock?

Sure. Just tell me when you decided to be intelligent, driven, and disciplined. Was it in high school? In the womb? As a sperm? Did you just think really hard and shift the neurons around a bit? Did you take the red pill? Or was it some magnetic wristband?

 

[DrBowtie]

While we're on the subject of how altruistic the medical profession is: please explain why a women with a crack-addiction, declining health, and an apartment in the middle of some ghetto none of us even want to drive through should get down on her knees and felate us for the Tylenol and sandwich we provide her but the physician making 6-figures whining about reimbursements and some loans is just being realistic...

Everyone makes their own choices. Choices have consequences.

 

[Bacchus]

While we're on the subject of how altruistic the medical profession is: please explain why a women with a crack-addiction, declining health, and an apartment in the middle of some ghetto none of us even want to drive through should get down on her knees and felate us for the Tylenol and sandwich we provide her but the physician making 6-figures whining about reimbursements and some loans is just being realistic...

I don't know if this was pure coincidence or in response to my anecdote above, but she should at least thank us for our services. It's not asking too much. "Thank you" will never make up for the $1000s of dollars written off, but it at least strokes my ego a little to let me know I'm doing something worthwhile.

FWIW, my above lady signed out 2 days later AMA even though she was clearly still exacerbating her COPD. She'll just wander over to the free clinic again and get something else for free. 😎

 

[Bacchus]

And, we weren't all born into this. It's about putting in the effort to make it this far. The 'genetics' argument doesn't stand for me. Take my parents, 1 who has a GED and the other that never graduated from HS. If I would have followed suit I'd be working at a big box retailer right now. It's about effort. You have to put in to receive. Back then it was a different mindset and no one from my community or the surrounding ones went beyond HS. Today, you have to. Its the reality of the situation. I'm not just here because I'm "smart."

 

[Gut Shot]

FWIW, my above lady signed out 2 days later AMA even though she was clearly still exacerbating her COPD. She'll just wander over to the free clinic again and get something else for free. 😎

Just think happy thoughts: soon enough she'll be dead and you'll be pulling off the lot in your new 5-series.

 

[410322]

How am I liberal? Where did I argue that poor people deserve free care? Where did I argue that physicians have an obligation to do charitable work? I've argued against some of the stupid self-felating beliefs dominant in medicine. Ignoring that, labels are pretty low-brow as far as debates go. Why not just call my mom fat?

This entire thread you've been preaching that accepting patients for free is not equivalent to charity. The logical extension of that is "Physicians that wish to be altruistic must do more free care." If you can't see this, I recommend a course in logic.

Also: Your mom's fat.

And where did I argue that everyone in medicine has a trust fund? I argued that anyone in medicine was obviously born with the tools and opportunities they needed to meet that goal. The end. It doesn't matter if you're an orphan in Harlem and made it to Harvard; you were gifted with the genetics and opportunities to make it. The end.

Let's see what tools and opportunities are needed to succeed in medicine:
1. High school education. Free, tax payer funded, and mandatory. All high schools are not equal, yes, but they have become more standardized to meet national requirements.
2. ACT and/or SAT. Both offer waivers for underprivileged students.
3. College. Special funding is reserved for underserved populations, many of those students are eligible for Pell Grants, subsidized loans, etc. With the amount of colleges in the U.S., there is a college for everyone. Again, not all colleges are equal, but they all give you a bachelor's and the vast majority have the requisite coursework for medicine requirements.
4. MCAT. Again, free waivers apply.
5. School applications. If you qualified for free MCAT, you qualified for a free AMCAS submission and 5(? I think) free school submissions. After that it is $10(?). Schools take into account the performance of the truly underprivileged.
6. A work ethic. Unfortunately, no government program is going to help you out with this. Nor is it genetic. Whether or not you're driven enough to want to escape your squalor is up to you alone.

You're right. Many people lack self-discipline, intelligence, and the other traits necessary for success in life. Others have them. The end. No one chooses to have any of those traits. No one decides to be stupid or lack drive. I'm sorry you need to comfort yourself with the ridiculous belief that people choose to be failures and you're allowed to succeed by some divine, judicious act. Life is not fair. The crackhead's fate is no more fair than the kid with a trisomy. I'm sorry that's so hard for you to accept...

Quoted for the lulz.

I'm done with this thread. You preach what you want, brotha! It's fairly obvious you don't listen to anyone else.

 

[DeadCactus]

You're right we're all fated to our circumstances. It's the stars, or maybe Zeus' influence. The sisters have spun the web with the threads of fate. Choice is just an illusion.

You're right. It makes much more sense to assume people purposefully make bad choices. They don't choose to smoke crack or drop out of school because they lack the faculties to make the correct choice, they just want to fail so you have something to look down upon from your majestic seat among the stars. It's all so clear now..

 

[DrBowtie]

You're right. It makes much more sense to assume people purposefully make bad choices. They don't choose to smoke crack or drop out of school because they lack the faculties to make the correct choice, they just want to fail so you have something to look down upon from your majestic seat among the stars. It's all so clear now..

There are plenty of people content to collect their welfare checks. Also nobody has ever forced me to do drugs.

 

[DeadCactus]

This entire thread you've been preaching that accepting patients for free is not equivalent to charity. The logical extension of that is "Physicians that wish to be altruistic must do more free care." If you can't see this, I recommend a course in logic.

Also: Your mom's fat.

Let's see what tools and opportunities are needed to succeed in medicine:
1. High school education. Free, tax payer funded, and mandatory. All high schools are not equal, yes, but they have become more standardized to meet national requirements.
2. ACT and/or SAT. Both offer waivers for underprivileged students.
3. College. Special funding is reserved for underserved populations, many of those students are eligible for Pell Grants, subsidized loans, etc. With the amount of colleges in the U.S., there is a college for everyone. Again, not all colleges are equal, but they all give you a bachelor's and the vast majority have the requisite coursework for medicine requirements.
4. MCAT. Again, free waivers apply.
5. School applications. If you qualified for free MCAT, you qualified for a free AMCAS submission and 5(? I think) free school submissions. After that it is $10(?). Schools take into account the performance of the truly underprivileged.
6. A work ethic. Unfortunately, no government program is going to help you out with this. Nor is it genetic. Whether or not you're driven enough to want to escape your squalor is up to you alone.


Quoted for the lulz.

I'm done with this thread. You preach what you want, brotha! It's fairly obvious you don't listen to anyone else.

No, I'm saying sending someone a bill and having them not pay it is not charity. That's called being stolen from. It's not exactly a subtle difference. And no, the extension is not that physicians should do more work for free. At no point did I argue that physicians have an obligation to do charitable work. I'm just laughing at trying to pass off running a profitable business as an act of charity.

Your list of tools and opportunities needed to get into medical school is pretty telling. You can't even imagine a world where mommy and daddy aren't pushing you into AP courses and violin practice. You can't even imagine a life where going to college isn't in the game plan. All you can imagine is having to find away around funding it. And then you try to pass off work ethic as some non-issue you magically chose and other's passed up on.

"Work ethic? Na, no thanks. I'd rather not be driven. Struggling through life sounds better than living comfortably."

I know you're done with the thread. You need to go back to convincing yourself the world is fair and just. You have what you have because you deserve it. Otherwise you'll have no justification in b--ching and whining about the 0.1% of the population doing better than you while ignoring the 99% doing worse...

 

[DeadCactus]

There are plenty of people content to collect their welfare checks. Also nobody has ever forced me to do drugs.

And why are they content with that? Because they chose to lack drive.
Why do they lack drive? Because they chose to be lazy.
Why are they lazy? Because they chose to lack self control.
Why do they lack self-control?

Yea, we can run in circles all day making asinine arguments. It's not exactly ground breaking that people fail because they make poor decisions. Saying they make poor choices because they make poor choices is just running in circles.

Ultimately you're left with the fact that they make poor choices because genetics and their environment failed to give them the traits of a successful person or with the asinine belief that people actually choose to be a failure with full understanding of what that entails.

It's ridiculous. It's not an argument to make physicians feel bad or do more charitable work. Hell you can take the path to either end and either argue it's a reason to stop wasting resources on the poor or a reason they are deserving of more help. I don't care.

It is however an argument to stop felating ourselves as if we did anything but enjoy the benefits we were born into...

 

[DrBowtie]

And why are they content with that? Because they chose to lack drive.
Why do they lack drive? Because they chose to be lazy.
Why are they lazy? Because they chose to lack self control.
Why do they lack self-control?

Yea, we can run in circles all day making asinine arguments. It's not exactly ground breaking that people fail because they make poor decisions. Saying they make poor choices because they make poor choices is just running in circles.

Ultimately you're left with the fact that they make poor choices because genetics and their environment failed to give them the traits of a successful person or with the asinine belief that people actually choose to be a failure with full understanding of what that entails.

It's ridiculous. It's not an argument to make physicians feel bad or do more charitable work. Hell you can take the path to either end and either argue it's a reason to stop wasting resources on the poor or a reason they are deserving of more help. I don't care.

It is however an argument to stop felating ourselves as if we did anything but enjoy the benefits we were born into...

See: http://en.wikipedia.org/wiki/Theory_X_and_theory_Y

We clearly disagree on which theory is correct.

 

[surftheiop]

At every level of training and work, including attending-land, there are situations and patients that lead to extreme frustration and ultimately to this sense of anger at patients and medicine. It happens to everyone. Your question, which I don't really see addressed in all of the posts, is what to do about this IF you wish to avoid this type of frustration and upset about your job and your patients. Read Melvin Konner's book on this.

There is no simple answer. My suggestion is to do the best you can to focus forward on the patients you like. For me, I couldn't stand most forms of adult medicine and would be very jaded about many of them. This didn't occur for me with pediatrics. Therefore, I avoided every elective, etc I could in adult medicine and even created one at a special needs school.

Even as an attending neonatologist, there are families and situations that are difficult from this perspective. Hopeless care situations, angry parents and other situations can be an issue even in pediatrics. Again, my solution is to do a range of things with my time (research, teaching, administration, SDN) in medicine so that I can see beyond those situations.

There are some who do things like spend a couple of years treating HIV positive children in southern Africa. This is one response but still has its own frustrations. Although I tremendously respect these people, they have not solved the dilemma of burnout and frustration just through this experience. It is, however, a start for some of them.

Best of luck as you consider your own pathway to avoid an attitude you wish to avoid. Those who don't wish to avoid it don't need to be concerned, but that wasn't what you asked.

Thanks for the response OBP, I will be sure to check out the book.

I tried to make my initial post clear in saying that I understand that some people do want to embrace the hidden curriculum and that I was just looking for advice towards those of us who dont. But I guess its the internet so I got what I asked for 🙄

 

[Kaustikos]

Just think happy thoughts: soon enough she'll be dead and you'll be pulling off the lot in your new 5-series.

Can I quote that for my sig?