what do you guys think of this article?

[maceo]

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Secretary
Many articles have been written recently expressing
concern with the seeming decline of professionalism
within the medical profession. Medical regulation by
medical boards and professional organizations are
increasingly focused on establishing standards of
professional behavior. The Liaison Committee on
Medical Education has promulgated and enforced the
requirement that professionalism and its evaluation be
part of the medical school curriculum. Those of us
who review and evaluate complaints by patients or their
families are seeing greater numbers of complaints
claiming indifference, delayed response, curt language,
and hurried clinical care.
Some blame working conditions, practice economics,
unrealistic patient expectations, and the general decline
of civility in our society as reasons for this decline in
professionalism. The fact remains that physicians and
other licensees have very intimate specialized
knowledge about our patients who depend on us to
allay their fears and relieve their distress. The penalties
we pay for declining professionalism include irate phone
calls, verbal confrontations, diminished community
reputation, and ultimately, medical board investigations
or lawsuits. From medical school until retirement, we
must recognize and nurture the special relationship we
have with patients. It is our professional obligation.
There are three issues we must keep in mind:
1) What are the characteristics of professionalism?
2) What personal barriers and attitudes diminish our
professionalism? and, 3) How can we better
communicate professionalism to our patients?
The American Board of Internal Medicine (ABIM) issued
a well thought out paper identifying six characteristics
of professionalism:
· Altruism
· Accountability
· Excellence
· Duty
· Honor and integrity,
· Respect of patients, colleagues,
and assistants
The ABIM also recognized the following attitudinal
pitfalls which erode professionalism:
• Abuse of power
• Arrogance
• Greed
• Impairment
• Lack of conscientiousness
• Conflict of interest
• Misrepresentation by commission
or by omission
If we adopt the characteristics of professionalism,
yet ignore the attitudinal pitfalls, should we ever be
considered “professional”? To truly be professional,
we need to embrace the key characteristics and
prevent the attitudinal pitfalls by talking with and
listening to our patients. We need to remember that
patients don’t converse in the language of medicine,
with its many acronyms, that is second nature to us.
Often, a patient may be embarrassed or unwilling to
admit that they don’t understand the information we
are telling them. Other patients are reluctant to ask
questions because we have made it clear that our
time is valuable and short. We inadvertently diminish
their worth by interrupting (an average of 17 seconds
into their chief complaint), avoiding eye contact, and
using body language which indicates we have no time
for them. We must be mindful of these behaviors
and attitudes. Simple adjustments can vastly improve
physician-patient relationships.
The prescription for such ill practice — sit, listen,
explain, ask for questions, and check for
understanding. Take the time to communicate more
effectively. This simple approach can raise the
professionalism bar for our profession.


what do you guys think of this article?

 

[SocialistMD]

what do you guys think of this article?

What part?

I agree with the principles of professionalism outlined in the article.
I agree with the "attitudinal pitfalls which erode professionalism" listed in the article.
I agree that professionalism is on the decline.

We just spent an entire day addressing issues in our residency at our annual retreat and decided that a lot of the problems were based on a lack of professionalism. I'm not sure what sort of evaluation you are seeking here, but, on the whole, I agree with the article.

 

[maceo]

What part?

I agree with the principles of professionalism outlined in the article.
I agree with the "attitudinal pitfalls which erode professionalism" listed in the article.
I agree that professionalism is on the decline.

We just spent an entire day addressing issues in our residency at our annual retreat and decided that a lot of the problems were based on a lack of professionalism. I'm not sure what sort of evaluation you are seeking here, but, on the whole, I agree with the article.

well i was just wondering WHY professionalism is on the decline? can it be due to reimbursements? can it be due to time constraints? (seeing 30 patients per day can lead to loss of eye contact, interupting, get to the point kind of interviewing. can it be due to publics loss of publics trust of respect. its gonna get worse as physicians are put on the defense more and more. the problem is the problem

 

[Winged Scapula]

I think its a generational thing in additional to the workplace constraints and the requirements of the profession.

People in general, including physicians, are pretty much ruder and less professional in attitude and behavior than generations past. Many medical students wouldn't know professional behavior and dress if it hit them over the head, so its not suprising they turn into less than professional physicians. IMHO in the past, professional white collar workers were much more polished and polite than our current "F your needs, what about mine" society.

 

[SocialistMD]

I think its a generational thing in additional to the workplace constraints and the requirements of the profession.

People in general, including physicians, are pretty much ruder and less professional in attitude and behavior than generations past. Many medical students wouldn't know professional behavior and dress if it hit them over the head, so its not suprising they turn into less than professional physicians. IMHO in the past, professional white collar workers were much more polished and polite than our current "F your needs, what about mine" society.

I agree. At my program, our RVUs have increased 10-20% each year for the last 4 years, yet our number of faculty has pretty much held constant, as have the elective OR times, etc... That means people are doing over 50% more work than they were 5 years ago in the same amount of time. Something has to give, and it is oftentimes the professional, customer friendly attitude. Add to that my generation's "me first" attitude and a shifting emphasis on "professional" attire and behavior and it lands us in the situation where we currently are.

 

[DarthNeurology]

I think medical students do, to some extent, model their behavior on how attending physicians act. I was surprised when I went to medical school and saw how the attendings treat medical students, when compared to clinical work I had done as a non-student in a hospital.

I think that few third and fourth year medical students would disagree that they have seen a large number of attending physicians who abuse power, are arrogant, etc . . . all of the traits that errodes "professionalism." Being in medical school is more like being a private in boot camp where you get hazed everyday on some rotations, NOT some enlightened professional school where you learn how to properly treat patients.

I learned most about being "nice" to patients i.e. the "professionalism" that this article laments from nurses and nurse's aides before medical school, i.e. how to make patients feel comfortable in the hospital and how to feel they are listened to. I've spent thousands of hours as a hospice volunteer, ER volunteer where my sole job was to be "nice" to patients, and it helps when you focus on this. Many attendings I have seen never worked in such a capacity and feel their job is to diagnose, order treatment, keep their booty clean i.e. no lawsuits, and not to be "nice" to patients, which is sad to see, but I feel it IS part of my job as a physician.

Many third and fourth year medical students are disillusioned when attendings verbally berate and even physically abuse them. I *thought*, past tense here, before third year that my job was to learn to be an efficient clinicians and also to learn how to care for patients in a professional manner.

Wrong, this is not what medical schools teach. Instead you learn how to dodge abusive comments and do you work and to spend less time doing "nice" things for patients which are actively discouraged by residents and attendings. Third and fourth year is about being almost constantly harassed and being put in your place, even if school administrators wanted someone to teach med students to be "nice" to patients, there are few attendings who model this behavior.

If you can survive residency and medical school and be able to practice your "niceness" towards patients then more power to you. But the "professionalism" learned on the tough streets of most med schools is the cold and uncaring professionalism of the business world where you learn CYA and try to deal with the full range of malignant personalities that take advantage of your subservient status as a student/resident.

There are many things the article "wants" which are not part of any "professionalism" that can be enforced, i.e. you can't fault an attending physician for interupting every 17 seconds if there is no error in care, this is just the physician not being "nice", the patient is uncomfortable, but legally no harm may have been done if the physician felt he or she was in a rush and got the pertinent info he/she needed and the care was appropriate. What the author seems to want is for physicians to be more "nice", this will require med schools to be more "nice" to med students, i.e. model nice behavior, for residents to have "nicer" attendings and for everyone to treat everybody better in the hospital.

The article seems to blame physicians for not being "nice" enough, which I think is more a product of the poor training environment.

I have seen some very abusive attendings, both to patients and students, and their behavior was explained away as being "OK" as they had been in specialty x for 40 years . . . I think that most people in medicine would agree that "higher ups" i.e. deans and attendings are some of the most abusive doctors, and that it doesn't make them to be the "nice" police as they have the most problems . . . I would sure hate to have an abusive attending who yells at patients to start counting how many second before I interupt a patient, the attendings with the biggest compalints are to some degree projecting their difficulties. . .

I think all med students know how most physicians interupt in the first 30 seconds and will ask open ended questions, etc . . . but even if you accidentally interupt you can apologize and still be a good listener, interruptions happen on both ends of normal everday conversation. I always wait what sounds like a couple minutes when first talking to a patient, sometimes a lot longer, because of this rule, but these rules can also sometimes not work, as when there is an inappropriate silence and the patient wants somebody to say something . . .

 

[DarthNeurology]

I think its a generational thing in additional to the workplace constraints and the requirements of the profession.

People in general, including physicians, are pretty much ruder and less professional in attitude and behavior than generations past. Many medical students wouldn't know professional behavior and dress if it hit them over the head, so its not suprising they turn into less than professional physicians. IMHO in the past, professional white collar workers were much more polished and polite than our current "F your needs, what about mine" society.

Some years ago, in the setting of a counseling session, I read a block of text about a statement about the new, young generation, and how disrespectful they were, in terms of talking to their elders, their dress, lack of respect ect . . . Everybody nodded their heads in agreement.

When I then told everyone that the statement had been written two thousand years ago, in Greece everybody scratched their head. I have pasted on such statement:


"I see no hope for the future of our people if they are dependent on the frivolous youth of today, for certainly all youth are reckless beyond words... When I was young, we were taught to be discreet and respectful of elders, but the present youth are exceedingly disrespectful and unrestrained."
Overheard at the Dhaka Club? Two retired colonels strolling through a park perhaps? An op-ed writer in these very pages? No, this quotation, from the Greek poet Hesiod, is just a little older than that. It dates back 2700 years in fact, and just goes to show how bemoaning the youth of today is an ancient and established custom. Much later, a mere two and a half thousand years ago, Socrates is said to have echoed these thoughts, in the following passage attributed to him:
"The young now love luxury. They have bad manners, contempt for authority, they show disrespect to their elders…. They contradict their parents, chatter before company, gobble up dainties at the table, cross their legs, and are tyrants over their teachers… They talk as if they alone knew everything, and what passes for wisdom with us is foolishness with them."


To some extent or another the older generation believes that the new generation has a worst attitude that the generation the preceded it. This is nothing new.

I have seen attendings in their "golden years" who seriously needed to have someone sit them down and tell them to stop acting like an @$$. I have seen some much younger attendings who were perfectly nice and would likely remain so throughout their lives.

There IS I think a dislike of older attendings disliking the new generation as perhaps there is a realization that they will retire and the new generation will take on the role of attendings and educators.

I have seen attendings of all ages act like perfectly miserable jerks who loved making everybody around them feel miserable. I don't think generation has much to do with this.

When you have been alive long enough, you realize that the jerk factory has been producing jerks for hundreds of years, and each year they come out with the same model.

The more things change, the more they stay the same.

 

[maceo]

I think medical students do, to some extent, model their behavior on how attending physicians act. I was surprised when I went to medical school and saw how the attendings treat medical students, when compared to clinical work I had done as a non-student in a hospital.

I think that few third and fourth year medical students would disagree that they have seen a large number of attending physicians who abuse power, are arrogant, etc . . . all of the traits that errodes "professionalism." Being in medical school is more like being a private in boot camp where you get hazed everyday on some rotations, NOT some enlightened professional school where you learn how to properly treat patients.

I learned most about being "nice" to patients i.e. the "professionalism" that this article laments from nurses and nurse's aides before medical school, i.e. how to make patients feel comfortable in the hospital and how to feel they are listened to. I've spent thousands of hours as a hospice volunteer, ER volunteer where my sole job was to be "nice" to patients, and it helps when you focus on this. Many attendings I have seen never worked in such a capacity and feel their job is to diagnose, order treatment, keep their booty clean i.e. no lawsuits, and not to be "nice" to patients, which is sad to see, but I feel it IS part of my job as a physician.

Many third and fourth year medical students are disillusioned when attendings verbally berate and even physically abuse them. I *thought*, past tense here, before third year that my job was to learn to be an efficient clinicians and also to learn how to care for patients in a professional manner.

Wrong, this is not what medical schools teach. Instead you learn how to dodge abusive comments and do you work and to spend less time doing "nice" things for patients which are actively discouraged by residents and attendings. Third and fourth year is about being almost constantly harassed and being put in your place, even if school administrators wanted someone to teach med students to be "nice" to patients, there are few attendings who model this behavior.

If you can survive residency and medical school and be able to practice your "niceness" towards patients then more power to you. But the "professionalism" learned on the tough streets of most med schools is the cold and uncaring professionalism of the business world where you learn CYA and try to deal with the full range of malignant personalities that take advantage of your subservient status as a student/resident.

There are many things the article "wants" which are not part of any "professionalism" that can be enforced, i.e. you can't fault an attending physician for interupting every 17 seconds if there is no error in care, this is just the physician not being "nice", the patient is uncomfortable, but legally no harm may have been done if the physician felt he or she was in a rush and got the pertinent info he/she needed and the care was appropriate. What the author seems to want is for physicians to be more "nice", this will require med schools to be more "nice" to med students, i.e. model nice behavior, for residents to have "nicer" attendings and for everyone to treat everybody better in the hospital.

The article seems to blame physicians for not being "nice" enough, which I think is more a product of the poor training environment.

I have seen some very abusive attendings, both to patients and students, and their behavior was explained away as being "OK" as they had been in specialty x for 40 years . . . I think that most people in medicine would agree that "higher ups" i.e. deans and attendings are some of the most abusive doctors, and that it doesn't make them to be the "nice" police as they have the most problems . . . I would sure hate to have an abusive attending who yells at patients to start counting how many second before I interupt a patient, the attendings with the biggest compalints are to some degree projecting their difficulties. . .

I think all med students know how most physicians interupt in the first 30 seconds and will ask open ended questions, etc . . . but even if you accidentally interupt you can apologize and still be a good listener, interruptions happen on both ends of normal everday conversation. I always wait what sounds like a couple minutes when first talking to a patient, sometimes a lot longer, because of this rule, but these rules can also sometimes not work, as when there is an inappropriate silence and the patient wants somebody to say something . . .

great post.

 

[bjackrian]

"I see no hope for the future of our people if they are dependent on the frivolous youth of today, for certainly all youth are reckless beyond words... When I was young, we were taught to be discreet and respectful of elders, but the present youth are exceedingly disrespectful and unrestrained.”
Overheard at the Dhaka Club? Two retired colonels strolling through a park perhaps? An op-ed writer in these very pages? No, this quotation, from the Greek poet Hesiod, is just a little older than that. It dates back 2700 years in fact, and just goes to show how bemoaning the youth of today is an ancient and established custom. Much later, a mere two and a half thousand years ago, Socrates is said to have echoed these thoughts, in the following passage attributed to him:
"The young now love luxury. They have bad manners, contempt for authority, they show disrespect to their elders…. They contradict their parents, chatter before company, gobble up dainties at the table, cross their legs, and are tyrants over their teachers… They talk as if they alone knew everything, and what passes for wisdom with us is foolishness with them.”

This the world is ending because young people are terrible nonsense has been around forever, yet somehow, we seem to keep pushing on.

 

[asmallchild]

I have seen attendings of all ages act like perfectly miserable jerks who loved making everybody around them feel miserable. I don't think generation has much to do with this.

When you have been alive long enough, you realize that the jerk factory has been producing jerks for hundreds of years, and each year they come out with the same model.

[YOUTUBE]http://www.youtube.com/watch?v=xwfioD-ING8[/YOUTUBE]

 

[michaelrack]

"I see no hope for the future of our people if they are dependent on the frivolous youth of today, for certainly all youth are reckless beyond words... When I was young, we were taught to be discreet and respectful of elders, but the present youth are exceedingly disrespectful and unrestrained.”
Overheard at the Dhaka Club? Two retired colonels strolling through a park perhaps? An op-ed writer in these very pages? No, this quotation, from the Greek poet Hesiod, is just a little older than that. It dates back 2700 years in fact, and just goes to show how bemoaning the youth of today is an ancient and established custom. Much later, a mere two and a half thousand years ago, Socrates is said to have echoed these thoughts, in the following passage attributed to him:
"The young now love luxury. They have bad manners, contempt for authority, they show disrespect to their elders…. They contradict their parents, chatter before company, gobble up dainties at the table, cross their legs, and are tyrants over their teachers… They talk as if they alone knew everything, and what passes for wisdom with us is foolishness with them.”


To some extent or another the older generation believes that the new generation has a worst attitude that the generation the preceded it. This is nothing new.

.

Greek society at the time of Socrates was in decline. American society is in decline. The young Greeks in the time of Socrates were worse than their ancestors, the same is true of young Americans today.

 

[Doodledog]

The young Greeks in the time of Socrates were worse than their ancestors, the same is true of young Americans today.

I respectfully disagree, not about the Greeks, because I have no idea about them, but about young Americans today. The ones I work with are motivated, work incredibly hard, and are very concerned about their world and about contributing to it in ways that I was not at their age. They have a distinct flaw in that they can't do multiplication in their head like I could, but, calculators have ruined this forever.😉. To each their own, but endlessly complaining about young people is non-productive and does not reflect the challenges they face and are responding to every day.

I would add one point about modeling professionalism and that is the idea that this modeling extends not just to medical students and residents, but also to junior attendings. When we work with our new attending colleagues, it is up to the older attendings not to be slackers and to demonstrate, in attitude and action, that the patient is central to their job. Work hour limits don't apply to us, and although attendings don't usually work the type of hours they may have many years ago, we need to remember that sometimes "our" patient needs us even when "we" are not on duty. The training of young attendings is not part of any ACGME/LCME guidelines but is an absolute obligation of older attendings.

Of course, one needs to avoid useless pontificating, but modeling the type of patient-centered and collegial relationships with each other matters a lot.

 

[Impromptu]

I like to blame everything bad in society on the baby boomers. We all know their selfishness is a root cause of all our problems. Having a ready scape-goat is quite nice. It saves me from having to think further about the issues.

Real reasons:
Selfishness, creating one's own rules of morality (creating one's own god in his own image), broken families, father's not in the homes, marriages deteriorating, living off the dole, sense of entitlement, vulgar entertainment considered normal, demonization of those who teach good values, bad examples from our elders, increased expectations for decreased pay.

 

[ChiDO]

I think its a generational thing in additional to the workplace constraints and the requirements of the profession.

People in general, including physicians, are pretty much ruder and less professional in attitude and behavior than generations past. Many medical students wouldn't know professional behavior and dress if it hit them over the head, so its not suprising they turn into less than professional physicians. IMHO in the past, professional white collar workers were much more polished and polite than our current "F your needs, what about mine" society.

We have a professional dress code at school and our one class addresses professional issues (talking to patients, drug reps, dressing ourselves, ect) during the rest of our medical careers. The clinicians who come in and teach our systems always comment on how our students act/dress "more" professionally then other med. students. (I've heard this from some 4th years as well).

I personally think that I would be able to dress/act professionally without these classes or dress code, but I'm sure it helps a ton of students in my class (you know the ones I'm talking about). I would also hope that these clinicians who say these things are indeed being sincere and not just saying something nice because they are teaching us.

 

[nancysinatra]

Greek society at the time of Socrates was in decline. American society is in decline. The young Greeks in the time of Socrates were worse than their ancestors, the same is true of young Americans today.

Yeah I kind of agree. Anyway doesn't the pendulum swing back and forth? I mean, some generations actually are better than the previous ones. I read somewhere how the WWI generation was super upright, then you had the lost, thrifty generation of the Great Depression, then the WWII generation with their judgmental 1950s morality, and the backlash to that was the 60s radicalism... Nowadays we're onto something where people are very entitled and decadent, at least it seems to me. Just witness the numbers of people who were going into finance in recent years like it was this big important sacrifice they were making for society.

I'd also add that the best mentors I've had in my life, by and large, skipped a generation and came from the 50s cohort and older end of the baby boomers. A few were younger. I took time off before med school so I'm a little older than my classmates, but I haven't found as much mentoring from the younger professors and attendings I've encountered.

We have classes on "professionalism" but all they are are rants from the dean on how important it is to be on time, or very patronizing theatricals about the importance of washing our hands, wearing our white coat just so. And no one gets in trouble if they are late, since most of the time no one is watching. Students' white coats are just filthy so often too. It just goes unnoticed.

 

[turkeyjerky]

I agree. At my program, our RVUs have increased 10-20% each year for the last 4 years, yet our number of faculty has pretty much held constant, as have the elective OR times, etc... That means people are doing over 50% more work than they were 5 years ago in the same amount of time. Something has to give, and it is oftentimes the professional, customer friendly attitude. Add to that my generation's "me first" attitude and a shifting emphasis on "professional" attire and behavior and it lands us in the situation where we currently are.

How ironic in the era of consumer driven medicine and patient satisfaction scores.

My view: the more people talk about this, the worse it's gonna get. Perhaps correlative rather than causative, perhaps not. The solutions invoked are all too often superficial alterations that are demeaning to both doctors and patients.

Patients (oops--customers, I keep forgetting) don't want a "customer-friendly" fast food attendant taking care of them. They want physicians who practice good medicine and treat their patients well. Not administrator-approved bags of humanistic crap.


On the other hand, perhaps patients are less professional nowadays too.

 

[Drawing Dead]

Only read the OP, so please don't skewer me if I repeat any comments (feeling really lazy tonight). I can't speak for everyone, but I can at least speak for myself.

I am not a professional person. I was raised in a blue collar family. My father is an electrician, his father was an electrician, my other grandfather worked in a dye house. I've always grown up around men who use curse words as articles. I went to medical school because I could, not because it was a life dream. To me, this is a JOB, not a career, not my life. Maybe that's why I chose EM, so I can punch the clock, turn it on for 12 hours, and turn it off and be me. Am I professional on the job? Of course, with the occasional Freudian slip. Off the clock, I'm still the beer drinking, sailor mouthed, gambling addicted, sports loving, woman chasing, partying person I have always been. And I'm sorry, but it's not going to change anytime soon.

At the same time, no one was born into the profession we are currently in. Everyone is so shocked when a teacher kidnaps and kills a little girl, or a priest touches a little boy, or a doctor gets a dui, or a politician has some skeletons in their closet. No one was genetically engineered to do what they do now. I'm sure that each and everyone of us either acted a certain way before med school, or still do. WE ARE ALL HUMAN BEINGS. I hate being put on a pedestal because of the job I have. And maybe I feels this way because I feel as if 9 out of 10 patients I see have the same arm crossed, whats taking you so long, me versus you attitude. Do I still maintain what I consider to be professionalism in these situations? Yes, but it is a struggle. And at the same time, I will change my tone of voice or will be very blunt to express to them that they are not the boss of me. Would some consider this to be unprofessional, that I allow my own personal feelings to come to light during work? Of course, but I've never been one to let people walk all over me, and it's not going to start now.

You ask me where this started, this started with the general public distrusting physicians and suing us for every little thing that goes wrong. The media for scaring the **** out of society from going to the doctor/hospital. As well as TV shows like ER, Scrubs, Greys Anatomy, Private Practice, and House, among others (And believe me, I do love 2 of these 5, and will watch another). The viewing public watches these shows, and that becomes their perception of us. And yes, it is refreshing sometimes when someone refers to me as doctor, and they show that form of respect, and we get to take advantage of perks like the doctor's lounge and parking. But, at the same time, who is to say I am better than anyone else? Should I look down upon people in "non-professional" fields? Should I even expect them to behave in a manner less professional than me? With the exception of my patients, I am on a first name basis with anyone that I meet. Even with my patients, I introduce myself as Dr. Last name, but it can be diffcult to understand/pronounce correctly. If a patient sees my first name on my coat, and addresses me as such, I don't correct them. We are all beings of the same species, and many of us have jobs/careers. It's what we do to provide income for ourselves/dependents. We should not be graded or judged based on how prestigious our job may appear to be or by how much income it provides over anyone else. And it should definately not dictate how we live our lives while we are not at said job.

I remember all throughout elementary school, whenever 2 of us didn't get along, teachers would remind us that even after school, we would have people in our lives we didn't like, and might as well learn how to get along now. And maybe I'm that guy, the "unprofessional" a-hole who gives modern medicine a black eye. But you know what, I think I do a pretty god damn good job everytime I put on that white coat. And to me, it is more important that I know what I am doing when I go into that room than the fact of whether or not I'm wearing my white coat and addressing everyone as sir and madam when I do go into that room.

 

[SocialistMD]

Patients (oops--customers, I keep forgetting) don't want a "customer-friendly" fast food attendant taking care of them. They want physicians who practice good medicine and treat their patients well. Not administrator-approved bags of humanistic crap.

Most patients wouldn't know this if it hit them in the face. If you treat a patient and his/her family well, they will think you are the greatest doctor in the world, even if the patient dies a terrible death because you missed something or caused some complication. Likewise, if you do everything right clinically, but are distant or abrasive, the patient will more often than not think poorly of you, even if you saved them from certain death. That's reality.

 

[dragonfly99]

I agree with Socialist MD about what most patients know...not a lot about medicine. They only see/notice your bedside manner, at least in most cases.

I agree with Darth about the professionalism thing. Students learn that they have to be very tough, cold and hard, and that being "nice" to your patient doesn't get you jack in terms of good evaluations in med school, or most of the time in residency. The patients will like you if you are nice, though. Patient are usually not the ones who evaluate "professionalism" in students or residents, however. That is usually done by attendings, or just the PD. Sometimes other house staff get to evaluate you also. It's mostly a personality thing...have to get folks to like you to get good evaluations.

 

[michaelrack]

Anyway doesn't the pendulum swing back and forth? I mean, some generations actually are better than the previous ones.
.

You're probably right.

I was just trying to make the point that things haven't been getting steadily worse for 3000 years, that each society/civilzation has to be considered individually. Things probably go in cycles, as you suggest.

 

[nancysinatra]

You're probably right.

I was just trying to make the point that things haven't been getting steadily worse for 3000 years, that each society/civilzation has to be considered individually. Things probably go in cycles, as you suggest.

Yeah, I agreed with what you said too. I think when he posted the Greek quote, DarthNeurology was trying to say (forgive me if I'm misunderstanding though), that things have been the same for 3000 years, not steadily declining. Whereas I think they definitely do decline at times in history. They must then get better if they are going to decline again later on... Other than that I agreed with lots of what DarthNeuro was saying!

I don't know that professionalism can be boiled down just to niceness. It's more than that. And not everyone is lacking in it. But there is something missing, somewhere. Certainly there are specific things I've witnessed that have led to this let down sense at the moment, but I don't feel surrounded by the most invigorated field full of professional and compassion minded people. A big part of it is people playing a game. Even a lot of the "humanistic" stuff we got taught in med school--it was facade. There is so much good humanities out there and material relating to true professionalism and ethics, and we just got facade, which I will never understand.

 

[turkeyjerky]

Most patients wouldn't know this if it hit them in the face. If you treat a patient and his/her family well, they will think you are the greatest doctor in the world, even if the patient dies a terrible death because you missed something or caused some complication. Likewise, if you do everything right clinically, but are distant or abrasive, the patient will more often than not think poorly of you, even if you saved them from certain death. That's reality.

I hate to bump a week-old thread just for personal vindication, but you repeated exactly what I said.

I've said it before and here it is again: all of this "professional training" crap can be easily summarized by slapping students on the forehead and saying, "Don't be a jerk!"

Nobody cares about how pristine your white jacket is, or how you carry your stethoscope. Patient-satisfaction scores are bunk, and if they don't know what good medicine is, then who cares what they think anyway? The last thing we should be doing is facilitating the takeover of medicine by MBA's (who've already ruined so many others sectors in our economy).

 

[SocialistMD]

I hate to bump a week-old thread just for personal vindication, but you repeated exactly what I said.

Not entirely.

Patients (oops--customers, I keep forgetting) don't want a "customer-friendly" fast food attendant taking care of them. They want physicians who practice good medicine and treat their patients well. Not administrator-approved bags of humanistic crap.

Treating patients well is being customer-friendly. Either you think customer-friendly is what patients want or you don't. I'm not sure what you think, because your post contradicts itself.

 

[Miami_med]

I think that professionalism is atleast in part the victim of a payment system that rewards you for being unprofessional. People have a limited choice as to which physician they see (especially in the HMOs, etc...), and this is even more true of specialists. The physician, who is not in imminent danger of losing most of his patients, then gets paid more to see everyone in 2 minutes. Taking time is punished. Returning phone calls or talking about personal problems is not reimbursed. The most cost effective way to run a practice is to hire a succession of people to run your patients through the place like an assembly line.

 

[doc4life95]

Greek society at the time of Socrates was in decline. American society is in decline. The young Greeks in the time of Socrates were worse than their ancestors, the same is true of young Americans today.

One can argue that of any subsequent generation. They tend to be reactionary. However with a large number of baby boomers retiring we (the younger generation - perhaps GEn X) are poised to be treating those same baby boomers.

What is boils down to is respecting what your patient has to say to you. Per Malcolm Gladwell in Blink, those doctors that spend the most time with a patient (be it telling a joke or discussing these various issues) are the ones that have fewer malpractice suits.

Take home point, RESPECT for the patient (and colleagues) is the primary quality of an OUTSTANDING physician!

 

[TTPHUS]

One can argue that of any subsequent generation. They tend to be reactionary. However with a large number of baby boomers retiring we (the younger generation - perhaps GEn X) are poised to be treating those same baby boomers.

What is boils down to is respecting what your patient has to say to you. Per Malcolm Gladwell in Blink, those doctors that spend the most time with a patient (be it telling a joke or discussing these various issues) are the ones that have fewer malpractice suits.

Take home point, RESPECT for the patient (and colleagues)* is the primary quality of an OUTSTANDING physician!

* respect for colleagues is earned - not given .

 

[scab]

Respect yourself someone once told ME

 

[dacrocytic]

Yeah I kind of agree. Anyway doesn't the pendulum swing back and forth? I mean, some generations actually are better than the previous ones. I read somewhere how the WWI generation was super upright, then you had the lost, thrifty generation of the Great Depression, then the WWII generation with their judgmental 1950s morality, and the backlash to that was the 60s radicalism... Nowadays we're onto something where people are very entitled and decadent, at least it seems to me. Just witness the numbers of people who were going into finance in recent years like it was this big important sacrifice they were making for society.

I'd also add that the best mentors I've had in my life, by and large, skipped a generation and came from the 50s cohort and older end of the baby boomers. A few were younger. I took time off before med school so I'm a little older than my classmates, but I haven't found as much mentoring from the younger professors and attendings I've encountered.

We have classes on "professionalism" but all they are are rants from the dean on how important it is to be on time, or very patronizing theatricals about the importance of washing our hands, wearing our white coat just so. And no one gets in trouble if they are late, since most of the time no one is watching. Students' white coats are just filthy so often too. It just goes unnoticed.

a little off topic.. but why do doctors persist in wearing their white coats outside of the hospital/ now that is just plain dirty.

the germs of the hospital are harboring their progeny on your coat while you grab a sandwich from the deli and proceed to pass them on to the cashier, who hands a person change and passes it to them, then they take the cash hoem and give it to their child/ wife/husband who then goes to work / school and passes it on to a colleague or fellow student..

and we wonder why swine flu is so epidemic...

it maybe US spreading it like wildfire!

 

[TTPHUS]

a little off topic.. but why do doctors persist in wearing their white coats outside of the hospital/ now that is just plain dirty.

the germs of the hospital are harboring their progeny on your coat while you grab a sandwich from the deli and proceed to pass them on to the cashier, who hands a person change and passes it to them, then they take the cash hoem and give it to their child/ wife/husband who then goes to work / school and passes it on to a colleague or fellow student..

and we wonder why swine flu is so epidemic...

it maybe US spreading it like wildfire!

IN surgery rotation , the attending used to patrol the neighboring stores for students who were wearing their scrubs outside the hospital . Any student caught was dropped from the rotation .