What would Johnny Cash think of the psychiatry forum?

[nancysinatra]

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So... a troll reared its ugly head on this forum recently and pretty soon there was the usual outpouring of moderation in the form of pacifying statements, "don't feed the troll" emoticons, and of course, bystanders who praised yet another successful disarmament from the "mods." Absolutely no one came out and said, "down with the troll!" Why is that??

What I want to know is, when did it become socially acceptable to just walk away from a fight? When it's a verbal fisticuffs, this just seems especially cowardly to me. I have to admit, I am starting to think that psychiatrists are not very tough. If I was on a desert island and could have one person with me, I wouldn't want it to be a psych resident! Even a pediatrician would probably be tougher, I bet.

There's this Johnny Cash song, "A Boy Named Sue," and it's all about how being named Sue taught this guy to stick up for himself. And I thought Johnny Cash set the standard for toughness. What would Johnny Cash think if he saw this forum???

Seriously, this applies all over the place in psychiatry. Lately I have all but stopped going to our residency program's monthly "administrative meetings" where the program directors placate the residents in regards to the numerous outrageous failings of our program, and the residents, with the chiefs in the lead, sit there and take it.

Does anyone else notice this trend too?

 

[OldPsychDoc]

I may come from the Great Land of the Passive-Aggressives, but I think that with experience one learns to pick one's fights carefully. There is nothing wrong with standing up for what you believe in, but there are many, many times when the effort involved in putting up a resistance far outweighs any expected benefit or change. I suspect that that is what occurs in your program meetings, and unless you have a feasible plan for change and the willingness to take on the burden of advancing change, attending a meeting solely to argue about what's wrong in the world is futile and frustrating.

 

[notdeadyet]

What I think you might be overlooking, nancy, is that when you argue with trolls, you are giving them exactly what they want, which further encourages their behavior.

Getting into silly arguments with trolls may sound appealing, but to me it's akin to knocking over the special ed kid on the playground and shouting triumphantly, "I won! I won!". It may feel like a victory, but really, all you've done is proven superiority when it was never really in question. And each time you're attracting more and more people, both trolls and the people who like to argue with them, who are itching to fight. Check out Doctors Lounge and you'll see plenty of it. Thankfully that's not the vibe on most of SDN. You single out Psychiatry, but I notice many specialty forums are savvy enough to not play the troll game. You see a fair bit on Preallo and the like, but I think that's pretty reflective of demographics.

I suspect that that is what occurs in your program meetings, and unless you have a feasible plan for change and the willingness to take on the burden of advancing change, attending a meeting solely to argue about what's wrong in the world is futile and frustrating.

And whining. Complaining without proposing implementable solutions you're willing to shoulder yourself isn't taking a stand, it's just... complaining. Interestingly, I see this happen way more in academia (particularly areas flush with students and residents with more passion than experience) than I ever did in the outside world. I'm frequently impressed by the patience of those who listen to it all.

 

[Dharma]

[YOUTUBE]http://www.youtube.com/watch?v=MT_nuwm252I&feature=fvwrel[/YOUTUBE]

 

[nancysinatra]

What I think you might be overlooking, nancy, is that when you argue with trolls, you are giving them exactly what they want, which further encourages their behavior.

Getting into silly arguments with trolls may sound appealing, but to me it's akin to knocking over the special ed kid on the playground and shouting triumphantly, "I won! I won!". It may feel like a victory, but really, all you've done is proven superiority when it was never really in question. And each time you're attracting more and more people, both trolls and the people who like to argue with them, who are itching to fight. Check out Doctors Lounge and you'll see plenty of it. Thankfully that's not the vibe on most of SDN. You single out Psychiatry, but I notice many specialty forums are savvy enough to not play the troll game. You see a fair bit on Preallo and the like, but I think that's pretty reflective of demographics.

And whining. Complaining without proposing implementable solutions you're willing to shoulder yourself isn't taking a stand, it's just... complaining. Interestingly, I see this happen way more in academia (particularly areas flush with students and residents with more passion than experience) than I ever did in the outside world. I'm frequently impressed by the patience of those who listen to it all.

I think you guys are missing my point. I'm not asking "why is it not strategic or effective to get into a fight with a troll?" I'm asking, "why do some people act like it is morally superior to always avoid a conflict, or assume an attitude that sides with authority?" This attitude can make life really bad sometimes! Also, my post above was in jest in any case... And I don't really think pediatricians are very tough.

There are clearly many fights that aren't worth getting into. And there are people who just complain endlessly in an unproductive way. But there's also the opposite extreme. Some people will applaud any compromise, just so as to avoid an argument, even if something important is at stake. A certain attending/administrator in my program is like this. He/she was once trying to get a certain elective for our program, and some people in another specialty got in the way of it. This attending bragged--yes, bragged--about how he/she backed down so as to avoid any conflict. Meanwhile I was unimpressed because I wanted that elective. The conflict avoidance did not impress me in the slightest.

And some people are very sycophantic. I notice this happens especially when my program is discussing an increase in call. The chief residents will side with the program moreso than the residents who have to take the call. They will give some ridiculous rationale that they never would have endorsed before they were chiefs. Eventually, the program wins and the call increases and the new normal becomes having this added call with its ridiculous rationale. The chiefs didn't even need to be there for that to happen! Then a new crop of residents arrive in July, and they buy into the explanation hook line and sinker. The result is that call increases incrementally. Notice that call never decreases.

I see it happening to attendings too. When I started residency, residents ran a lot of the hospital, and this was seen as a positive thing. Then the ACGME demanded more attending supervision of residents, and suddenly, everyone is talking about how "important supervision is." Ok but it has been a nightmare to implement. However when the ACGME tells a program to do something, programs roll over. I can see why; I'm just saying, the outcome isn't always good.

The reason I don't go to administrative meetings is simple. My program hasn't increased salaries for residents in years. It isn't keeping up with local cost of living increases. Our pay is on the low side, nationwide. Our vacation time has been chipped away at while I've been in the program, because they give the rationale that "psychiatry residents don't work weekends so you don't need as many days off as internal medicine." Well then they added weekend rounding at multiple sites, for no reason other than that patients in 2012 apparently need more attention than they did in 2009. But they didn't add any compensatory vacation days. Our vacation is already not competitive. Additionally, the volume of patients seen at the numerous hospitals we cover for call has increased dramatically in the last several years, but the program refuses to increase the size of the residency program.

I do have a solution: it's called--improve the financial situation of the institution. I realize financial problems are big nationwide, but our program has some special issues. Still, do I have pity for these people?? No!

Is my solution going to be implemented?? No!! But then I get some chipper email from a chief with a smiley face, trying to "motivate" us or whatnot and it is annoying.

 

[nancysinatra]

What I think you might be overlooking, nancy, is that when you argue with trolls, you are giving them exactly what they want, which further encourages their behavior.

Well, with regards to this, the definition of a troll on SDN, at least in the resident forums, seems to be anyone who doesn't belong on the forum or who says something that ruffles one too many feathers. I am pretty sure that if I took some really controversial view on this forum, with regards to psychiatry, that I would be labeled a troll too. I can sort of understand why we label interlopers who aren't in the medical field as trolls, but if the reason is merely that someone has a highly disagreeable viewpoint then I am not as understanding.

 

[Medstudent85]

I think Johnny would refer to this forum as "The Ring of Fire"

 

[PikminOC]

I was just trying to reassert my dominance of emoticons.



And I don't mind arguing with people who are not clearly mentally unstable and unable to form logical arguments.

 

[PikminOC]

..plus I get worn out sticking up for myself with contractors, subcontractors, the phone company, insurance companies, patients, patient's families, and on and on...

 

[billypilgrim37]

Sometimes there is stuff that you can make better. You should fight for this stuff.

Sometimes there is stuff that you cannot make better. You should not fight for this stuff.

Sometimes there is stuff that you could maybe make better but doing so would make your life a living hell and piss off people you would otherwise think are okay and might even be your friends. Then you perform a simple calculus about whether it's worth it.

If I had read Candide more recently than 2002 I would try to say something clever about just tending to your own garden. But I haven't, so you'll have to be satisfied with my sheer lack of wit.

 

[nancysinatra]

I think Johnny would refer to this forum as "The Ring of Fire"

Thank you!!!

Someone should make an emoticon out of the ring of fire. Now that, I would go for.

 

[nancysinatra]

Sometimes there is stuff that you cannot make better. You should not fight for this stuff.

Does that include airline service?

If I had read Candide more recently than 2002 I would try to say something clever about just tending to your own garden. But I haven't, so you'll have to be satisfied with my sheer lack of wit.

What? You last read Candide in 2002? What have you been doing all this time?

 

[nancysinatra]

I was just trying to reassert my dominance of emoticons.



And I don't mind arguing with people who are not clearly mentally unstable and unable to form logical arguments.

The latter people just drive me up the wall. I wish there was an emoticon for that too.

 

[nancysinatra]

Everyone would agree though, that in terms of toughness, psych is in the lower half of medicine, if not the lower third, right? I mean, we are not ortho, or cardiothoracic surgery. We also do not perform 10 hour whipple procedures without taking bathroom breaks. We do not have the fearlessness needed to deal with infectious disease. I would put us on about par, maybe slightly above pediatrics, and just below maybe PM&R. But definitely we are above cosmetic derm.

 

[toothless rufus]

Everyone would agree though, that in terms of toughness, psych is in the lower half of medicine, if not the lower third, right? I mean, we are not ortho, or cardiothoracic surgery. We also do not perform 10 hour whipple procedures without taking bathroom breaks. We do not have the fearlessness needed to deal with infectious disease. I would put us on about par, maybe slightly above pediatrics, and just below maybe PM&R. But definitely we are above cosmetic derm.

But if you yourself as a psychiatrist wrassle and restrain your out-of-control, often dangerous (and sometimes very big!) patients this raises you to the head of the class for specialty bad-ass!!

 

[F0nzie]

I love this rant. Nicely sums up my frustrations. Thanks for stepping up so I didn't have to. Wait is that passivity on my part? Oh no! I've become one of them! Noooooooooooooooo!!!!!

 

[billypilgrim37]

What? You last read Candide in 2002? What have you been doing all this time?

Trying to make it through Remembrance of Things Past... the Bermuda Triangle of French literature...

 

[PikminOC]

Everyone would agree though, that in terms of toughness, psych is in the lower half of medicine, if not the lower third, right? I mean, we are not ortho, or cardiothoracic surgery. We also do not perform 10 hour whipple procedures without taking bathroom breaks. We do not have the fearlessness needed to deal with infectious disease. I would put us on about par, maybe slightly above pediatrics, and just below maybe PM&R. But definitely we are above cosmetic derm.

I am confused by this argument. Are you referring to physical toughness, emotional toughness, willingness to fight, or what?

I worked at a forensic county psych facility..I needed plenty of "fearlessness". And every day, psychiatrists can become emotionally drained trying to treat patients, their families, and a society that thinks psychiatry is a quack field. Physically, no I don't have to wheel around 350 pound patients or lift their pannus.

Weren't you in surgery before switching to psych? Do you think you are less 'tough' now?

You said in another thread that psychiatrists dont take care of the whole patient. Are you unhappy in psychiatry?

And I am limited to the emoticons SDN offers. Maybe you would like to advocate for more emoticons.

 

[OldPsychDoc]

But if you yourself as a psychiatrist wrassle and restrain your out-of-control, often dangerous (and sometimes very big!) patients this raises you to the head of the class for specialty bad-ass!!

Psych has a bad-assness that the surg jocks can only dream of: telling people you're putting them on a 72-hour hold, and saying the dreaded words "No more Xanax." Takes a pretty strong sense of self to be the Doc That Says No.

 

[notdeadyet]

I can't help but feel that the medical field's obsession with "toughness" comes from the socioeconomic background of most of its participants. In education, I never heard the economics department claim to be tougher than the biology department. In business, I never heard the marketing guys beat their chests that they were tougher than development.

I wonder if this is a reflection of the narcissism of our field combined with the relative lack of diversity. Everyone's pretty smart, so we can't whip out intelligence as a very useful thing to try to feel superior over. "Tough" is a great one to play with because it's like "funny": everyone likes to see themselves this way and it's in reality not all that testable.

But God the whole thing is tiring. Especially as someone who came to medicine late in life and after being raised a good few economic demographics below your average bear in this field. I found it particularly irritating in Surgery, which not only likes to tout toughness (which in reality is more ego and bullying than actual toughness) but also describes itself as being "like the military" which is laughable to anyone who has put on a uniform. I found the culture a lot more palatable when I imagined your average surgeon put on ACU's for a month and try being an actual soldier. THAT would be fun to see.

Tough is having the sand to doing the challenging job you signed up for with dignity, making sacrifices to ease things for those around you, and not whining to the irritation of everyone within earshot. The more folks tout their toughness, the more it's called into question.

 

[BobA]

And whining. Complaining without proposing implementable solutions you're willing to shoulder yourself isn't taking a stand, it's just... complaining. Interestingly, I see this happen way more in academia (particularly areas flush with students and residents with more passion than experience) than I ever did in the outside world. I'm frequently impressed by the patience of those who listen to it all.

👍👍

My ideal is to never raise a problem with the administration - only propose solutions. "Hey I think I've found a way for xyz to work better. . . here it is in a proposal. . . let's have a meeting and discuss this in person."

It's so much less frustrating for me that way, and a lot more productive.

There's that whole Motivational Interviewing thing of the more you talk about something the more you believe it (ie, the reason to elicit change talk). If a person complains, they just take on that negativity. If they use "solution talk" instead of "complain talk" (to extend the MI metaphor) the more positive their outlook becomes.

Also, talking about solutions instead of problems makes a person a better co-worker and person to be around.

It's easier said than done, but it's been an ideal I've been working towards all year.

 

[BobA]

Tough is having the sand to doing the challenging job you signed up for with dignity, making sacrifices to ease things for those around you, and not whining to the irritation of everyone within earshot. The more folks tout their toughness, the more it's called into question.

👍

 

[PikminOC]

👍👍

My ideal is to never raise a problem with the administration - only propose solutions. "Hey I think I've found a way for xyz to work better. . . here it is in a proposal. . . let's have a meeting and discuss this in person."

It's so much less frustrating for me that way, and a lot more productive.

There's that whole Motivational Interviewing thing of the more you talk about something the more you believe it (ie, the reason to elicit change talk). If a person complains, they just take on that negativity. If they use "solution talk" instead of "complain talk" (to extend the MI metaphor) the more positive their outlook becomes.

Also, talking about solutions instead of problems makes a person a better co-worker and person to be around.

It's easier said than done, but it's been an ideal I've been working towards all year.

I wholeheartedy agree with this. It is much easier said than done so this is something I will strive for as well.

Dale Carnegie - "Do not criticize, condemn, or complain."

😍

 

[Doctor Bagel]

You know, I think medicine in general has this culture of not standing up for things that I think is driven by many things -- fear and the risk avoidant nature of residents, the authoritarian nature of medicine and our general people pleasing personalities. Not being from the medical culture (my parents aren't physicians and I did other stuff before medicine), it's particularly odd and often annoying to me, but I can also see that going with it is kind of how it is. And I guess I want to graduate, so maybe I should play into it.

Now on the note of advocacy, though, the residents in my program did recently stand up about something that maybe actually made a difference, so hey, maybe total passivity isn't the answer.

 

[PikminOC]

I think medicine is fractured, the psychs worry about psych issues, the anesth worry about anesth issues so the AMA is not strong. The ADA (dental) and nurses assns are united and strong and can effect change or protect themselves.

Everything is becoming such a "team" effort and PBL is hawked at most schools. So we have the highest education but are still a cog.

Don't forget nurses say they are "professionals" but they are allowed to strike and we aren't!

 

[Bartelby]

Edit: someone else already explained why it's counterproductive to argue with a troll.

 

[nancysinatra]

I am confused by this argument. Are you referring to physical toughness, emotional toughness, willingness to fight, or what?

I worked at a forensic county psych facility..I needed plenty of "fearlessness". And every day, psychiatrists can become emotionally drained trying to treat patients, their families, and a society that thinks psychiatry is a quack field. Physically, no I don't have to wheel around 350 pound patients or lift their pannus.

Weren't you in surgery before switching to psych? Do you think you are less 'tough' now?

You said in another thread that psychiatrists dont take care of the whole patient. Are you unhappy in psychiatry?

And I am limited to the emoticons SDN offers. Maybe you would like to advocate for more emoticons.

I think you are giving my rant more credit than due when you describe it as an "argument."

I don't really think one medical specialty is tougher than another, although, if the stereotype of a hip surgeon is sawing through bones, whereas the stereotype of a psychiatrist is sitting in an expensive chair and asking about the patient's mother, then does anyone seriously disagree?

The stuff you describe definitely requires toughness and resilience--especially on the emotional side. Still I'm not sure that's the kind of toughness Johnny Cash was referring to in his song. That's not the same as saying I don't respect that kind of toughness personally, though, because I do.

I happen to attend a program where a lot of people yak about patients' mothers. Or they spout terminology that is essentially psychobabble, but if you ask them to explain themselves in plain English, they can't! So sometimes I just want to vent about it.

As far as not taking care of the "whole" patient, I meant that literally. We don't do foot exams. We don't do eye exams. We don't do abdominal exams or deliver babies. Just in terms of sheer organ count, family practice takes care of way more stuff than we do. I find it odd that this viewpoint gets disputed. When is the last time a psychiatrist diagnosed a ruptured spleen? Or put in a chest tube? Or dealt with issues involving the ribs, tendons, or for that matter, the peripheral nervous system or even the brainstem?

Yet some people love to say, in a sappy way, that psychiatrists "treat the whole patient." Usually this platitude is brought up in contrast to some other specialty that is the topic of debate at the moment. As in, "surgeons are just plumbers. They don't treat the 'whole patient.'" Ok maybe surgeons are just plumbers. But that doesn't mean psychiatrists don't yak about people's mothers an awful lot.

Please as a caveat here, I hope no one will come at me regarding this post with an overly earnest socioeconomic argument about what sector of society is represented in my rant.

The only reason I posted it, anyway, was that I found some people's responses in another thread, regarding a "troll," to be rather on the overly earnest, take themselves-too-seriously side. The troll in question wasn't really a troll, even, in my view--as annoying as he/she seemed. To be a troll in my book there needs to be some malicious intent. Yet there was this chorus of approval about how "well" the situation was handled, because a continuing argument with a troll was averted. Ok but seriously, there was almost nothing at stake. So why would the diplomacy merit applause? In my view, diplomacy is impressive only when there is a true conflict.

My point is: a verbal debate between posters on SDN is NOT the Cuban Missile Crisis.

 

[nancysinatra]

I can't help but feel that the medical field's obsession with "toughness" comes from the socioeconomic background of most of its participants. In education, I never heard the economics department claim to be tougher than the biology department. In business, I never heard the marketing guys beat their chests that they were tougher than development.

Of COURSE econ didn't claim to be "tougher" than biology. Economics is a lowly social science. Biology, as unscientific as much of it is, is at least a physical science. Although it is not as hard a science by any means as physics, and none of the above are as respectable of mathematics.

It sounds like the school you went to is a rare, class-free educational utopia of departments co-existing in perfect harmony. But in academia, that would certainly be an exception.

 

[nancysinatra]

👍👍

My ideal is to never raise a problem with the administration - only propose solutions. "Hey I think I've found a way for xyz to work better. . . here it is in a proposal. . . let's have a meeting and discuss this in person."

It's so much less frustrating for me that way, and a lot more productive.

There's that whole Motivational Interviewing thing of the more you talk about something the more you believe it (ie, the reason to elicit change talk). If a person complains, they just take on that negativity. If they use "solution talk" instead of "complain talk" (to extend the MI metaphor) the more positive their outlook becomes.

I'm sorry but this sounds like either the pitch line for some crazy motivational cult, or else the makings of a good bureaucrat. Sorry, I like to know that my fellow humans are "human" and not just tools who work on behalf of the administration.

Also, talking about solutions instead of problems makes a person a better co-worker and person to be around.

A more tolerable residency coworker, sure. But a better person? Wow. And here I wasn't even sure I knew what makes one person a better doctor than another.

 

[nancysinatra]

I can't help but feel that the medical field's obsession with "toughness" comes from the socioeconomic background of most of its participants. In education, I never heard the economics department claim to be tougher than the biology department. In business, I never heard the marketing guys beat their chests that they were tougher than development.

I wonder if this is a reflection of the narcissism of our field combined with the relative lack of diversity. Everyone's pretty smart, so we can't whip out intelligence as a very useful thing to try to feel superior over. "Tough" is a great one to play with because it's like "funny": everyone likes to see themselves this way and it's in reality not all that testable.

But God the whole thing is tiring. Especially as someone who came to medicine late in life and after being raised a good few economic demographics below your average bear in this field. I found it particularly irritating in Surgery, which not only likes to tout toughness (which in reality is more ego and bullying than actual toughness) but also describes itself as being "like the military" which is laughable to anyone who has put on a uniform. I found the culture a lot more palatable when I imagined your average surgeon put on ACU's for a month and try being an actual soldier. THAT would be fun to see.

Tough is having the sand to doing the challenging job you signed up for with dignity, making sacrifices to ease things for those around you, and not whining to the irritation of everyone within earshot. The more folks tout their toughness, the more it's called into question.

I'm sorry to post so much, but your post got me thinking. Ok so maybe there is a socioeconomic component to the "issue" of debating which specialties are "tough." And if so, so what? How does that makes it a "reflection" of "narcissism?"

If the Queen of England wanted to sit around and debate the merits of one set of rare Windsor family heirloom silver cutlery vs another, or if Prince Phillip pulled out his hunting gear and spent 3 hours deciding which outfit made him look the "toughest," and everyone else thought the exercise was "tiring," does that make it "narcissistic?" Perhaps their debate seems "trivial" and "irrelevant" or even "self indulgent" to the rest of us, but wouldn't you need more information to call it "narcissistic?" Being a member of the leisure class or higher and having nothing more earthy or "productive" to do is, in and of itself, not grounds for being labeled "narcissistic."

 

[diagonal]

I can't help but feel that the medical field's obsession with "toughness" comes from the socioeconomic background of most of its participants. In education, I never heard the economics department claim to be tougher than the biology department. In business, I never heard the marketing guys beat their chests that they were tougher than development.

I wonder if this is a reflection of the narcissism of our field combined with the relative lack of diversity. Everyone's pretty smart, so we can't whip out intelligence as a very useful thing to try to feel superior over. "Tough" is a great one to play with because it's like "funny": everyone likes to see themselves this way and it's in reality not all that testable.

But God the whole thing is tiring. Especially as someone who came to medicine late in life and after being raised a good few economic demographics below your average bear in this field. I found it particularly irritating in Surgery, which not only likes to tout toughness (which in reality is more ego and bullying than actual toughness) but also describes itself as being "like the military" which is laughable to anyone who has put on a uniform. I found the culture a lot more palatable when I imagined your average surgeon put on ACU's for a month and try being an actual soldier. THAT would be fun to see.

Tough is having the sand to doing the challenging job you signed up for with dignity, making sacrifices to ease things for those around you, and not whining to the irritation of everyone within earshot. The more folks tout their toughness, the more it's called into question.

 

[notdeadyet]

I happen to attend a program where a lot of people yak about patients' mothers. Or they spout terminology that is essentially psychobabble, but if you ask them to explain themselves in plain English, they can't! So sometimes I just want to vent about it.

Ah, this I can sympathize with. That would drive me nuts too. One of the things I tried to carefully screen for is programs that came across too shrink-y. I wanted to be amongst well-rounded people with actual lives and life experience rather than those who wrapped themselves in the psychiatrist image like a pancho. What you describe would be nails on a chalkboard for me too.

As far as not taking care of the "whole" patient, I meant that literally. We don't do foot exams. We don't do eye exams. We don't do abdominal exams or deliver babies. Just in terms of sheer organ count, family practice takes care of way more stuff than we do. I find it odd that this viewpoint gets disputed. When is the last time a psychiatrist diagnosed a ruptured spleen? Or put in a chest tube? Or dealt with issues involving the ribs, tendons, or for that matter, the peripheral nervous system or even the brainstem?

Yet some people love to say, in a sappy way, that psychiatrists "treat the whole patient."

I'm not sure who uses the "whole patient" motto. I think psych takes into account more of the patient's life circumstances than most specialties. I can't imagine anyone believing that psychiatrists take care of more organ systems and the like, but who knows, people surprise me.

In my view, diplomacy is impressive only when there is a true conflict.

Good diplomacy stops the true conflict from presenting itself. If diplomacy comes in for the big win, it wasn't good diplomacy.

 

[notdeadyet]

I'm sorry to post so much, but your post got me thinking. Ok so maybe there is a socioeconomic component to the "issue" of debating which specialties are "tough." And if so, so what? How does that makes it a "reflection" of "narcissism?"

The need to feel superior to those around us is narcissistic. It's hard for a narcissistic doctor to go around feeling insanely smarter than colleagues because, frankly, most doctors have a fair degree of intelligence. So we can choose things like "toughness" to consider ourselves superior to others. This is particularly effective in a field like medicine where the majority of folks did not come from particularly demanding socioeconomic backgrounds. So folks can say their specialty is tougher than another because they have to stand still for long surgeries or they have to stay awake for x hours.

They can use something like "toughness" because not many peers will counter with the arguments like "Tough? Try growing up in foster care..." or "Tough? Try raising a kid with no support from family or a husband..." or "Tough? Try a summer in Parris Island..."

That's why hearing doctors interrupt their time talking about the fancy toys they'll buy once they walk into their near guaranteed $150K/year job for life after graduation with debating how "tough" one specialty is to the other smacks of narcissism. Hope this clarifies.

 

[BobA]

I'm sorry but this sounds like either the pitch line for some crazy motivational cult, or else the makings of a good bureaucrat. Sorry, I like to know that my fellow humans are "human" and not just tools who work on behalf of the administration.



A more tolerable residency coworker, sure. But a better person? Wow. And here I wasn't even sure I knew what makes one person a better doctor than another.

Read the quote: better person to be around.

Of course, most things about a residency can't be changed - the financial setting of the hospital, the attitude of attendings, the VA, etc.

But work is more enjoyable when I'm effective and I find I'm more effective when I put my energy into solutions and ignore the unchangeable.

 

[PikminOC]

Read the quote: better person to be around.

Of course, most things about a residency can't be changed - the financial setting of the hospital, the attitude of attendings, the VA, etc.

But work is more enjoyable when I'm effective and I find I'm more effective when I put my energy into solutions and ignore the unchangeable.

 

[nancysinatra]

Of course, most things about a residency can't be changed - the financial setting of the hospital, the attitude of attendings, the VA, etc.

So then what things are you talking about that can be changed? The type of brownies eaten at administrative meetings? The restaurant you will go to for recruitment dinners?? Some really minor aspect of the call schedule? All the power to you in that case! I personally can't think of a single meaningful issue in residency where a resident can have much impact, at least at my program. Any "impact" we do have is suspect.

Read the quote: better person to be around. ...

But work is more enjoyable when I'm effective and I find I'm more effective when I put my energy into solutions and ignore the unchangeable.

I guess I just differ on this. I see 4th year of psychiatry residency as a labor relations battle and not much else. The propaganda about residency being "training" has some truth to it in years 1-3, but the way I see it, in the 4th year I'm here to provide cheap patient care and not much else. After all, if IM, peds and FM can be done in 3 years, then in my opinion, so can psych. The knowledge base is smaller for psychiatry and the only reason I can think of for it to take longer to learn is that either a) we are dumber, b) I am wrong and our knowledge base is greater, or c) we're just cheap labor.

Now some people say psych residency is 4 years because "psychotherapy takes longer to learn" but I don't buy that. Psychotherapy takes SO long to learn that the one extra year of residency is not going to make much difference. Plus the fast track child option proves the 4th year is expendable. As a result, I'm seriously convinced that I am here this year for no reason other than to pad the bottom line of my department and its affiliated hospitals. Ok, well, in that case I don't feel very compelled to offer "solutions" to the higher ups who are better paid as it is. If you ask me, PDs ought to be smart enough to figure problems out on their own. They're getting cheap labor after all. One "solution" might be for residency to end after 3 years. Oh but that would inconvenience the PDs because then how would they honor their contracts to provide coverage at all the hospitals???

(Ok if they offered me tons of elective time and a cush 4th year schedule I'd have a different attitude, but at my program the 4th years work hard. And the PGYI-IIIs work incredibly hard.)

And I don't think that residents who do nothing but placate the administration by offering "solutions" to trivial problems when there are larger, more systemic, problems, are better people to be around. They're just annoying, and in many cases, oblivious.

 

[nancysinatra]

frankly, most doctors have a fair degree of intelligence. So we can choose things like "toughness" to consider ourselves superior to others.

I just don't agree. There is a huge range of intelligence and abilities in the medical profession if you ask me. Ok most doctors can tie their shoes, but that doesn't make them contenders for the next Nobel Prize in medicine. There's a big range.

 

[PikminOC]

That's why hearing doctors interrupt their time talking about the fancy toys they'll buy once they walk into their near guaranteed $150K/year job for life after graduation with debating how "tough" one specialty is to the other smacks of narcissism. Hope this clarifies.

😆

 

[Doctor Bagel]

So then what things are you talking about that can be changed? The type of brownies eaten at administrative meetings? The restaurant you will go to for recruitment dinners?? Some really minor aspect of the call schedule? All the power to you in that case! I personally can't think of a single meaningful issue in residency where a resident can have much impact, at least at my program. Any "impact" we do have is suspect.



I guess I just differ on this. I see 4th year of psychiatry residency as a labor relations battle and not much else. The propaganda about residency being "training" has some truth to it in years 1-3, but the way I see it, in the 4th year I'm here to provide cheap patient care and not much else. After all, if IM, peds and FM can be done in 3 years, then in my opinion, so can psych. The knowledge base is smaller for psychiatry and the only reason I can think of for it to take longer to learn is that either a) we are dumber, b) I am wrong and our knowledge base is greater, or c) we're just cheap labor.

Now some people say psych residency is 4 years because "psychotherapy takes longer to learn" but I don't buy that. Psychotherapy takes SO long to learn that the one extra year of residency is not going to make much difference. Plus the fast track child option proves the 4th year is expendable. As a result, I'm seriously convinced that I am here this year for no reason other than to pad the bottom line of my department and its affiliated hospitals. Ok, well, in that case I don't feel very compelled to offer "solutions" to the higher ups who are better paid as it is. If you ask me, PDs ought to be smart enough to figure problems out on their own. They're getting cheap labor after all. One "solution" might be for residency to end after 3 years. Oh but that would inconvenience the PDs because then how would they honor their contracts to provide coverage at all the hospitals???

(Ok if they offered me tons of elective time and a cush 4th year schedule I'd have a different attitude, but at my program the 4th years work hard. And the PGYI-IIIs work incredibly hard.)

And I don't think that residents who do nothing but placate the administration by offering "solutions" to trivial problems when there are larger, more systemic, problems, are better people to be around. They're just annoying, and in many cases, oblivious.

Nancysinatra, you're the breath of fresh air this forum has needed. I'm loving this rant and agree with you like 1000%. You're making me glad I'm at one of those programs with a cushy 4th year because, yeah, why?

And let's drop this narcissistic business because, face it, we've all walking around with lots of narcissistic traits.

 

[nancysinatra]

Nancysinatra, you're the breath of fresh air this forum has needed. I'm loving this rant and agree with you like 1000%.

Thanks! I just wish my program director felt the same way...

And let's drop this narcissistic business because, face it, we've all walking around with lots of narcissistic traits.

I sure agree with that. There's a saying, "if you don't like your patient they are borderline, and if you don't like your colleague they are a narcissist."

A lot of times a person can be irritating without being narcissistic in the slightest. They can be smug, they can have an attitude of superiority, they can be elitist--or the reverse, they can claim some kind of anti-elistist moral high ground--but none of that necessarily = "narcissistic." A lot of the time, people are just misled or mistaken in believing they're the best.

 

[nancysinatra]

They can use something like "toughness" because not many peers will counter with the arguments like "Tough? Try growing up in foster care..." or "Tough? Try raising a kid with no support from family or a husband..." or "Tough? Try a summer in Parris Island..."

I was using the word "toughness" in regards to verbal sparring, i.e. not literally. The conversation had nothing to do with economic deprivation or military service. Plus doctors can sit around and compare the physical or mental "toughness" of specialties all they want, and the conversation still won't be about economic deprivation or military service, and it still won't necessarily follow that someone is being a "narcissist." I don't even know why this came up.

That's why hearing doctors interrupt their time talking about the fancy toys they'll buy once they walk into their near guaranteed $150K/year job for life after graduation with debating how "tough" one specialty is to the other smacks of narcissism. Hope this clarifies.

If you are referring to my thread about what stuff people want to buy, first, it was for amusement, and second, shouldn't your criticism be that the thread smacks of "materialism?"

One of the things I tried to carefully screen for is programs that came across too shrink-y. I wanted to be amongst well-rounded people with actual lives and life experience rather than those who wrapped themselves in the psychiatrist image like a pancho.

Ok well then don't use shrink lingo like "narcissistic" unless it really fits.

 

[notdeadyet]

Ok well then don't use shrink lingo like "narcissistic" unless it really fits.

Oi, I'll leave you to it. When you pull stuff out of context and try debating and arguing even what were points of agreement (which is what you were replying to here), it feels like arguing-for-arguing's sake, which makes a conversation kind of draining.

Anyway, After residency you'll have the ability to find a practice or institution of likeminds. I'm sure you'll find an environment less frustrating and you'll find you niche. Take care.

 

[BS81]

Apparently "shouting down trolls" and arguing on the internet makes you tough in the eyes of Johnny Cash.

 

[nancysinatra]

Oi, I'll leave you to it. When you pull stuff out of context and try debating and arguing even what were points of agreement (which is what you were replying to here), it feels like arguing-for-arguing's sake, which makes a conversation kind of draining.

Anyway, After residency you'll have the ability to find a practice or institution of likeminds. I'm sure you'll find an environment less frustrating and you'll find you niche. Take care.

Did I misunderstand something? If so I'm sorry! It's entirely possible I drew the wrong conclusions from some posts--it's the Internet, after all. In that case I was wrong!

 

[BobA]

--

 

[Abider]

This topic of course begs the opposite question: What do psychiatrists think pf johnny cash's techniques. Man wants to toughen up son. The Pschodynamics of gender identity.....naming him Sue.

As to toughness, I think it takes some to take care of the patients we do. Our patients scare some people. We just have some shrinky bow tie wearing types that make us look wimpy.

But toughness is kind of a slippery notion. I agree with notdeadyet that many of the outward forms are not the most resilient or real when things really get bad.

 

[nancysinatra]

This topic of course begs the opposite question: What do psychiatrists think pf johnny cash's techniques. Man wants to toughen up son. The Pschodynamics of gender identity.....naming him Sue.

As to toughness, I think it takes some to take care of the patients we do. Our patients scare some people. We just have some shrinky bow tie wearing types that make us look wimpy.

But toughness is kind of a slippery notion. I agree with notdeadyet that many of the outward forms are not the most resilient or real when things really get bad.

I like this post, and totally agree. I will admit you gotta be rather tough to deal with some of our patients. And the "opposite question" about A Boy Named Sue is way more interesting than the original question.

I'm at a program that is hard core in some ways (namely our call and rotation duties) and super wimpy in other ways (steeped in psychoanalytic beliefs. They love to discuss psychodynamics. I would not trust them to survive in the wilderness though). So we tend to get these stuffy attending types who sit around in their bow ties discussing the egregious things that happen to residents on call, with this detached, impersonal attitude. It gets irritating at times.

 

[Abider]

I like this post, and totally agree. I will admit you gotta be rather tough to deal with some of our patients. And the "opposite question" about A Boy Named Sue is way more interesting than the original question.

I'm at a program that is hard core in some ways (namely our call and rotation duties) and super wimpy in other ways (steeped in psychoanalytic beliefs. They love to discuss psychodynamics. I would not trust them to survive in the wilderness though). So we tend to get these stuffy attending types who sit around in their bow ties discussing the egregious things that happen to residents on call, with this detached, impersonal attitude. It gets irritating at times.

Yeah that's interesting because I really got turned on to psych working in my hospital which is really community oriented towards a very underserved community. It's way off the grid of academicky powerhouse psych circles. The attendings that work here do it for love and commitment for less money and far more hassles, systemically and social work wise.

I would imagine psychoanalysis-steeped shrinky-type **** would get on my nerves too. But then again so does most of medical culture. So I'm not sure which phenomenon would be causative.

Perhaps psych does attract a crowd that is deficient in jujitsu and wilderness survival skills. Among other things. Maybe we do more emo rock than R&B. Perhaps our sex is less hot, but more sensitive and considerate.

But it also seems to attract interesting people who like to think about a variety of things. Ultimately, I suppose, we're destined to be on the Anthony Michael hall end of the breakfast club. And more band geek than jock.

I guess I'm ok with it. I would rather look at someone's butterfly collection that hear about their old football glory days.

 

[PikminOC]

love is in the air....

 

[PikminOC]

Apparently "shouting down trolls" and arguing on the internet makes you tough in the eyes of Johnny Cash.

Well then I am super tough. I must have gotten activated on this thread and then argued too much... lol

I should stick to emoticons.