What's going on?

[kusb]

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Hello there you all.

I made my account few days ago and I was checking out some random threads. I've enjoyed reading most of therads in here and I think I can't find a broader medicine forum on the net, hopefully.

Even though this web based community sounds very heterogeneous, which is very positive in my oppinion, I had a first impression that most of medstudents see medicine as a mere science. Most of non-scientific stuff related to daily activities said is taken as jokes or something. I remind several jokes on Anamnesis I heard in school (Regarding its fundamental role on Diagnosis, still not that I'm not to blame for laughing at them). But afterall, what happened to the dream to help people after we entered medicine school, if it ever existed?

Is that the excess of pressure we take daily on being 'perfect'?

Is that the role of proletarian doctors have assumed nowadays, that turns one into a mere 'part of the system'?

Is that blind greed for money/power?

This may be a 1st year annoying naive post, but sometimes I really get shocked when I come across some people points of views in human/ethical aspects. I'm not questioning users of this forum only, but medstudents in general, including me. I think entering MedSchool changes our minds a bit on some subjects. Ok I've vented off.

 

[JDovers]

What?

 

[kusb]

Hm I may have been too idealistic...

 

[Tired Pigeon]

Hello there you all.

I made my account few days ago and I was checking out some random threads. I've enjoyed reading most of therads in here and I think I can't find a broader medicine forum on the net, hopefully.

Even though this web based community sounds very heterogeneous, which is very positive in my oppinion, I had a first impression that most of medstudents see medicine as a mere science. Most of non-scientific stuff related to daily activities said is taken as jokes or something. I remind several jokes on Anamnesis I heard in school (Regarding its fundamental role on Diagnosis, still not that I'm not to blame for laughing at them). But afterall, what happened to the dream to help people after we entered medicine school, if it ever existed?

Is that the excess of pressure we take daily on being 'perfect'?

Is that the role of proletarian doctors have assumed nowadays, that turns one into a mere 'part of the system'?

Is that blind greed for money/power?

This may be a 1st year annoying naive post, but sometimes I really get shocked when I come across some people points of views in human/ethical aspects. I'm not questioning users of this forum only, but medstudents in general, including me. I think entering MedSchool changes our minds a bit on some subjects. Ok I've vented off.

What?😕 Are you smoking something down there in Brazil?

 

[Biscuit799]

Hm I may have been too idealistic...

It's not so much that you're too idealistic, it's just that once you get into what medical education really is, you lose some of it. Your ideals about feeding starving babies and curing AIDS for free gives way to the realities that there aren't infinite healthcare resources, there are only so many hours in a day, and most of healthcare is inefficient, redundant, defensive, unrewarded, and just plain hard work. It's great to say you want to serve humanity, but it's a completely different story when you've been studying Path for 8 hours a day for a week, or when you're on hour 18 of a shift, or when you have to document that you did a rectal 4 different times because last time you only documented it 3 times and got sued.

It's not so much that med students/residents/etc lose their idealism so much as they succumb to the realities of healthcare. I'd love to serve poor populations, but I also don't want to work 90 hours/wk, I want to raise a family, I have 120K in loans to pay back, and I'm going to be in school for 12 years post-HS, so I feel that I deserve to be compensated for that time.

We all have that soft spot in our hearts where rainbow sunshine beams sing joyous melodies to the skipping, hand holding bunnies below, but it's not possible in a world of finite resources, esp when 90% of those resources are used to keep dying people not-dead for an extra month.

 

[tacrum43]

Hello there you all.

I made my account few days ago and I was checking out some random threads. I've enjoyed reading most of therads in here and I think I can't find a broader medicine forum on the net, hopefully.

Even though this web based community sounds very heterogeneous, which is very positive in my oppinion, I had a first impression that most of medstudents see medicine as a mere science. Most of non-scientific stuff related to daily activities said is taken as jokes or something. I remind several jokes on Anamnesis I heard in school (Regarding its fundamental role on Diagnosis, still not that I'm not to blame for laughing at them). But afterall, what happened to the dream to help people after we entered medicine school, if it ever existed?

Is that the excess of pressure we take daily on being 'perfect'?

Is that the role of proletarian doctors have assumed nowadays, that turns one into a mere 'part of the system'?

Is that blind greed for money/power?

This may be a 1st year annoying naive post, but sometimes I really get shocked when I come across some people points of views in human/ethical aspects. I'm not questioning users of this forum only, but medstudents in general, including me. I think entering MedSchool changes our minds a bit on some subjects. Ok I've vented off.

I've heard that the first two years are about learning the science and learning to distance yourself from getting too emotionally involved in your patient care. Supposedly, you regain your humanity sometime before you graduate (or better yet you haven't lost it at all).

I don't know if it should be that way, and I think some schools are indeed trying to emphasize the human/compassionate side of medicine.

Also, internet users talk a big talk, and frequently it's not exactly (or even mostly) true. Take whatever is said on SDN with at least a gram of salt.

And finally, don't let the haters get you down. You can still be the caring, compassionate doctor even if some others don't want to be. Focus on what you can do.

 

[kusb]

I don't mean the ol' fighting poverty thing, and (just to deny what some of you guys must be thinking) I know I can't save the world ok...

I meant even patient-doctor relationship becomes fishy because of that.

I personaly consider older teachers masters of this issue, considering that its a matter of experience.
For instance, one of my teachers openly admitts he is not able to check out Magnetic Ressonances properly. Some RM's happen to reach his hands from time to time, since there's always a patient with those big envelopes waddling arround offices.
Patients still insist in getting him checking out their exams. And he does that, even tho the only real need is to read Radiologist's end notes. He ends up stating that being a physician is much of exercising acting skills.

Is he wrong afterall? I'm not to judge.

Little gestures build up strong links. And pretending is just a mechanism of approaching a positive patient-doctor relationship. Nobody gets hurt.

Before you attempt to atack this statement with medical malpractice arguments, I'd ask you to check for yourself how some increased numbers of suites are strictly connected to bad relationships with doctors, besides obvious Iatrogeny.

Still, the success of therapies are undoubtly linked to "unmeasurable factors" as: trust, patient's will, etc...

Ps: This apparently doesn't apply to emergencists! 😀

 

[Tired]

Even though this web based community sounds very heterogeneous, which is very positive in my oppinion, I had a first impression that most of medstudents see medicine as a mere science. Most of non-scientific stuff related to daily activities said is taken as jokes or something. I remind several jokes on Anamnesis I heard in school (Regarding its fundamental role on Diagnosis, still not that I'm not to blame for laughing at them). But afterall, what happened to the dream to help people after we entered medicine school, if it ever existed?

I never had it. Medicine is a commodity provided by trained practitioners. I'll never be a therapist, priest, or social worker. If patients need someone to 'talk' to, they need to see someone trained in that.

Is that the excess of pressure we take daily on being 'perfect'?

No pressure. I'm not perfect.

Is that the role of proletarian doctors have assumed nowadays, that turns one into a mere 'part of the system'?

Yes.

Is that blind greed for money/power?

How come medicine is the only field where "doing it for the money" is considered 'blind greed'? How come we have to pretend like we don't care about the paycheck? My kid brother works at McDonalds, and he does it for the money. No one asks him to develop a deep love for feeding high-fat foods to obese Americans.

This may be a 1st year annoying naive post, but sometimes I really get shocked when I come across some people points of views in human/ethical aspects.

I guess all I can say is 😴

 

[taylor6902]

am i the only one who has no idea what this guy is posting about?😕

 

[Critical Mass]

am i the only one who has no idea what this guy is posting about?😕

No. Same problem here.

Tired, you need an avatar!

 

[shivasHeroLike]

i like biscuit's reply. we share the same perspective.

 

[Tired]

Tired, you need an avatar!

Two reasons I haven't done it yet:

1) I'm kind of lazy and haven't bothered to figure out how to do that.

2) I've been looking for a good picture of a real poop hotdog, but have so far been unsuccessful.

 

[Wanna_B_Scutty]

2) I've been looking for a good picture of a real poop hotdog, but have so far been unsuccessful.

I suspect you could make this yourself after a dose of bran flakes and a trip to the supermarket's bread isle.

 

[Tired]

I suspect you could make this yourself after a dose of bran flakes and a trip to the supermarket's bread isle.

As if I don't piss off my wife enough already.

"Honey, do we have any hotdog buns?"

"I think they're in the pantry. Are you still hungry? We just ate!"

"I know. It's just that I just took a huge crap, so I need a hotdog bun."

"What?"

"I'm trying to impress people on the internet, so I'm going to put poop in a hotdog bun. They call it a 'poop hotdog'. It's really funny once you get the context."

" . . . <sigh> . . . I really don't know what's wrong with you."

"Then I won't tell you about my plan to make it a chili dog."

"I'm calling a divorce lawyer."

 

[kusb]

I never had it. Medicine is a commodity provided by trained practitioners. I'll never be a therapist, priest, or social worker. If patients need someone to 'talk' to, they need to see someone trained in that.

So I'm assuming it sounds more reasonable to graduate only surgeons from now on. We don't need physicians anymore, since we can find all information we need on diseases/treatments on internet. When we happen to have robots perfoming surgery action, then we won't need to have doctors at all.

How come medicine is the only field where "doing it for the money" is considered 'blind greed'? How come we have to pretend like we don't care about the paycheck? My kid brother works at McDonalds, and he does it for the money. No one asks him to develop a deep love for feeding high-fat foods to obese Americans.

Of course greed does exist in many other professional fileds, I was just wondering if it was a CAUSE for what I was mentioning.

 

[kusb]

am i the only one who has no idea what this guy is posting about?😕

No. Same problem here.

Alright I'm talking about the excess of technicism and dehumanization of doctors. Sorry for my confuse first post. I'm not an activist of human rights watch, I was just raising a discussion. And ey I'm not a guy.

 

[deleted77919]

It's also a bit tough to "establish a relationship" when you have a 15 minute time slot allocated to making that patient all better and a room of 30 people waiting for your services.

Back in the day physicians could do little more than hold someone's hand, then medicine leaped forward and they could hold someone's hand while they got abx. There was all kinds of time for chit-chat, telling the pt everything was going to be ok (even though it wasn't) and asking about their 18 nieces and nephews and grandkids. Today we can actually do things to make people better. The way the system is designed, unless you have a boutique practice which only serves the wealthy, you have seriously limited time with your patients, especially for just shooting the breeze, which seems to be what people consider "establishing a good relationship."

 

[kusb]

It's also a bit tough to "establish a relationship" when you have a 15 minute time slot allocated to making that patient all better and a room of 30 people waiting for your services.

Back in the day physicians could do little more than hold someone's hand, then medicine leaped forward and they could hold someone's hand while they got abx. There was all kinds of time for chit-chat, telling the pt everything was going to be ok (even though it wasn't) and asking about their 18 nieces and nephews and grandkids. Today we can actually do things to make people better. The way the system is designed, unless you have a boutique practice which only serves the wealthy, you have seriously limited time with your patients, especially for just shooting the breeze, which seems to be what people consider "establishing a good relationship."

True. Lack of time is an evident fact.

But I'm questioning how docs keep distant per se, even when they have chances of getting closer. And how some docs mock at the ones who try to have a positive approach in this case. It's like a structural problem.

 

[deleted77919]

In my (limited) experience the mocking is aimed towards these touchy-feely empathy classes which do little to make students more empathetic. These classes do, however, tend to make the instructors feel better about themselves.

This is not to say that empathy isn't important, but canned experiences and lectures tend to not be effective at modifying student behavior in this regard.

 

[kusb]

In my (limited) experience the mocking is aimed towards these touchy-feely empathy classes which do little to make students more empathetic. These classes do, however, tend to make the instructors feel better about themselves.

This is not to say that empathy isn't important, but canned experiences and lectures tend to not be effective at modifying student behavior in this regard.

Yeah I totally agree with you that the way school usually deals with it is another factor that helps increasing this problem. Lack of effectiveness is the main issue of giving lectures about it. Perhaps even practical activities would fall out to be helpless.
Mind changing isn't easy. Still if nothing is done, experiencing the other side of the table would be a painful manner to learn.

 

[Haemulon]

Hello there you all.

I made my account few days ago and I was checking out some random threads. I've enjoyed reading most of therads in here and I think I can't find a broader medicine forum on the net, hopefully.

Even though this web based community sounds very heterogeneous, which is very positive in my oppinion, I had a first impression that most of medstudents see medicine as a mere science. Most of non-scientific stuff related to daily activities said is taken as jokes or something. I remind several jokes on Anamnesis I heard in school (Regarding its fundamental role on Diagnosis, still not that I'm not to blame for laughing at them). But afterall, what happened to the dream to help people after we entered medicine school, if it ever existed?

Is that the excess of pressure we take daily on being 'perfect'?

Is that the role of proletarian doctors have assumed nowadays, that turns one into a mere 'part of the system'?

Is that blind greed for money/power?

This may be a 1st year annoying naive post, but sometimes I really get shocked when I come across some people points of views in human/ethical aspects. I'm not questioning users of this forum only, but medstudents in general, including me. I think entering MedSchool changes our minds a bit on some subjects. Ok I've vented off.

Huh? 😕

 

[Robizzle]

Bad wingman material

 

[Tired]

So I'm assuming it sounds more reasonable to graduate only surgeons from now on. We don't need physicians anymore, since we can find all information we need on diseases/treatments on internet. When we happen to have robots perfoming surgery action, then we won't need to have doctors at all.

Yes, you can find all you need to know about diseases and treatments from the internet. Alternatively, you could wave your magic fairy wand to cure you illnesses. Tool.

Look, if you want to sit around talking to people about their kids, jobs, and stress, feel free. But personally, I think that if you're going to teach people to cope with their problems, you should have some training in it. I don't know what they teach you in Brazil, but I didn't learn to conduct therapy in medical school. I also didn't learn the intricacies of social welfare programs, or ways to utilize spirituality in daily life.

I'm not going to charge my patients an office fee only to give them uninformed advice about things I know nothing about.

 

[kusb]

Look, if you want to sit around talking to people about their kids, jobs, and stress, feel free.

I'm not going to charge my patients an office fee only to give them uninformed advice about things I know nothing about.

Yes I think we both agree that clinical conduct of each doctor is unique, and thus should be respected. It turned out to be a principle, I guess.

But personally, I think that if you're going to teach people to cope with their problems, you should have some training in it. I don't know what they teach you in Brazil, but I didn't learn to conduct therapy in medical school. I also didn't learn the intricacies of social welfare programs, or ways to utilize spirituality in daily life.

Apart from scientific basic subjects, medical education varies if one compares schools within US, and even more comparing a country to another, as a reflex of adequation to local needs, public health management models, available technology and resources, etc.

This thread may have fallen out to be obsolete, if one assumes these huge differences as guides of this discussion.

But I believe there must be something in common amongst medicine courses all arround the world(At least the ones you call allopathic, or in extension all evidence-based medicine graduations). The matter is: We deal with people. Even if it's not directly, our decisions affect people. We can't just turn off our memories when we walk in our house doorway after work.
If a doc can't or they don't teach him how to deal with people, then I don't know what makes Doctors differents from Biochemistry majors.

No that doctors should also be psychologists (psychologists still need their jobs!). But I think in a rough manner finding the balance between being a biochem and a psychologist is the key. Somewhere between a ultratechnicist and a life counselor. A doctor is a bit of jack of all trades. Note I'm not mentioning specializations. Just making my point.

 

[Law2Doc]

Before you attempt to atack this statement with medical malpractice arguments, I'd ask you to check for yourself how some increased numbers of suits are strictly connected to bad relationships with doctors, besides obvious Iatrogeny.

Um, if you pretend to read someone's MRI even though you cannot make heads or tails of it, and then advise them they are fine, you open yourself up to a big lawsuit when they do not seek further medical attention and something worsens. That's malpractice in a big way. While it's true that doctors with good relationships with patients tend to get sued less, in this kind of situation you'd always rather have a patient annoyed with you that you couldn't read his film than sick because you pretended you did. You seem to be adding two unrelated notions together and getting to a really bad decision here.

 

[naegleria brain]

"Before you attempt to atack this statement with medical malpractice arguments, I'd ask you to check for yourself how some increased numbers of suits are strictly connected to bad relationships with doctors, besides obvious Iatrogeny."

while noble in sentiment, think of the practicality. over your lifetime you will be treating over 5000 patients. do you honestly believe that you'll have an excellent relationship with every single one of those 5000? the relationship goes both ways, and some patients are just idiot dinguses. when this is looked at retrospectively, the relationship was sour even though you tried to make it work.

no doctor purposely tries to alienate his patients. no one tries to have a bad relationship. no doctor tries to get sued. yet it still happens, and assuming that you can keep a good relationship with all of them is outlandish, and, well, a bit naive

 

[Biscuit799]

So I'm assuming it sounds more reasonable to graduate only surgeons from now on. We don't need physicians anymore, since we can find all information we need on diseases/treatments on internet. When we happen to have robots perfoming surgery action, then we won't need to have doctors at all.



Of course greed does exist in many other professional fileds, I was just wondering if it was a CAUSE for what I was mentioning.

There is a huge difference in doing something for the money, and greed. There is NOTHING wrong with doing something for the money. In fact, there's nothing wrong with doctors doing something for a lot of money. For some reason, doctors seem to think making money is evil, and that we should treat everyone for free all the time. This is just wrong. What's wrong is greed. That's the guy who really loves IM, but goes into Derm bc he knows a guy that'll pay him 500K/yr at 40 hrs/wk. Note: I'm not saying all Derms are greedy, but it is a field that is lucrative to greedy people.

 

[Law2Doc]

no doctor purposely tries to alienate his patients. no one tries to have a bad relationship. no doctor tries to get sued.

You obviously are not a fan of the TV show "House".🙂

 

[naegleria brain]

im a rather avid fan actually. helps me review some infectious diseases when i dont feel like reading anymore. btw naegleria brain came before i saw the naegleria fowleri episode.

in real life though, all house characters are asses with each other, and in general cool it a little when actually with patients...more of the cox-ish character i guess? or alex karev if you're a grey's fan?

 

[kusb]

Um, if you pretend to read someone's MRI even though you cannot make heads or tails of it, and then advise them they are fine, you open yourself up to a big lawsuit when they do not seek further medical attention and something worsens. That's malpractice in a big way. While it's true that doctors with good relationships with patients tend to get sued less, in this kind of situation you'd always rather have a patient annoyed with you that you couldn't read his film than sick because you pretended you did. You seem to be adding two unrelated notions together and getting to a really bad decision here.

Patients still insist in getting him checking out their exams. And he does that, even tho the only real need is to read Radiologist's end notes.

I don't know how it works there, but the whole formulation of diagnostic hypothesis is a teamwork job along with an Imagenologist/Radiologist. If you follow Radiologist's diagnostic hypothesis, and it leads to a malpractice, then the Radiologist is suitable. It's not just getting rid of blame though.

I was just trying to bend some pre-built concepts and give a naive example of how extreme scientificism can be left aside for a good reason. And it was not my decision.

I appologize if this is getting too confusing. I'm still trying to make issues clear.

 

[Law2Doc]

I don't know how it works there, but the whole formulation of diagnostic hypothesis is a teamwork job along with an Imagenologist/Radiologist. If you follow Radiologist's diagnostic hypothesis, and it leads to a malpractice, then the Radiologist is suitable. It's not just getting rid of blame though.

I saw your bold in your prior post before, and it doesn't really change anything in my answer. While the radiologist would be liable for his review, another physician who subsequently reads and interprets the films to the patient at the subsequent request of the patient can also create liability for himself. So you don't pretend to do this. If you can't read the films, never pretend. Pretending is malpractice. Just pass the buck to rads.

From a lawsuit perspective the most important lesson you can learn is that it's better to say "I don't know" than guess. Because people will rely on the second one, sometimes to their detriment.

 

[Biscuit799]

I don't know how it works there, but the whole formulation of diagnostic hypothesis is a teamwork job along with an Imagenologist/Radiologist. If you follow Radiologist's diagnostic hypothesis, and it leads to a malpractice, then the Radiologist is suitable. It's not just getting rid of blame though.

I was just trying to bend some pre-built concepts and give a naive example of how extreme scientificism can be left aside for a good reason. And it was not my decision.

I appologize if this is getting too confusing. I'm still trying to make issues clear.

A Radiologist will never give you a diagnostic hypothesis, just a reading. Let's take the simplistic example of a CXR. The Radiologist will say "Coin lesion in left lower field." Then the PCP will read this and send the pt for a biopsy of said lesion. The oncologist (or perhaps pulmonologist, or heck, even interventional radiologist) will take a needle biopsy of the lesion and send it to pathology. The pathologist will (in a similar manner as the radiologist) simply look at the cellular makeup of the lesion and say "resembles mesothelioma." Then the PCP will refer to oncologist for Tx, the pt will go home, see a commercial for a PI attorney, and sue the PCP and possibly the construction company who built his home for everything they're worth. (I just saw a commercial about this)

What's an Imagenologist?

 

[Dr. McDreamy]

am i the only one who has no idea what this guy is posting about?😕

no, you're not alone. I too, have no fvcking clue.

 

[Dr. Roket]

I suspect you could make this yourself after a dose of bran flakes and a trip to the supermarket's bread isle.

I couldn't find a pic of a poop hot dog either😱 which, given the power of the internet is extremely surprising, however, I was able to find a picture of a turd sandwich? 😳