When a nurse is your health-care provider, you’re at risk

[acceptmeplease]

I truly can't fathom how generalization about people either way will make a difference.
There are compassionate nurses and compassionate docs, and there are those that really don't have a lot of compassion, understanding, insight, and listening abilities--both docs and nurses--and then there are a lot of people that fall in-between these two poles.

I mean the midlevel practice issue, at it's core, is about cutting costs and saving money. At the same time, schools everywhere are just psyched about all that they can make off of such problems. And if anyone really cared about real quality of turn-out--not mere dollars for schools or pushing an agenda, they would not be allowing nurses with very minimal experience entrance into advanced practice nursing programs.

But again, individuals are who they are regardless of if they go through MS programs or nursing programs. If anything, the crucible of each kind of program and practice will ultimately strengthen their underlying character or the programs and real life healthcare experiences will reveal their true characters.

I think one area in which we see where patients care not only about competence in practice but compassion is in the OBGYN field. Some women are hell-bent on having only female physicians--feeling they will be more compassionate, understanding, and it will be less embarrassing for them. But this is not necessarily true. Now, I am not saying there are not truly compassionate female OBGYNs. It's just for me, at least in my area, well, it's usually male OBGYNs that have been more compassionate, tender and not painful upon examination, and more active listeners, etc. And believe me, there have been a few male OBGYNs that I refused to see, b/c they were hurtful upon examination, and they didn't listen, and they just didn't have that sensitive nature women look for in an OBGYN. But remember, in my area at the time, 99% of the OBGYNs were male. So, the compassionate female OBGYNs with the tender touch and ability to actively listen and be sensitive, well, I never got a chance to meet them.

You just can't generalize. I look for certain characteristics regardless of gender, age, race, whatever. It's wrong to generalize. And I would add that it's also unfair to lead a campaign that implies one group of providers are "listeners," so the inference is that the other providers are not. That's really on the manipulative side.

Also, nursing is running off a older model where holistics in medicine were laughed at in education and practice, in general, and where the main focus was on the pathology and not the human being as a whole person--an individual, and there was a sense of distance from this approach. But medical education has improved to look more at the whole person. But the campaign is running off of older models and exploiting this. Actually, the psyh0-social dynamics of this is interesting.

But the other thing that must be considered is that in the educational process for nursing, a strong amount of emphasis is placed on active listening, compassion, avoiding judgment, and holistics. It's there in every course from fundamentals and onward. Now, some of this will just wash over some people, but the points are emphasized repeatedly in these programs. In medical school, there is so much focus on the science and such, that the position of the nursing profession is that holistic approach, active listening, etc is lost. In other words, it would tend to get lost in the great magnitude of material or in is not embedded deeply enough through each and every course in medical education. Again, I think MS programs have worked to try and change this. But the model in nursing begins and ends with the whole human being--not just pathologies. Hence to them, the use of the declarative, "We listen," is not necessarily manipulative. Perhaps nursing needs more education about the MS educational process and their programs. IDK.

Whatever, just sharing from the position I have seen. Regardless, generalizations suck.

So..your posts are so long.

Ain't got time.

---

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[midweststudent1]

Generalizations suck,yes. But unfortunately the generalizations are often putting patients health care in danger. For instance, the generalization that a DNP has a doctorate so they're a doctor--it's harming patients. The generalization that just because someone cares enough to listen, that they can treat you--it's just not a good, sustainable healthcare model.

And NPs/midlevels aren't cheaper in the long run for most specialties. They run way more tests than physicians because they rely on them a whole lot more. And if there's one thing I've learned from my pathology department, it's that no one benefits when we start ordering tests like without having an understanding of what exactly it is that we're looking for

 

[jl lin]

So..your posts are so long.

Ain't got time.

Dude. Cool. It's your dime.

 

[jl lin]

Generalizations suck,yes. But unfortunately the generalizations are often putting patients health care in danger. For instance, the generalization that a DNP has a doctorate so they're a doctor--it's harming patients. The generalization that just because someone cares enough to listen, that they can treat you--it's just not a good, sustainable healthcare model.

And NPs/midlevels aren't cheaper in the long run for most specialties. They run way more tests than physicians because they rely on them a whole lot more. And if there's one thing I've learned from my pathology department, it's that no one benefits when we start ordering tests like without having an understanding of what exactly it is that we're looking for

First part, ITA.

Second part, I only partially agree. We don't necessarily know that all midlevels are running more tests, do we?
One article or even study doesn't prove that overall. Perhaps it will in the future.
And the sad thing is all practitioners without the right mix or understanding, judgment, seeing all angles, and compassion and insight can either under-run tests or over-run them. The issue is what get's missed. Now, b/c I have a fear, especially with more complicated patients of what can get missed, I prefer to have them seen by the right physicians. But even great physicians can miss things. It's all tricky business. There is a reason it can take ten years or more for certain diseases to be diagnosed in certain patients. In fact that are a number of reasons. So, I am not just looking at the core education when I evaluate a practitioner. I am also looking at them and their ability to zoom in and zoom out and really think--and this also means, many times, to really listen to the patients. Many times, if you listen to a patient, you will get very important clues about what's going on. Hell, sometimes they will pretty much tell you. And you may be taken aback or think, well, there is another Internet diagnostician. But understand, they are living with this thing and know their bodies. Sure some don't and are just stabbing in the dark. Others do. They are intimately aware of how they feel and what's been going on with them. Regardless, it always pays to listen, especially with an open mind.

 

[username456789]

First part, ITA.

Second part, I only partially agree. We don't necessarily know that all midlevels are running more tests, do we?
One article or even study doesn't prove that overall. Perhaps it will in the future.
And the sad thing is all practitioners without the right mix or understanding, judgment, seeing all angles, and compassion and insight can either under-run tests or over-run them. The issue is what get's missed. Now, b/c I have a fear, especially with more complicated patients of what can get missed, I prefer to have them seen by the right physicians. But even great physicians can miss things. It's all tricky business. There is a reason it can take ten years or more for certain diseases to be diagnosed in certain patients. In fact that are a number of reasons. So, I am not just looking at the core education when I evaluate a practitioner. I am also looking at them and their ability to zoom in and zoom out and really think--and this also means, many times, to really listen to the patients. Many times, if you listen to a patient, you will get very important clues about what's going on. Hell, sometimes they will pretty much tell you. And you may be taken aback or think, well, there is another Internet diagnostician. But understand, they are living with this thing and know their bodies. Sure some don't and are just stabbing in the dark. Others do. They are intimately aware of how they feel and what's been going on with them. Regardless, it always pays to listen, especially with an open mind.

To be effective, though, you have to know what you're listening for.

 

[oldanddone]

oh, and given that i ain't nobody's standardized sexy, i hate that typical hetero 'beautiful' middle-class sexy flirting works, but hey, use it if you got it. i'm with you jl, sedein

I truly can't fathom how generalization about people either way will make a difference.
There are compassionate nurses and compassionate docs, and there are those that really don't have a lot of compassion, understanding, insight, and listening abilities--both docs and nurses--and then there are a lot of people that fall in-between these two poles.

I mean the midlevel practice issue, at it's core, is about cutting costs and saving money. At the same time, schools everywhere are just psyched about all that they can make off of such problems. And if anyone really cared about real quality of turn-out--not mere dollars for schools or pushing an agenda, they would not be allowing nurses with very minimal experience entrance into advanced practice nursing programs.

But again, individuals are who they are regardless of if they go through MS programs or nursing programs. If anything, the crucible of each kind of program and practice will ultimately strengthen their underlying character or the programs and real life healthcare experiences will reveal their true characters.

I think one area in which we see where patients care not only about competence in practice but compassion is in the OBGYN field. Some women are hell-bent on having only female physicians--feeling they will be more compassionate, understanding, and it will be less embarrassing for them. But this is not necessarily true. Now, I am not saying there are not truly compassionate female OBGYNs. It's just for me, at least in my area, well, it's usually male OBGYNs that have been more compassionate, tender and not painful upon examination, and more active listeners, etc. And believe me, there have been a few male OBGYNs that I refused to see, b/c they were hurtful upon examination, and they didn't listen, and they just didn't have that sensitive nature women look for in an OBGYN. But remember, in my area at the time, 99% of the OBGYNs were male. So, the compassionate female OBGYNs with the tender touch and ability to actively listen and be sensitive, well, I never got a chance to meet them.

You just can't generalize. I look for certain characteristics regardless of gender, age, race, whatever. It's wrong to generalize. And I would add that it's also unfair to lead a campaign that implies one group of providers are "listeners," so the inference is that the other providers are not. That's really on the manipulative side.

Also, nursing is running off a older model where holistics in medicine were laughed at in education and practice, in general, and where the main focus was on the pathology and not the human being as a whole person--an individual, and there was a sense of distance from this approach. But medical education has improved to look more at the whole person. But the campaign is running off of older models and exploiting this. Actually, the psyh0-social dynamics of this is interesting.

But the other thing that must be considered is that in the educational process for nursing, a strong amount of emphasis is placed on active listening, compassion, avoiding judgment, and holistics. It's there in every course from fundamentals and onward. Now, some of this will just wash over some people, but the points are emphasized repeatedly in these programs. In medical school, there is so much focus on the science and such, that the position of the nursing profession is that holistic approach, active listening, etc is lost. In other words, it would tend to get lost in the great magnitude of material or in is not embedded deeply enough through each and every course in medical education. Again, I think MS programs have worked to try and change this. But the model in nursing begins and ends with the whole human being--not just pathologies. Hence to them, the use of the declarative, "We listen," is not necessarily manipulative. Perhaps nursing needs more education about the MS educational process and their programs. IDK.

Whatever, just sharing from the position I have seen. Regardless, generalizations suck.

it's true that med school is focusing more on the 'caring regime' these days, but that it is put in a binary with the 'competence regime', and then measured as less worthy. as a former psychotherapist/anti-oppression academic now trained in medicine, i'm interested in how these things are pitted against each other, and for what purposes - i.e. for lower payment of services rendered in how these things support the debate as played out in the midlevel creep. not just lower payment, but also a taking away of autonomy. so some nurses get more autonomy. but then everyone gets less autonomy as the whole thing becomes super regulated and guidelined into a hogtie.

what is interesting about np= we listen, is that the more nursing looks for entrance into autonomous practice, the more they will need to argue for their equivalence in the competency paradigm. so many nurses on the ground may get more interested in proving their competency...at the expense of their excellent education around patient-centredness and caring. the discipline will look less caring on the ground. look at how caring gets compromised already by time constraints and 'factorization' of the job by profit-focused admins (or 'taxpayer savings' focused, whichever). that taking away of autonomous definition of caring has been happening, and makes for some crusty people. the wanting to enter into the competent discourse will also affect things. an np so far can seem more caring now because they are given more time with a patient because they are 'cheaper'. that too will change. let's see where all the caring goes.

 

[giantswing]

are you even in medical school

If she were in med school she wouldn't have such long posts.

 

[jl lin]

To be effective, though, you have to know what you're listening for.

Very true, but a lot of this you get vis-à-vis the right kinds of experience. As you can see, or should see, I have no problem and am all for the knowledge and rigorous residency (GME) that comes through proper medical education process. I have made no qualms about the superiority of education and exposure and rigor that comes through them.

Still, generalizing is problematic. It is also very problematic when ANY practitioner ignores or oversimplifies the dire importance of listening. Careful listening and knowing what to listen for comes with sound education, strong active listening, and very ample portions of humility. It means being OK with the possibility of being wrong. Many experienced docs have shared through books and their own experiences how there is some glaring contradictions in education and post-grad experiences, where the culture seems to be, "God forbid that I should be wrong." "If I am wrong, that means that I suck--not a good doctor, nurse, whatever." We don't go out of our way to "be wrong," but in truth it is a vital part of learning and growing and understanding. It's tough also to get around the reality that medicine and also nursing must be both mix both science and art. Some people will sadly not get to the art of their field. Some of that has to do with an indoctrinated culture lacking humility. Sure, the processes are humbling; but what you often get is just a hyper-anti-can't-be-wrong mentality, rather than embracing the limitations of our humanity and even science. Each patient is a unique individual. The problem comes when we lose sight of that and put the science as the end-all/be-all over humanity and people--even as we do so within ourselves. I've met very non-compassionate and arrogant nurses, NPs, PAs, RRTs, as well as MDs or DOs. It's a human problem that needs constant attention is all I am saying. It's kind of like racism. Everyone, well, at least pretty much everyone seems to want to believe they are not racists. But we have to be constantly evaluating that within ourselves, from a more evolved human perspective. The second we say, "We arrived," and we are not racist or above really listening to people, is the moment we can hurt others, either directly or indirectly, and it's also the moment we stunt our own growth.

The fact remains, however, that the whole acceptance/push for equating the expertise or midlevel providers with that of those that have learned well and went through the more demanding rigors of PGE is pretty much money driven in terms of politics and from bean counters. The only way you are going to fight that is to unite, to grow in the ability to emphasize true holistic approaches, and continue to point out the advantages of the academic and post-grad rigors of medical education.

 

[oldanddone]

The only way you are going to fight that is to unite, to grow in the ability to emphasize true holistic approaches, and continue to point out the advantages of the academic and post-grad rigors of medical education.

i think there's something too that point of view.

in terms of need to be right...from a wholistic angle, that may not be just an expression of arrogance, but something related to being where the buck stops, knowing that 'i don't know' is not sufficient, if in the role of leader. there must be an answer, and understanding, and an approach developed. 'i don't know' is just not good enough an answer when it is up to a person to have some kind of answer, even if based on much that is uncertain. that position, borne out of need to have competency, can create blindspots, but they are not necessarily just an expression of arrogance.

also, in terms of generalizing...these discourses unfortunately do limit what we can choose...i.e. i will likely choose something like competency and caring, rather than for instance a totally different approach like clowning (unless i am patch adams...but i believe his clowning is within the realm of the 'caring' paradigm). discourses do constrain us. stereotypes do constrain us. it is almost utopic to think that we might see each other outside of these constraints. we can pay attention to the constraints we are under, though.

 

[jl lin]

oh, and given that i ain't nobody's standardized sexy, i hate that typical hetero 'beautiful' middle-class sexy flirting works, but hey, use it if you got it. i'm with you jl, sedein


it's true that med school is focusing more on the 'caring regime' these days, but that it is put in a binary with the 'competence regime', and then measured as less worthy. as a former psychotherapist/anti-oppression academic now trained in medicine, i'm interested in how these things are pitted against each other, and for what purposes - i.e. for lower payment of services rendered in how these things support the debate as played out in the midlevel creep. not just lower payment, but also a taking away of autonomy. so some nurses get more autonomy. but then everyone gets less autonomy as the whole thing becomes super regulated and guidelined into a hogtie.

what is interesting about np= we listen, is that the more nursing looks for entrance into autonomous practice, the more they will need to argue for their equivalence in the competency paradigm. so many nurses on the ground may get more interested in proving their competency...at the expense of their excellent education around patient-centredness and caring. the discipline will look less caring on the ground. look at how caring gets compromised already by time constraints and 'factorization' of the job by profit-focused admins (or 'taxpayer savings' focused, whichever). that taking away of autonomous definition of caring has been happening, and makes for some crusty people. the wanting to enter into the competent discourse will also affect things. an np so far can seem more caring now because they are given more time with a patient because they are 'cheaper'. that too will change. let's see where all the caring goes.

Well, I don't disagree. Personally, I say put them through the same testing that docs go through; but even then, what happens when you have a good test-taker? To me, without the same full rigors, they will not be able to be considered equivalent, for they are not. It is true that you may have a few talented people that will be able to learn and apply through hard experience. This reminds me of the apprenticeships of olden days in medicine here in America. Things had to change for a reason, and we can't lose sight of that reality. The exception cannot make up the rule.

About the sexy deal comment, it's funny. This is something I've seen women do more than men. Innocent flirting is one thing. We have all done that probably to some degree. My focus, however, is the patient. I could care less how sexy you are or how sexy you think I am; b/c I am not big into such silly games. Respect is more important than trying to get over on someone. Plus, there is nothing sexier than a sharp and caring mind. The poster that wrote that doesn't know that there are some of us that see right through that kind of thing, so they would not necessarily be more apt to get props from us. We may give them some anyway, as we go on and do the work that is needed for the patient,, so long as we can move them forward or get the patient/s what they need. I could give zillions of examples. Worst thing is to get into some pzzing contest with someone. That could delay effective treatment. If they are still going that way and the patient doesn't get what they need, nurses have ways to cover themselves. At the end of the day, someone is going to come after the doc.

And you are right, where independent practice is concerned, indeed,where will the NP or PA be when the finger is pointing at them? I see this hurting docs that practice with them. The example of the ophthalmologist with the incompetent CRNA, for example. @Grover posted a thread about it. The ophthalmologist took a huge hit. Know why? They made the case of the ophthalmologist having a higher expectation of practice standards and expertise, even though he was not an anesthesiologist. Those that are fully independent will have to face the malpractice on their own. But when MDs or DOs agree to work with NPs and PAs as independent practitioners, they are putting themselves at risk--especially if they are not fully aware of the practitioner's clinical acumen.

 

[jl lin]

i think there's something too that point of view.

in terms of need to be right...from a wholistic angle, that may not be just an expression of arrogance, but something related to being where the buck stops, knowing that 'i don't know' is not sufficient, if in the role of leader. there must be an answer, and understanding, and an approach developed. 'i don't know' is just not good enough an answer when it is up to a person to have some kind of answer, even if based on much that is uncertain. that position, borne out of need to have competency, can create blindspots, but they are not necessarily just an expression of arrogance.

also, in terms of generalizing...these discourses unfortunately do limit what we can choose...i.e. i will likely choose something like competency and caring, rather than for instance a totally different approach like clowning (unless i am patch adams...but i believe his clowning is within the realm of the 'caring' paradigm). discourses do constrain us. stereotypes do constrain us. it is almost utopic to think that we might see each other outside of these constraints. we can pay attention to the constraints we are under, though.

Come on. This is why physicians refer out to specialists. This is why they double check tests. And there will always be some degree of etiology unknown. Hyper-fear about being wrong is an attitude that holds back progress. Lack of humility in the field of medicine is something doctors themselves have written extensively about over the decades. There are scores of books, written by physicians, that reflect on this, both as a problem in medical education and in further practice.


[“Granted it is easy at least comparatively to find pleasure in error when there's nothing at stake. But that can't be the whole story since all of us have been known to throw tantrums over totally trivial mistakes. What makes illusions different is that for the most part we enter in them by consent. We might not know exactly how we are going to err but we know that the error is coming and we say yes to the experience anyways.

In a sense much the same thing could be said of life in general. We can't know where our next error lurks or what form it will take but we can be very sure that it is waiting for us. With illusions we look forward to this encounter since whatever minor price we paid in pride is handily outweighed by curiosity at first and by pleasure afterward. The same will not always true when we venture past these simple perceptual failures to more complex and consequential mistakes. Nor is willing the embrace of error always beyond us. In fact this might be the most important thing that illusions can teach us: that it is possible, at least some of the time, to find in being wrong a deeper satisfaction then we would have found being right.”--Katherine Schultz, Being Wrong: Adventures in the Margin of Error]

 

[Nasrudin]

oh, and given that i ain't nobody's standardized sexy, i hate that typical hetero 'beautiful' middle-class sexy flirting works, but hey, use it if you got it. i'm with you jl, sedein


it's true that med school is focusing more on the 'caring regime' these days, but that it is put in a binary with the 'competence regime', and then measured as less worthy. as a former psychotherapist/anti-oppression academic now trained in medicine, i'm interested in how these things are pitted against each other, and for what purposes - i.e. for lower payment of services rendered in how these things support the debate as played out in the midlevel creep. not just lower payment, but also a taking away of autonomy. so some nurses get more autonomy. but then everyone gets less autonomy as the whole thing becomes super regulated and guidelined into a hogtie.

what is interesting about np= we listen, is that the more nursing looks for entrance into autonomous practice, the more they will need to argue for their equivalence in the competency paradigm. so many nurses on the ground may get more interested in proving their competency...at the expense of their excellent education around patient-centredness and caring. the discipline will look less caring on the ground. look at how caring gets compromised already by time constraints and 'factorization' of the job by profit-focused admins (or 'taxpayer savings' focused, whichever). that taking away of autonomous definition of caring has been happening, and makes for some crusty people. the wanting to enter into the competent discourse will also affect things. an np so far can seem more caring now because they are given more time with a patient because they are 'cheaper'. that too will change. let's see where all the caring goes.

I'm blocking that poster because....I just can't...anymore.

But I tend to exaggerate to make a point. I'm also fascinated by animal behavior and how these professionalism regimes....as your calling them...i like the language by the way...try to act like we're not animals in clothes. So it's that thesis I'm working with. The arrogance of my post is sort of, off target with my reality.

What I like to do is very subtly, treat a middle aged lady who's been beat down by a hard shift and raising kids or whatever and look at her ever so cryptically like she's her 20 something self. That and I'm middle aged myself and find a wide variety of women and races sexy. So I play around on that frequency. Strictly professional and polite.

And I find that it works. It's a very social professional environment. As you say, it'd be pointless not to use whatever is available. It's really more like friendliness with a touch of mischief.

 

[jl lin]

LOL. Oh brother. Dude, aren't you middle age? I was contemplating the same thing, but I thought against it b/c I believed you were beyond it. Whatever.

The idea that a person thinks they can manipulate intelligent people in such a way amuses me. Yes, intelligent females are easily manipulated by such nonsense. Oh, wait. Nurses aren't all that intelligent.


Ignore? I am glad to oblige with the same. There should be no issues then.

 

[fancymylotus]

LOL. Oh brother. Dude, aren't you middle age? I was contemplating the same thing, but I thought against it b/c I believed you were beyond it. Whatever.

The idea that a person thinks they can manipulate intelligent people in such a way amuses me. Yes, intelligent females are easily manipulated by such nonsense. Oh, wait. Nurses aren't all that intelligent.


Ignore? I am glad to oblige with the same. There should be no issues then.

Your ignore list probably has as many people on it as I have pairs of shooz

 

[midweststudent1]

You keep saying that the medical schools have to incorporate this stuff into their curriculum (looking at the whole patient, active listening, learning empathy) , but my school DOES. I'm sure that 90% of the schools do nowadays. Lol....in fact for some of ours, our standardized patients are trained to just give very subtle clues on some cases, where the issue that were supposed to investigate is depression, even though they're in for back pain.. If we don't catch it---we lose credit for it.

The line that nurses are better listeners is crap, and every med student in America should think so too.

 

[acceptmeplease]

Your ignore list probably has as many people on it as I have pairs of shooz

Pretty soon she'll only be able to talk to the high school kids.

 

[Nasrudin]

Your ignore list probably has as many people on it as I have pairs of shooz

Not unless you have 2 pairs of shoes. Somehow I'm guessing that's not the case.

 

[fancymylotus]

Not unless you have 2 pairs of shoes. Somehow I'm guessing that's not the case.

126 :/

 

[jl lin]

You keep saying that the medical schools have to incorporate this stuff into their curriculum (looking at the whole patient, active listening, learning empathy) , but my school DOES. I'm sure that 90% of the schools do nowadays. Lol....in fact for some of ours, our standardized patients are trained to just give very subtle clues on some cases, where the issue that were supposed to investigate is depression, even though they're in for back pain.. If we don't catch it---we lose credit for it.

The line that nurses are better listeners is crap, and every med student in America should think so too.

No I said that they have been increasing the inclusion in their curriculum. I stated that earlier. I also stated that current powers that be in nursing stick to that old school of thinking with re: to MS education. I went as far as to say, perhaps nursing needs to be more educated about MS education. *shaking head*

I am not taking sides on who is the better listener, b/c that depends on a number of things, and a good portion of those things have less to do with which educational process a person attended. Some are and some aren't. It's too much of an individual thing to link to a degree or education. LOL. That is basically what I was saying as far as that is concerned.
It's a good idea to steer away from taking sides on such things, b/c it's really silly. Now taking a stand against midlevel creep. . .that is completely understandable. I certainly wasn't arguing against taking such a stand. In fact, I have argued for it...several times.
But it's childish to get all anti-nurse/anti-doctor. It's kind of ridiculous and high-schoolish in and of itself.

 

[giantswing]

Pretty soon she'll only be able to talk to the high school kids.

It's the same kind of warning when you're out on a date and the person goes on about how alllllll their exes are crazy.... But not them.

Back. Away. Slowly.

 

[SouthernSurgeon]

Your ignore list probably has as many people on it as I have pairs of shooz

If only. I'd bet dollars to donuts 9/10 of the "i'm ignoring you" threats are false ones. Otherwise there would be no one left for them to respond to at this point.

 

[DocVapor]

126 :/

 

[RJGOP]

126 :/

Holy crap!

 

[Kahreek]

126 :/

wat those are lik 252 individual shoes!!!

 

[Psai]

I've had maybe 20 pairs of shoes in my entire life

 

[RJGOP]

wat those are lik 252 individual shoes!!!

Yes, hence the definition of pair.

 

[fancymylotus]

before i get in trouble for off topic posts, i shall explain.
some people collect stamps
some people collect coins
some people spend their money on alcohol
others on illegal stuff

i buy expensive shooz. its sort of a hobby. chasing down limited edition totally ridiculous and totally impractical but still pretty ones

126 is nuffin. i have friends that have double and triple that number of pairs of shooz.

 

[RJGOP]

before i get in trouble for off topic posts, i shall explain.
some people collect stamps
some people collect coins
some people spend their money on alcohol
others on illegal stuff

i buy expensive shooz. its sort of a hobby. chasing down limited edition totally ridiculous and totally impractical but still pretty ones

126 is nuffin. i have friends that have double and triple that number of pairs of shooz.

Maybe one day you'll surpass Imelda Marcos.

 

[fancymylotus]

Maybe one day you'll surpass Imelda Marcos.

That day is only gonna happen when I get to start spending Kaus' vascular surgeon monies on my shooz. Sorry not sorry.

 

[DocVapor]

before i get in trouble for off topic posts, i shall explain.
some people collect stamps
some people collect coins
some people spend their money on alcohol
others on illegal stuff

i buy expensive shooz. its sort of a hobby. chasing down limited edition totally ridiculous and totally impractical but still pretty ones

126 is nuffin. i have friends that have double and triple that number of pairs of shooz.

How are they organized?

By heel height? Style? Color? Potential to be used as a deadly weapon?

Edit: I'm imagining this whole situation like this except with a brown woman.

 

[fancymylotus]

How are they organized?

By heel height? Style? Color? Potential to be used as a deadly weapon?

Edit: I'm imagining this whole situation like this except with a brown woman.

All those loubs make me so happy

 

[W19]

...

 

[hallowmann]

What is this thread? I just... I just... just... can't.

 

[jl lin]

I actually think med school buy into that BS too much... Nursing is really winning the war if they somehow force med school to incorporate these BS into their curriculum. Certain aspect of compassion and professionalism can not be taught in med school IMO...

While I agree that certain aspects of compassion cannot be taught in school, professionalism and awareness of others and people as individuals--even such things as cultural awareness--can be emphasized in the curriculum and through leadership example. It's really not about "nursing winning any war." It's about building educationally evolved precepts throughout the pedagogy. It's really something that always needed to be there. Some people value respect of people as individuals--and as they do so, they have respect and value for the lives of others. It's like how some people respect and appreciate the perspectives of Albert Schweitzer, for example. A person develops a reverence for life or he/she does not--or does so exclusive only to empathizing with a few within his circle. It is sad when the circle beyond that is limited for them in terms of empathy. But in as much as ethics is taught in all the health sciences, so then is the importance of a unifying paradigm, which involves respect for the whole of the individual. Don't assume it's common knowledge that people should be respectful and mindful of such things. Sadly, often, in the daily experiences of life, they are not.

There's a great proverb that says basically, "As a person thinks in their heart, so is the person." How we set the paradigms influences how we affect others--b/c it influences our thinking. If any group of people have the power to affect others, it is most definitely physicians.

"Ethics is nothing else than reverence for life."-Albert Schweitzer

Truthfully, I wish everyone here well on their paths.

 

[Psai]

I lost a good chunk of my compassion when I started actually seeing patients

 

[jl lin]

I lost a good chunk of my compassion when I started actually seeing patients

Psai, I am sorry that happened. May I ask what area were you rotating through that made you feel like this? Was it ED? Was it the combination of the patients with the pressures of school? I'm interested in what can be done to help prevent the emotional drain.

 

[Psai]

Just wait til you start rotating and see for yourself

 

[jl lin]

Just wait til you start rotating and see for yourself

Well, I mean do you regret your choice--to go to medical school? I see a lot of negativity in a number of posts, and I am curious how much is merely stress-related and how much has to do with feeling chagrin over choosing medicine in the first place? Seriously. It's an honest question.

 

[Pacna]

While I agree that certain aspects of compassion cannot be taught in school, professionalism and awareness of others and people as individuals--even such things as cultural awareness--can be emphasized in the curriculum and through leadership example. It's really not about "nursing winning any war." It's about building educationally evolved precepts throughout the pedagogy. It's really something that always needed to be there. Some people value respect of people as individuals--and as they do so, they have respect and value for the lives of others. It's like how some people respect and appreciate the perspectives of Albert Schweitzer, for example. A person develops a reverence for life or he/she does not--or does so exclusive only to empathizing with a few within his circle. It is sad when the circle beyond that is limited for them in terms of empathy. But in as much as ethics is taught in all the health sciences, so then is the importance of a unifying paradigm, which involves respect for the whole of the individual. Don't assume it's common knowledge that people should be respectful and mindful of such things. Sadly, often, in the daily experiences of life, they are not.

There's a great proverb that says basically, "As a person thinks in their heart, so is the person." How we set the paradigms influences how we affect others--b/c it influences our thinking. If any group of people have the power to affect others, it is most definitely physicians.

"Ethics is nothing else than reverence for life."-Albert Schweitzer

Truthfully, I wish everyone here well on their paths.

I find it easier to maintain empathy if I think of everyone as strictly determined. That way, it's none of their fault the way they are; I can't blame them. They were just a rock rolling down a hill. You don't say "WOW look at the stupid bounce that rock made!! What an idiot." You just accept where the rock is now and help move it towards a better direction.

I realize that this doesn't make a whole lot of sense, as to be totally consistent I have to 1. view myself as determined (empathy in its true sense wouldn't exist), and 2. have empathy for rocks... but it helps keep me from being judgmental, so I'm keeping it.

Not in opposition to anything you said, I'd just like to split a hair: compassion does not require that you respect every aspect of a person. In fact, I would argue that you are showing more compassion if there are things about your patient that you do not respect. For instance: treating your mother (probably) doesn't demonstrate much compassion. Treating an injured Nazi/terrorist/etc is demonstrating compassion. Like you said quite elegantly, compassion is about respecting people as individuals. Valuing people based on anything else (race, gender, nationality, etc) is the antithesis of compassion and is, perhaps subconsciously, most peoples' basis for determining douches from non-douches.

People like to fall into camps (docs vs everybody else in medicine, Pats vs Seahawks, 'with-us-or-against-us', etc). It's natural because it was an evolutionary advantage in the past. Further improvements in race and gender relations won't happen unless we recognize this tendency as illogical and reject it. There are excellent docs and nurses who I would trust with my life. There are terrible docs and nurses who I wouldn't trust with a dead dog. Assuming either is just another form of bigotry. Besides, we're really all on the same side.

Also, **** the AMA and ANA. And while they are ****ty, **** the institutions that make them necessary and unavoidable more.

 

[Psai]

Well, I mean do you regret your choice--to go to medical school? I see a lot of negativity in a number of posts, and I am curious how much is merely stress-related and how much has to do with feeling chagrin over choosing medicine in the first place? Seriously. It's an honest question.

Why are you assuming that there's something wrong with me? I'm totally fine. It's the system that's messed up. You still haven't answered my question about whether you are in medical school or not because you don't sound like a medical student especially seeing as how naive you are

 

[oldanddone]

medicine has long had a 'caring regime' - it's the reason many cite for even going into it in the first place, and wanting to be of service. (this is not something that is coming into medicine from nursing, necessarily, but certainly something that nursing also has, in a more predominant way. )

medicine has long had a 'competence regime' that in the 'hidden curriculum' tells us there's no time, so whatever we have is going to be on gaining scientific competence. we do also have official curricula around cultural competence, patient-centred interviewing, etc, that comes from the caring regime. we are taught to dismiss the 'caring regime' at times, even though most of us saw its importance at some point. i'm sure some nurses get into that sense of prioritizing competence, particularly in certain specialties. both docs and nurses deal with this polarity, in different ways.

we have a long history of becoming bitter in the meat-grinder that is medical education. enough studies that talk about ending school with less compassion than what was begun with. i believe the research describes this balancing off when we get more control of our schedule, past training, and less likelihood to be suffering depersonalization and burnout.

jl...please just go look up the articles on decreased empathy during med ed...they are out there in abundance. it's prolly worthwhile if you are also preparing to enter the grinder. i cringe as you ask a person in the thick of it to give an analysis of all that goes into the burnout. you are right, though, some rotations are more likely to have more grind than others. just go do some reading. it's all out there.

next step beyond us vs them is trying to relate across differences....many ways to do so...in theatrical play this may be about role-playing each other's stereotyped roles until we all end up laughing together. i can see the psychiatrist being game....but pair them with the orthopod? I don't know if that exercise is gonna happen or not...

or else try and take the edge off with some shuz...here is a gif of liam kyle sullivan and 'shoes'...look up on youtube...well worth it. here is a gif from that performance on the importance of shoes in decompressing.

 

[jl lin]

Why are you assuming that there's something wrong with me? I'm totally fine. It's the system that's messed up. You still haven't answered my question about whether you are in medical school or not because you don't sound like a medical student especially seeing as how naive you are

Psai, your replies seem hostile-toned and unnecessarily so. But it's OK. So how is the system messed up?

Alright. No Psai. I have been on SDN for a while. I am post-bac pre-med and have a vast amount of experience as a critical RN of both peds and adults--surgical, cardiac, OH, etc. I am a non-trad. I am trying to understand. I know you will say it's not the same experience, but really, the general environment of HC is tough. I mean for both nursing school--rotations and in nursing practice, well, they have not been picnics. Yes. Patients can wear you down at times. But I haven't lost my compassion. I am not even 100% sure why. A number of my colleagues have. Many of them have just decided to say, "Screw it!" and then the apply to CRNA school, get through it, get licensed as such, and make bank. I have the grades, testing, and intensive care experience to do this, but I don't feel led to go this route. It would be less of a financial load to go this way. It would be less time. Even though it wouldn't be a picnic either, I'd get through it faster. Trust me, in the critical care areas, working with very intense, critical people is often a given. So, yea, I could do this and make some decent bank; but no. I guess, like an idiot, I am pushing forward to move into primary care. I'd consider critical care med or ED; but I have really had my fill of off-shift work over many years. And I now want to see people/pts on an ongoing basis.

I hope that answers your questions and that you might see that my questions are sincere.
Thanks.

 

[JoBreeze]

Fear of being wrong is what drives me that much harder to make sure I'm right. God this country is soft.

 

[jl lin]

medicine has long had a 'caring regime' - it's the reason many cite for even going into it in the first place, and wanting to be of service. (this is not something that is coming into medicine from nursing, necessarily, but certainly something that nursing also has, in a more predominant way. )

medicine has long had a 'competence regime' that in the 'hidden curriculum' tells us there's no time, so whatever we have is going to be on gaining scientific competence. we do also have official curricula around cultural competence, patient-centred interviewing, etc, that comes from the caring regime. we are taught to dismiss the 'caring regime' at times, even though most of us saw its importance at some point. i'm sure some nurses get into that sense of prioritizing competence, particularly in certain specialties. both docs and nurses deal with this polarity, in different ways.

we have a long history of becoming bitter in the meat-grinder that is medical education. enough studies that talk about ending school with less compassion than what was begun with. i believe the research describes this balancing off when we get more control of our schedule, past training, and less likelihood to be suffering depersonalization and burnout.

jl...please just go look up the articles on decreased empathy during med ed...they are out there in abundance. it's prolly worthwhile if you are also preparing to enter the grinder. i cringe as you ask a person in the thick of it to give an analysis of all that goes into the burnout. you are right, though, some rotations are more likely to have more grind than others. just go do some reading. it's all out there.

next step beyond us vs them is trying to relate across differences....many ways to do so...in theatrical play this may be about role-playing each other's stereotyped roles until we all end up laughing together. i can see the psychiatrist being game....but pair them with the orthopod? I don't know if that exercise is gonna happen or not...

or else try and take the edge off with some shuz...here is a gif of liam kyle sullivan and 'shoes'...look up on youtube...well worth it. here is a gif from that performance on the importance of shoes in decompressing.
View attachment 188844

LOL. Yours is a great reply.

No need to cringe. Thank you for sharing about references. Regardless, as the pragmatically-forced-down idealist, this is on the sad side to me. I mean I don't believe that the process absolutely has to be as abusive as it seems. I mean why does it? Is it like this for mostly everyone? Can it be changed or improved upon? Nursing definitely has its level of abuse--especially in certain areas. But now I just want to know why the MS/ GME journey has to be so toxic for people.

 

[giantswing]

I lost a good chunk of my compassion when I started actually seeing patients

As did I. People think this would diminish your love for what you do - it really doesn't. It lets me cope better with every day tragedy; it's the compassionate bleeding hearts that burn out and hate medicine in the end.

Kiddies: go into medicine because you like to learn and are willing to work your butt off, not because you want to help people.

 

[Psai]

Your nursing experience doesn't matter to me. I have an idea of what it entails and it's not the same experience. It's not even close. You can't know what the experience is like until you go through it yourself. What do you want me to do? Describe my life to you? I spent tons of time telling circulos vitios about how much medical school sucked and he wouldn't have a word of it. Just talked big about his manual labor experience and how it would be a million times better to sit in a climate controlled environment just chilling on the computer than it is to be working outside in the hot sun. Turns out, he couldn't even handle one semester. So go try it out for yourself and see what it's like. I've heard nursing students and PA students disparaging our education without having the slightest idea of what goes in to it. For us, we earn the title of doctor. We don't have to go around playing dress up and telling our patients that we're basically the same thing

 

[chasm-e-baddoor]

I mean I don't believe that the process absolutely has to be as abusive as it seems. I mean why does it? Is it like this for mostly everyone? Can it be changed or improved upon? Nursing definitely has its level of abuse--especially in certain areas. But now I just want to know why the MS/ GME journey has to be so toxic for people.

My dad is an MD and my mom is an RN. Nursing does have its share of hardships but in the end RNs do not have anywhere near the same level of responsibility as physicians. From what I know from my own, still limited ,experience and from what I gather from my dad and his friends/colleagues, training to become a physician is meant to be tough and grueling for enormous amounts of time. In order to be able to be able to handle any patient - human life - that walks through the door, you need to have the top level of knowledge while being pushed to your limits in less-than-optimal conditions (residency). Even after this, the "lifestyle" specialties in medicine are considered 40-50 hr work weeks.

This entire process is almost soul crushing to many people. Medical students are meet several thousands of hours of stress and misery, lose their friends, no hobbies, family life suffers, health sometimes suffers, sacrifice 20's/30's, debt, many patients are self-centered laymen (who dont understand the job or responsibility of a doctor), lawsuits, etc.

The tough training is necessary to become the last and finest option in the healthcare system able to handle anything on a walking, living highly complex organism.

Think about how physicians practice - they see several thousands of patients over the course of their careers. It is not good enough to train until you get something right, you have to train until youre never wrong, and that's what the tough training seeks to achieve

 

[jl lin]

Your nursing experience doesn't matter to me. I have an idea of what it entails and it's not the same experience. It's not even close. You can't know what the experience is like until you go through it yourself. What do you want me to do? Describe my life to you? I spent tons of time telling circulos vitios about how much medical school sucked and he wouldn't have a word of it. Just talked big about his manual labor experience and how it would be a million times better to sit in a climate controlled environment just chilling on the computer than it is to be working outside in the hot sun. Turns out, he couldn't even handle one semester. So go try it out for yourself and see what it's like. I've heard nursing students and PA students disparaging our education without having the slightest idea of what goes in to it. For us, we earn the title of doctor. We don't have to go around playing dress up and telling our patients that we're basically the same thing

Although you continue in a hostile vein, I thank you for responding. You think you have an idea, but no. You do you know what my experiences have been in all kinds of critical care settings over a long period of time. I tend to think that pizzing contests about who has it worse than whom are nonsensical. Life in general is difficult. That is a fact. Some people resist understanding this, and they become bitter in going through the difficult experiences.

I, at least for one, have never disparaged physicians' education. In fact, b/c of my experiences, I would be the last to do this. Is it your own bitterness that leaves you sounding unduly hostile and then justified in your undue hostility? If that is what you think will make you feel happier, well, so be it.

The funny thing is that the sheer venom and hate and even that sad group-bullying that goes on is telling to me. I mean, sure. You have a right to feel any way you want to feel. I personally think, even though some will say it's venting, that all the hating is counterproductive. But you won't believe me, b/c you have convinced yourself it is not.

Circ, as far as I can recall--and I admit it's scanty recollection, b/c usually I have preferred to engage in the non-trads thread or even to ask questions in some of the various attending specialty threads--wasn't at all interested in what he was learning. He hated it from jump street it seems. There was another person on here, I can't remember his name, well, he forced himself through MS, got into an anesthesia residency, and is probably an attending now. He admitted he lied to adcoms and others about his motivation to go to MS. I think the main gist of what he finally admitted was that he believed doing so would help him meet women, find someone, and get married. Call me nuts, but for someone with a lot of life and professional experience in the most demanding areas of critical care, I just found this astonishing. I mean, so, of course he ended up being miserable in medicine.

At any rate, I refuse to be imbalanced and a hater, and trust me. I have been in some tough situations and then some in my life. I mean it's nothing you should feel all "pregnant" over--meaning that as pregnant women, you feel like you are the only one who has ever felt that way. Many aspects of my life have been harsh and heartbreaking. But I fully understand and expect that life to be difficult. I also expect that there will be some folks that believe that crap runs down hill, so they treat MS students and first year or even PGY-2's, 3's, 4's or fellows in line of descending order, like they are the catchers of the crap, which everyone has to catch at some point. I have also seen a lot of this in my field and I have witnessed it with residents and fellows. It's not a good model for bringing people up in the arena of Health CARE; but those that are often less able to be good preceptors are often what you get--at least in the health care learning environment. Overall, I come in fully knowing it is an abusive environment. If you think nurses that have to work closely with residents, fellows, and attendings in critical care don't see a fair amount of it, you are wrong. Perhaps it depends more on where you work; but I have always worked in very busy, inner city and /or crazy teaching critical care areas.

I guess someone has to take the crap; b/c it's that old mentality of where the crap runs downhill--so nurses and such are prime targets. Maybe it is why at least some nurses have developed attitudes as well. I am not saying it is right. I am saying that all this negativity goes back and for--and ultimately to what end?

Why do people feel that being condescending or venomous is necessary? It truly isn't. Spin it whatever way you want. In the end, is it not merely rationalization for not getting in touch with one's own feelings and taking responsibility for them? IDK. Maybe I'm wrong, but I can't be honest in saying I believe that I am.

Nothing I will say will please you; b/c I am, in your mind, at the lower end of the hill, and the crap is coming my way, and that's just the way it goes. Sure. Some might spatter on to me on the way down, but trust me. I won't let it crush, suffocate me, or make me bitter. I refuse to hate, especially since it only perpetuates the problem/s.

I am sorry that you are feeling whatever negative things you are feeling. I can't change how you are feeling. I only have control over my own feelings.

 

[fancymylotus]

Your nursing experience doesn't matter to me. I have an idea of what it entails and it's not the same experience. It's not even close. You can't know what the experience is like until you go through it yourself. What do you want me to do? Describe my life to you? I spent tons of time telling circulos vitios about how much medical school sucked and he wouldn't have a word of it. Just talked big about his manual labor experience and how it would be a million times better to sit in a climate controlled environment just chilling on the computer than it is to be working outside in the hot sun. Turns out, he couldn't even handle one semester. So go try it out for yourself and see what it's like. I've heard nursing students and PA students disparaging our education without having the slightest idea of what goes in to it. For us, we earn the title of doctor. We don't have to go around playing dress up and telling our patients that we're basically the same thing

Give me a condensed version of this for my signature.

But seriously, why cant we all just agree to disagree and keep it moving? jl lin is going to continue to post novel length responses that are mostly fluff and have nothing to do with the topic at hand, and 98% of us are going to get grouchy about it. and on and on and on

 

[jl lin]

It is not good enough to train until you get something right, you have to train until youre never wrong, and that's what the tough training seeks to achieve

I get what you are saying; but being vigilant to get to the bottom of what is going on is different than worrying about always being right. No one ever is always right. No one has been always right. No one will ever be always right. You leave knowing you did the absolutely best that you can do, and you did so with vigilance, competence, and compassion. Then you can put your head on the pillow at night and sleep the sleep of the just. It's this whole issue that is delineated in books like "Learning to Play God," by Dr. Robert Merion--and it evokes more a sense of desperate pride than overwhelming commitment and dedication to people in need.

I don't know. Whatever comes out of this whole "discussion," I am wondering now if in fact I may fit more into the school of Osteopathy. So, perhaps this back and forth has been a good thing, at least for me. I mean, I have never really taken sides on MD vs. DO, b/c that always seemed rather pointless. But if I do lean towards being more holistic in nature, maybe I should apply to more Osteo schools? Seriously.