Crabby 2nd Years

Dear second year medical students, we're all getting a little bit crabby. Let's tone it down. Now, before I launch into a long diatribe about whining and entitlement, let me state for the record that I know this post may seem a bit hypocritical. I certainly can whine and complain with the best of them. Even now I realize that I am actually whining and complaining about the whiners and complainers. I have also used this blog as a forum to vent some of my frustrations (see the paragraphs near the end of this blog). But it is patently obvious that, as the first semester winds down, our class is getting especially angsty, and this angst is being taken out on the course directors. Everything seems to be "a waste of time," and Christmas break really can't come soon enough.

Being a course director is a thankless job; it really is. I will admit that some courses are run better than others. Apparently, one of the problems is that professors who run their Blocks really well for a couple years get promoted because they do so well. So there is turnover of good directors. But even if that is the case, we have had some very well run Blocks. Perhaps there are other Blocks that could use a bit of work. However, even the best run courses (Hematology-Oncology for example) still get lambasted in person and electronically. These course directors only hear the complaints and criticisms, rarely any praise. Every test has to be perfect. When there is an ambiguity on an exam, students argue vehemently with professors about test questions in a public forum. I have never understood this. If one or two questions are going to be the line where you fail the Block, I understand. Haggle away. If you've already passed the course though, what does it matter? I guarantee there is no haggling on the National Board Exams; and, try to argue with your attending surgeon next year when you're getting pimped on the wards. That'll go over just peachy. Sometimes things don't work out in your favor.  That's life. Arguing about a question will not change your Step 1 score in June. Residency programs don't even see your second year grades!

I feel especially bad for the course directors of our last Block, "Clinical Medicine Cases." We've been worked pretty hard recently; I'll admit that. The last few systems Blocks have run together, starting right after a Monday test. We finally got a break (a whole weekend!) before a two day mini-Block on Geriatrics, 8am to 5pm, old people all day long. I realize this is not the most exciting topic in the world, but the baby boomers are going to make up a significant portion of our population in years to come, and people are living longer and longer these days. I also realize that most people are not going to be geriatricians, and that this Block was right before Thanksgiving break. But damn, it was like nothing could go right. I want to be home with my family too, but that's not the fault of those running the course! Was the course run with perfect efficiency? No, but life goes on. Let's just all breathe.

One thing I've realized during this semester is that I can recharge my internal batteries a heck of a lot quicker these days. By the middle of Sunday this weekend, I was ready to get back in the swing of things again. I needed Friday and Saturday night to rest and recover, and then I could get back to the grind. I'm not burnt out yet, which I think has a lot to do with what I did last summer. Working with Dr. Carey in health policy analysis 1) was something I really wanted to do, 2) was not bench top research, and 3) allowed me to have a very flexible work schedule where I spent most days typing away at Bean Traders coffee shop. I'm done doing things just for the curriculum vitae, or to make other people happy, things I "should" do. This summer was fantastic, and I wouldn't change it for the world. Kelly Esposito and I are already planning our post-Step I trip across the pond: Morocco, Egypt, and then maybe Turkey. I'm taking care of flights and perhaps Moroccan lodgings, while she is packing in the activities (Ronnie is taking care of security and looking pretty). Again, recharging the batteries.

Another thing. None of us have the right to be in medical school. It is a privilege to take care of others. I worry about this entitled mindset. I was volunteering with Parkwood EMS a couple weeks ago, and we got a call to an 87-year old male "syncopal episode." Sometimes the computer gives other tidbits of information; for example, it might say, "the patient will meet you outside the lobby" or "come through the back door, it's unlocked." This time it said, "two doctors on scene." Okay. There is nothing worse than having a doctor on an EMS scene, unless the problem involves what the doctor does for a living, and the doctor is not a douche bag. Is the patient having a myocardial infarction? Okay, I wouldn't mind having a nice cardiologist there who is willing to let the paramedics do their work and offer to help if needed. Is it a mass casualty incident? Okay, I'll take the county medical director. But we rolled up to a syncopal episode with two drunk dermatologists on scene. Absolutely obnoxious. The patient did not want to go to the hospital, and if he could answer all questions oriented to person, place, time, and event, then removing him from the premise would be kidnapping. So please, don't yell at EMS; it doesn't help.

We finally got the patient into the ambulance, just so we could talk with him alone without any distractions. My personal feeling is if you are 87 years old, you can do whatever you want. You don't want to go the hospital, you don't have to. You've been on this earth for nine decades; if you're having an MI and want to do so in peace, get a DNR and enjoy Heaven. But meddlesome doctors tapping on the ambulance window telling us, "we need cardiac enzymes" doesn't help an 87 year old man make decisions. It also doesn't get him cardiac enzymes any sooner. Don't tell us to draw blood; that doesn't happen in the back of the truck. That happens at the hospital, the place you are actually impeding us from going to. So, if you are a physician on scene, here's what you say,

Hello other members of the health care team! I am a physician who would be willing to help in any way I can if you would like another pair of hands. I know that you are experts in prehospital care, and I am (almost always) not. I will not get in your way because I am not a douche bag. I will not advance the stereotype that doctors are assholes on emergency scenes, because I am not a douche bag. And I will not tell you what to do, because I am not a douche bag. Did I mention I will try my best not to be a douche bag? Okay, I will now sit in this corner and let you let me know if I can help. Thank you.

This can be shortened to, "Hey, I'm an emergency room physician, let me know if you need another pair of hands." And then walk away.

Whew. I am sorry for all the venting today, but as a medical student sitting in the back of an ambulance, I don't like to be embarrassed by members of my future profession. And this is not the first time. There is a lot of animosity between the health care professions. The bottom line is, that animosity does not help patients.

It hurts them.