Saturday, November 1, 2008


Sometimes I wonder who's actually crazy- me or everyone else. And sometimes it's a hard call.

My school promotes "civility in the learning environment" which basically means that the dean's office works to ensure that medical students are not hit by flying surgical instruments, launched in an operating room temper tantrum, and that we are not routinely humiliated, belittled, or otherwise abused. The dean's office also works to limit student work hours. Working 100 hours a week, coming to the hospital at 4 am, and working for 36 hours in a row, for instance, is no longer tolerated. We're also supposed to average one day off a week.

The dean's office is going to great lengths to ensure what any other reasonable institution outside of medicine would offer automatically.

Now, there are things in the medical school environment that are difficult but that work. Pimping, for instance, is a term used to describe the Socratic Teaching Method. This is where an attending physician asks medical students questions that they may or may not know the answer to. So, why do we use warfarin instead of heparin in this case? What is this (pointing to part of an x ray)? Is this drug metabolized by the kidneys? Yes? What percent of the drug is metabolized by the kidneys? The questions may go on and on. But when done in a benign manner, a student might feel embarassed about the sudden attention to his or her lack of knowledge on the subject of indirect hernias, in rabbits, but the student leaves with a lasting memory of the significance of rabbit hernias.

Incivility is being purposely humiliated in the absence of any detectable learning or teaching. At worst, it may involve physical harm, although I've never had the pleasure of witnessing this. One incident that has forever embedded itself in my mind involves an attending physician I had the pleasure of meeting during a particularly difficult rotation.

For background, this particular medical specialty rotation took place at Madison Hospital (not the real name). Other students having done this rotation at Madison described it as "the worse experience of my adult life," "miserable," "depressing," and any other number of adjectives commonly used to describe a horrific experience.
Every day I travelled 45 minutes to arrive at the hospital at 5 am to round on my patients and I'd generally get out at around 7 pm, unless it was a "short call" day in which case I'd "officially" be done at 10 pm, although this was often subject to interpretation.

Anyway, one particular attending was about to start a didactic session for the medical students, a bunch of the interns, and a bunch of the residents. There were about 20 of us in all. I made a flip comment to someone about how women's lib and chivalry couldn't co-exist.

Attending: Chivalry and womens lib had nothing to do with one another
Me: (thinking- whoops, maybe that was a dumb thing to say; turning bright red) Um
Attending: But, I'm interested, Emily, what are your thoughts on chivalry?
Me: Uh, sorry! (bright red)
Attending: I think Emily has something to say to all of us about chivalry. Go ahead Emily, you have the floor..
Me: (wondering if my comment was inappropriate, still bright red) uh
Attending: We all want to hear what you have to say about Chivalry. Emily is a big expert on chivalry (gesturing)

Meanwhile I had about 20 sets of eyes staring at me. Someone else tried to say something

Attending: No, I think we should all see what EMILY has to say.
Me: (not sure where to look, everyone's staring; I had NO IDEA what to say so I decided to talk about some things I'd read pertaining to the attending's area of expertise) Well, I was reading some papers about gastric cancer and uh
Attending: No, we're all interested in your thoughts on women's lib and CHIVALRY. Please tell us all how the two are related...

After what seemed like forever, it ended. I'm still not sure whether my comment was inappropriate and I certainly never meant to annoy the attending.

I'm not sure if that counts as incivility in the learning environment, but it was embarrasing, unpleasant, and I afterwards regarded this particular attending physician with some amount of fear.

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Med Student said...

Some people are pricks. You just need to work on your gamesmanship (first part is never piss off your of course if they are a prick that is easier said then done). Even before getting to med school I've seen and heard of some really nice incidents ... like an NSX throwing a chair across the break room because he was asked where the coffe filters where.

Anonymous said...

its not that the comment was inappropriate - its that you were talking when he was trying to start his presentation