Subcultures in Medicine [long]

[Neonanocyborgasm]

As a medical practitioner, I've become aware of the culture that exists in the community. There is definitely a way in which medical professionals are expected to behave, both among ourselves and among the public. I get a kick out of "civilians" who watch shows like "House", "ER", and "Gray's Anatomy" because they're either gross inaccuracies or obvious truths that everyone's known for years. What I'm going to reveal here is something rarely noted to the public.

Much of medicine is a carefully acted play, designed to demonstrate to laymen that we are infallible. This is to engender trust with the patient, so that he will feel that he is in capable hands. The reality is that doctors are humans, just like everyone else, and they are not without flaw. Be that as it may, a doctor's judgement will tend to be right about 95% of the time.

What is also not necessarily noticed are the myriad of subcultures within medicine. Here I present, for information purposes, the descriptions of those subcultures. This is, naturally, my opinion, but I suspect it falls well within the opinions of others in the profession. This is presented somewhat in jest, so do not take everything I say too seriously.

Surgeons:
When people think of a doctor with a "God Complex", they are usually thinking of surgeons. Surgeons tend to have big egos and will throw their weight around wherever they go, making proclamations and off-color comments that would get anyone else reprimanded. The surgeon's intimacy with the patient's anatomy seems to have a tendency to emphasize their intimate power over them, and this may be where the attitude begins. Their subculture emphasizes this, so that each generation of surgeons learns to feel that they are invulnerable. Some surgical subspecialties are particularly notorious for hubris, such as cardiac and neurosurgery. An old saying is that "a surgeon is just an internist with a good pair of hands." Despite their massive pride and operative skill, surgeons are also infamous for being big on brawn, and not much on brain. Some subspecialties, such as orthopedics, cannot even admit patients to hospitals under their own service, in some centers, for fear that they might mismanage them. They must admit under another service, such as internal medicine, and then follow the patient as consultants.

Internists:
These are typically primary care physicians who non-surgically treat a wide variety of adult ailments. While surgeons are widely regarded as stupid, and the equivalent of the jocks of a high school, internists are believed to be hyperintellectual blowhards who ponder much but do a lot less. There is a kind of friendly rivalry between internists and surgeons. Each blames the other for faults, but secretly realizes one cannot function without the other. The TV show "House" is an exaggerated example of an in-house internist. It demonstrates how an internist must sort out a presentation to determine a diagnosis. It is exaggerated because the diseases are so exotic that no internist could possibly arrive at the diagnoses without subspecialty consultation.

Psychiatrists:
This is one of the least respected branches of medicine. Psychiatrists are often believed to be as eccentric as the patients they treat, and are often regarded as only physicians by virtue of the technicality of a medical school diploma. Their opinions, even when consulted, are rarely respected and carry no weight.

Pediatricians:
Despite their great skill and knowledge base, pediatricians seem to have the most thankless job in medicine. Much of the scorn appears to come from overzealous mothers who believe they know more about their children's health than the doctor. This puts them at a defensive constantly against nagging and recrmination. Pediatricians also seem to be the lowest paid of physicians.

I could go on and on about all of the many subspecialties, such as cardiology, pulmonology, and so on, but that would take up too many pages.

I leave it open for questions.

 

[Marshy]

Surgeons:
When people think of a doctor with a "God Complex", they are usually thinking of surgeons. Surgeons tend to have big egos and will throw their weight around wherever they go, making proclamations and off-color comments that would get anyone else reprimanded. The surgeon's intimacy with the patient's anatomy seems to have a tendency to emphasize their intimate power over them, and this may be where the attitude begins.

Slightly off the point but a few years ago a saw a "fly on the wall" documentary about the State Pathologist in Ireland, Dr. John Harbison. It amazed me how casual he was when performing autopsies. He peppered his commentry with numerous jokes and throwaway remarks and seemed completely unmoved by the sight of the semi mutilated body in front of him. I guess it's the same for surgeons. Familiarity breeds contempt and all that!
To give them some credit perhaps it's a type of defence mechanism?

 

[Sidhe]

Apparently in our hospital, about 2700 staff, all doctors have the lowest sickness absence of any profession in the hospital, this is apparently more of an ego thing bread out of time, sickness show weakness to the pack sort of deal.

Does this happen in the US? I mean I've seen you mention before that Dr's generally have large egos and that all Dr's are like house IIRC, but it does seem somewhat amusing, although I think it can be beneficial to patients to have a highly competitive environment,does it extend everywhere to every aspect of a DR's profession, are you constantly trying to maintain a front of superiority or taking chinks out of other Dr's armour too? Or isn't it that big of a deal.

 

[Eran of Arcadia]

I for one am willing to trust a doctor. If he told me my child had a 95% chance of recovering from a disease and the kid died anyways, I would just accept that I got screwed by statistics; I wouldn't call the doctor incompetent or a liar.

But I think I am in the minority. People for some reason expect doctors to be infallible. I remember reading a letter to Ann Landers or someone where a woman said, "The doctor told me I had 6 months to live! How dare he play God!" Idiot. If I were a doctor I would have a complex too.

 

[Neonanocyborgasm]

Slightly off the point but a few years ago a saw a "fly on the wall" documentary about the State Pathologist in Ireland, Dr. John Harbison. It amazed me how casual he was when performing autopsies. He peppered his commentry with numerous jokes and throwaway remarks and seemed completely unmoved by the sight of the semi mutilated body in front of him. I guess it's the same for surgeons. Familiarity breeds contempt and all that!
To give them some credit perhaps it's a type of defence mechanism?

Familiarity does breed contempt (and children).

This kind of humor is widespread. Every doctor is a "Dr. House" when the patients aren't looking. We'll make all sorts of humorous disparaging remarks about various patients, and their families. It's not so much a defense mechanism as it is a way to cut the tension in the room. If everyone was fixated on the illness, no one could function enough to render care.

An example of one of my typical catch-phrases is:

Me: Has the patient been cured yet?

Nurse: Working on it.

 

[Neonanocyborgasm]

Apparently in our hospital, about 2700 staff, all doctors have the lowest sickness absence of any profession in the hospital, this is apparently more of an ego thing bread out of time, sickness show weakness to the pack sort of deal.

Does this happen in the US? I mean I've seen you mention before that Dr's generally have large egos and that all Dr's are like house IIRC, but it does seem somewhat amusing, although I think it can be beneficial to patients to have a highly competitive environment,does it extend everywhere to every aspect of a DR's profession, are you constantly trying to maintain a front of superiority or taking chinks out of other Dr's armour too? Or isn't it that big of a deal.

There is no such thing as absence for a doctor. The only time in which you don't show up are:
1) personal illness to the point of being hospitalized yourself
2) death in the family

As a doctor, you should know the severity of your illness. If all you have is the sniffles, you know you could function. If people notice you are frequently absent for minor things, they'll think you're a coward.

It's considered contemptible to openly disparage another doctor. Hospitals that have this kind of culture are considered dysfunctional. People tend to be uncomfortable working in that kind of environment. If you dislike working with some doctor, you're supposed to get someone else. Unfortunately, this isn't always possible. In some hospitals, there are systemic problems that prevent it, and political inertia avoids fixing it.

Speaking of dysfunction, I remember working in one hospital where there was a "pass the buck" culture. Everyone was so lazy that it seemed to require more effort to come up with excuses to avoid work, than it did to actually just do the work. Combined with this was an aura of open displays of tireless work, to compensate. As in many situations in life, people can see better than they can feel, and those that appeared to be working a lot were praised, even if they weren't really doing anything. I remember many situations in which people looked at me cockeyed for not having stayed up till dawn to get something done, unlike someone else. People seemed to have come up with the notion that the harder you work, the more you accomplish. Needless to say, this is neither true in life, nor at that hospital. Most of the time, the tasks that were said to be so labor intensive were actually easy.

 

[Neonanocyborgasm]

I for one am willing to trust a doctor. If he told me my child had a 95% chance of recovering from a disease and the kid died anyways, I would just accept that I got screwed by statistics; I wouldn't call the doctor incompetent or a liar.

But I think I am in the minority. People for some reason expect doctors to be infallible. I remember reading a letter to Ann Landers or someone where a woman said, "The doctor told me I had 6 months to live! How dare he play God!" Idiot. If I were a doctor I would have a complex too.

You're not supposed to give a prognosis of time. If a patient is terminally ill, you give an approximation, with ranges of time.

What amuses me are patients who tell me far-fetched stories, such as cancers disappearing without treatment.

 

[Eran of Arcadia]

You're not supposed to give a prognosis of time. If a patient is terminally ill, you give an approximation, with ranges of time.

What amuses me are patients who tell me far-fetched stories, such as cancers disappearing without treatment.

That reminds me of the story Stephen Jay Gould told, published as "The Median Isn't the Message", of when he was diagnosed with some disease (I forget which) and wasn't told how long he should expect. He eventually looked up that the median length was 8 months - not that on average a patient lived only 8 months with the disease, but that half died after 8 months. The rest lived much longer.

Could a cancer, theoretically, disappear without treatment, ever? I ask because I consider "medical miracles" not to be a disease disappearing without reason, or without treatment, but just "beating the odds" or being one of the lucky 5%.

 

[Ayatollah So]

What amuses me are patients who tell me far-fetched stories, such as cancers disappearing without treatment.

I thought some cancers disappear without treatment - which is why AIDS leads to so many skin cancer problems? Doesn't the immune system knock off many cancers? Does it depend on the size of the tumor?

 

[Sidhe]

@Nanocyborgasm: Well my hospital isn't like that as far as I can tell, but the nurses say there is some level of competitiveness with Dr's, I just wondered how deeply it went. Oh I know alot about appearing to be busy in a hospital it's a veritable art form in some cases, it's considered so evil and malicous to be efficient at times that people actually make a meal of their work just to fit it into the time, of course sometimes they are flat out, but hospitals aren't always over worked and so the slacker periods leave people with more time on their hands than they feel comfortable with, me I get the job done and if my boss wants to find me some pointless busy work, so be it if I get the work done in an efficient manner if the s**t hists the fan I'm ready for action, not dithering about stringing out the workload.

 

[Neonanocyborgasm]

That reminds me of the story Stephen Jay Gould told, published as "The Median Isn't the Message", of when he was diagnosed with some disease (I forget which) and wasn't told how long he should expect. He eventually looked up that the median length was 8 months - not that on average a patient lived only 8 months with the disease, but that half died after 8 months. The rest lived much longer.

So, in other words, he never had that disease, right?

Could a cancer, theoretically, disappear without treatment, ever? I ask because I consider "medical miracles" not to be a disease disappearing without reason, or without treatment, but just "beating the odds" or being one of the lucky 5%.

I've heard rumors that there were legitimate reports of diseases having spontaneous remission that were not otherwise thought possible. I've yet to actually see those reports. I suspect that they are indeed just rumors that are repeated so often that they become legends. And once legends become entrentched, they are often given the air of fact. Many patients find it comforting to believe these legends, because it gives them hope beyond what they see as fallible medical care.

 

[Mathilda]

How could you leave gynecologists out of your list?

 

[Neonanocyborgasm]

I thought some cancers disappear without treatment - which is why AIDS leads to so many skin cancer problems? Doesn't the immune system knock off many cancers? Does it depend on the size of the tumor?

You're thinking of immunosurveillance. Some cancers arise due to immunodeficiency states, but this is a minority of cancers. The vast majority of patients who get cancer have normal immune systems.

The skin cancer you're thinking of is Kaposi's Sarcoma. Some patients who experience immune reconstitution upon taking highly effective HIV medication get better immunologically, but the KS still isn't cured.

 

[Neonanocyborgasm]

@Nanocyborgasm: Well my hospital isn't like that as far as I can tell, but the nurses say there is some level of competitiveness with Dr's, I just wondered how deeply it went. Oh I know alot about appearing to be busy in a hospital it's a veritable art form in some cases, it's considered so evil and malicous to be efficient at times that people actually make a meal of their work just to fit it into the time, of course sometimes they are flat out, but hospitals aren't always over worked and so the slacker periods leave people with more time on their hands than they feel comfortable with, me I get the job done and if my boss wants to find me some pointless busy work, so be it if I get the work done in an efficient manner if the s**t hists the fan I'm ready for action, not dithering about stringing out the workload.

You know what, Sidhe, you're a funny guy.

I'm not sure what you mean by competitive. How does one doctor compete against another?

 

[Masquerouge]

2 things:

1. what about men gynaecologists? What goes on in a man's mind when he decides to focus his entire life on women's genitalia?
2. I though anesthaesists were the most depreciated medical profession.

 

[Neonanocyborgasm]

How could you leave gynecologists out of your list?

Easily.

Honestly, I don't have much exposure to them. Your average ob/gyn is an outpatient practitioner. Their patients are only admitted when they're in labor, and then only to labor and delivery, which is away from the rest of the hospital grounds. Ob/gyn patients are usually healthy and therefore there is no interaction with any of the other medical services. L&D, prepartum and postpartum are usually little more than holding areas, in comparison to the rest of the hospital. I can only recall 2 cases in my entire career that involved the care of a patient from that service.

Ob/gyn's are regarded as having busy but cushy lifestyles. As I said, their patients are nearly always healthy, and even when there are complications, they pale in comparison to what other physicians must deal with. They are well paid, because they deliver both inpatient and outpatient services, and because there are always a steady supply of women who require their services, even when they are well. What makes them busy is that they have so many patients, and when a patient is in active (uncomplicated) labor, there is little for them to do other than... wait. I've often noticed that female ob/gyn's are hot.

 

[Neonanocyborgasm]

2 things:

1. what about men gynaecologists? What goes on in a man's mind when he decides to focus his entire life on women's genitalia?

I have no idea. I have even less understanding of why a homosexual man would be interested in ob/gyn (yes, there are those too!). Supposedly, the practice is very uplifting. The patients are rarely ill, and the ending (delivery of a child) is usually happy. I've noticed a lot of these men are very family oriented as well.

2. I though anesthaesists were the most depreciated medical profession.

I don't have a very high opinion of them myself, and the reason is due to the admission of an anesthesiologist. He told me that, "an anaesthesiologist is little more than a very skilled recovery nurse, who occasionally must make some very important decision, which he hopes to god he never has to make." I've noticed this to be largely true. Except for the most exceptionally skilled, anesthesiologists are content to render anesthesia and just sit back and relax. They are very flustered when something unexpected goes awry, and can't seem to handle themselves under pressure. The only thing that impresses me about them is their skill at certain procedures, such as epidural catheterization, endotracheal intubation, and so on. Anesthesiologists are slowly being replaced by nurse anesthetists, who can do most of the same things that they can.

 

[Eran of Arcadia]

So, in other words, he never had that disease, right?

No, he had it. What I mean is that half of all patients with the disease die within 8 months, but the other half live much longer. However, the average person would think that they had an average of 8 months to live, which wasn't true. And he realized that he was in the group most likely to live - young, otherwise healthy, and optimistic. This is what he wrote about it.