Screw it

I’m just so tired of having to be persistently pleasant while at work, in the grocery store, on email. If I’m not, I’m seen as a bitch. Other (read male) physicians are allowed to be as moody, rude, blunt, cruel as they want to be. If I’m not smiling constantly and holding peoples’ hands I’m the bitchy doctor. 

Screw this. Screw gossipy nurses who still treat me like I’m not a physician. Screw the backwoods attitude that men are held to a lower standard and that women are supposed to be soft, pink, and fluffy 24/7. Screw “business feminists” who write crappy leadership literature that perpetuates these ideals. Screw jackass patients that don’t like hearing the truth. Screw the parts of my professional life that are unprofessional and make me lose my temper. 

Fluids are Magical

Everybody feels better after fluids. When I'm working ER I call them my fairy dust. Everyone who looks bad gets 'em. 

Kid who is pale and crying and sleepy? Enough Advil that she can latch and get all the breast milk needed to get her up and dancing. 

Lightheaded and falling down? Litre of saline and his blood pressure is stabilized and he's ready to go home. 

Head splitting in half, vomiting, pneumonia, and fever of almost 40'? 2 litres, some metoclopramide and she's ready to go home with antibiotics. 

And yet, I'm just starting to drink something myself 13 hours into my shift.

Soft skills

I’ve become part of the medical culture that minimizes the “soft skills”. Before the brainwashing cult of medical school, I almost worshipped those soft skills. The culture I’m embedded in has made me loathe much of what makes me a good doctor. In general, the men I’ve been working with have little respect for the areas I excel in - palliative, psychiatry, geriatrics, and pain management. They think that patient centred methods are not something any physician should aspire to.

 This has rubbed off on me. Now I think that the areas that I am strong in are not worthy of being considered real medicine. It’s something I’ve been struggling with since clerkship. On all my evaluations, I was lauded for excellent communication and advocacy skills. I never took these seriously because the hidden curriculum taught me that my soft skills aren’t real medicine. I wished that someone would say that my cardiology skills were amazing, or that my physical exam skills are exemplary.

 If these skills are so soft then why do so many physicians have a hard time with them? Maybe there needs to be another name for them. Making a list of possible alternatives, I think about collaboration, organizational, conversational skills, but I imagine these as also being diminished as being too “pink” to be considered real medicine. Could try something like supratentorial skills but given how frequently we use that as code for somatization, that also wouldn’t be treated seriously. Even people skills are “pink” - something we expect those who work in retail to have to learn by watching videos in a break room.

 These “soft skills” are not gained that easily though. Yes, we can learn them through videos and work, but the best of them are learned by experience. By watching what our mentors do well and emulate the people skills they display. We learn them through collaborating with our allied providers and seeing how they advocate for patients. There are no textbooks to show us how to be the best at advocating, listening, collaborating, communicating, organizing, and generally being patient centred. We need to shed tears, sweat, blood, to get to that point.

 These skills are not obvious and difficult to describe, maybe the opposite of concrete skills? Abstract skills? That might work.

 But then again, what is so wrong with calling them soft skills? As long as we start to acknowledge the efforts made to learn them. There shouldn’t be anything wrong with the pink skills that are associated within the soft skills. All physicians should strive to be the best doctors they can. That means practicing their concrete skills, (clinical skills, rote learning, anatomy) as well as their abstract or soft skills. To be a fantastic doctor, one shouldn’t have to hire another MD to provide bedside manner. We should expect it of each other to want to be a complete physician who is able to provide all a patient needs from their specialist or primary care provider.

 If female providers are better at the abstract skills, we should be congratulating them rather than acting like they have done something wrong. I’ve been told several times that I care too much, that I am too passionate. This is ridiculous.

 I want a doctor who is passionate about their job. I want a doctor who cares. No, I don’t want my doc taking their work home with them, spending their night going through all the coulda’ woulda’ shoulda’s. They shouldn’t cross boundaries to make my experience better. But, that doesn’t mean that they shouldn’t cry when they feel like, argue with specialists who refuse to take my care, give 100% during office hours.

 If you think my passion and caring is the problem, I think it’s safe to say that you are the problem. The concrete thinking physicians with a limited view of medicine should really just get the hell out of the way of the physicians who flex both soft and hard skills and are kicking ass. Those are the physicians who are asking the questions in research, are pushing the boundaries of what we are able to do to make our patients’ lives better. We need to repair our culture to catch up with what patients expect from their physicians, and what we expect from our colleagues. The concrete thinking docs need to be called out for being the dinosaurs that they are.

How could I be mad?

When at the end of my 24 hour shift my patient’s epigastric pain changed to a STEMI? As I explained to him and his wife what was going on and how dire the situation was given his prostate cancer? As I told them the high risk of bleeding to death on our way to the city to see the cardiologist? As he kept sneaking his thumb over to touch my hand that was on his leg while I talked to him? Tough old coot was scared at the odds I gave him, worried about his wife, worried about his chest pain, worried. 

These are patients who are used to the doctor just telling them what to do. I won’t do that. I’ll present the options as I see them, and likely bias the discussion one way or the other, but I ask them to make the decision. Sometimes the decision is to let me decide, then I check if they are relieved or distressed with that decision and adjust accordingly. Not by the book med school ethics, but patient centred. Luckily my patient’s wife was able to decide for all of us. 

I’m worried too. I hate sending my patients to the city with another doc but I’m not safe to still be caring for him. Very happy I kept doing serial ECGs though and trust my gut when I think something is wrong. 

Sexism in Clerkship

I’m going to point out that frequently during your clerkship, you will experience sexism. Sometimes these moments will be not too bad, a patient thinking you’re a nurse (are you kidding? I wish I knew that much in clerkship!)

Most times, it will be subtle. It will be everyone ignoring the suggestions made by the female clerk. It will be judging her outfit or flirting with anyone. It will be interrupting her, presenting her ideas as their own. It happens. It becomes common. Everyone will act like this is just how it is. Your job, male or female, is to make sure this is no longer common. Your job is to make sure that clerk feels supported. This is your team, you all need to be strong.

Here’s how to do it without waving a flag and making everyone on the team afraid of you.

When she is interrupted or ignored, wait until the interrupter is finished speaking, then say “I think that Meredith was making a good point, did everyone get to hear it?” When derogatory comments are made, ignore them and change the topic to whichever patient was being discussed prior to the comment. If someone is presenting Meredith’s ideas as their own, be subtle, this one is tricky. Something along the lines of “It’s a great idea, I thought as much when Meredith said it this morning at rounds. Maybe you two should work on it together!”

Everyone on your clerkship team deserves to feel supported. Everyone deserves to be able to show what they know and learn. When your colleagues thrive they bring you with them.

Be the colleague you want to have.

Not gone. Dead.

I love when I’m working emerg and my next patient is someone I already know. It makes it so easy to get to the bottom of what’s happening and get them feeling better.

Unless they come in VSA. Then it just sucks.

Especially when they are young and their kids aren’t ready to be an orphan in high school.

Especially when they’re your own patient.

Especially when the family thinks, because of a diagnosis you magically pulled out of your ass that you walk on water.

Especially when no matter how many of the Hs you cross off the PEA list, he just doesn’t come back. His pulse never returns. He doesn’t have another joke, or jab, or hug. He’s just purple and bloaty and looking nothing like you’re guy anymore. His brain stem hasn’t caught up to his heart and doesn’t realize he is dead so keeps telling his lungs to breath horrific, agonal breathes and you have to explain to his children that he is dead.

Not gone. Not done. Dead. Without those words his kids can’t move on.

But they need answers. Why? How? What did I do wrong?? Who can I blame? Maybe I didn’t love him enough? I just want to hide and cry. Because I have the same questions and no answers.

It’s an honour to say that I fought valiantly to save his life. But would be a greater honour to say I had actually won.

My current patronus is Lewis Black

I am furious. So angry. Yelling at people angry. I never yell at people.

The group of middle aged men I work with has described my work as less than medicine. They are suggesting that as someone who practices patient centred medicine, I am not a real doctor.

I work my ass off all day every day, and their interpretation of my work is that a middle aged man could easy double the patients seen just by not being nice.

Protecting these men’s reputation is more important than caring for patients. Slagging patients is ok as long as I don’t question a man’s clinical judgement. As of Hallowe'en I am done here. Until then I will try to avoid hurting anyone. And destroying my reputation.