Beware the Dog Skinners

Remember when you were young and your parents did everything for you?  If you do then you remember when you became independent, when it became annoying as they tried to parent you, you felt grown up.  That's what I'm dealing with more and more now.  When I work with other general pediatricians, I find more and more a growing sense of independence.  More and more I want to get out on my own.  The majority of the time I'm accepted as a peer, especially with the doctors that I have worked with for 3 years, who know and respect that I do good work.  Occasionally, though, I have the displeasure to work with a general pediatrics attending who is substandard, one you find yourself disagreeing with on a regular basis.  You'll find that despite your medical knowledge, despite your knowledge that you are right and they are wrong (I always look it up before assuming), that their experience and their "role" will trump your "role".  Doctors have power and attendings much more so than residents.  If you are smart, you stay political, you stay polite, and you stay quiet, until you are out from under their sphere of influence.  It sounds spineless, but the people I've seen who went the other way always regretted it.  I've seen them given bad evaluations and I've even seen them fired.  It's harder to do than you would think as these doctors are often sooo bad and sooo full of themselves (I find one goes with the other often).

I recently came under the tutelage of a general pediatrics practicioner from the community, 1 day a week.  In 1 month that I've been privey to his ignorance, I've watched this doctor read tests wrong and treat patients inappropriately for it, I've sat by and had him berrate me for giving a correct and evidence based diagnosis (in front of the patient no less), and what drives me crazy is his inability to explain his reasoning when he disagrees with me, which is often.  This guy for whatever reason is fairly skilled in heart murmurs, which I do try and pick his brain on, but I'm having trouble staying with him for that reason only, as the only other thing he shows me consistently is what not to do. My plan is fairly mild in reaction to this, I'm switching to a better clinic where I know there is alot to learn.  I will politely excuse myself from working with him and thank him for his "education", and I might annonymously report him so that other future residents will steer clear of his bad habits/malpractice.  In the time I have seen him I can say that he is not dangerous or I would be obligated to a greater reaction, but he is also not very good.  Seriously, I see this guy for 1 half day a week and when I go home I'm so mad I can't sleep at night. 

In medicine, there are often many ways to skin a cat, many ways to go about solving a medical problem.  If you are halfway worth your salt, it's not hard to spot the wackadoo's who on regular occasion skin dogs.

The Check List

I'm filling out a mountain of paperwork for credentialling in the state where I will work once I graduate residency.  It's all about what I've done, who I've been for the last 11 years of my life.  When I review the documents it's like a detailed account of a very long journey or mountain I've climbed.  Next to my years in medical school it simply says the words, "completed"...not even capitalized.  It doesn't talk about the swings in my life that have happened because of it all.  It doesn't talk about who I've become or what I was, other than I was able to jump through said "hoop".  All of the things that I struggled with, triumphed over, failed at, and worked so hard for seems so perfunctory when I look at this list, like it was just expected to occur, in the moment that certainty is so much harder to find.  When you watch someone "clutch" intubate someone while they are crashing, you don't see that skill as a check box...yet one day if you were to take my path, you'll find yourself checking it off.  This job can be so duplicitous.

Newbie Doc

Moving Mountains

As doctors we get divorced of the human element sometimes, that's the only way we get by is to see the person as a disease instead of a person.  We make a lot of sick dark jokes about it, really what are we supposed to do, cry all the time?  Instead we dehumanize the situation, maybe we dehumanize ourselves a bit too. 

The scary times are when it's someone you know, when you can't step away, when it's still there at the end of the day. It's a sense of dread I don't think I've experienced in medicine before, when the lines between your dearest loved ones blur with the patients you've treated, when you hear them speak in echoes of patients passed.  

So far, it seems like I can always come up with a fix, some new option to try.  But I know the odds are stacked against me, someone I love is going to be in trouble and I'll be powerless to help them.  I wonder if other doctors constantly feel inadequate when faced against what we are faced with.  If they too constantly wish they were smarter, better, more impervious.  

It's like society has pulled regular men and women off the street, dressed them in a superman costume and said, "Ok, now go save everybody." The "suit" and everyone's belief that we, the doctors, will be able to help is just enough that we are crazy enough to try.  In fact, we succeed just enough to keep us pushing, but it's never enough.  Suddenly you realize your nearly 30 years old and standing in front of everyone wearing a superhero outfit, pushing against a mountain which you ridiculously expect will move.

Maybe if I can just move it one inch...one centimeter...come on damn it, I'm so close!

Newbie Doc