Thursday, March 1, 2012


Dear Nurse,

I am grateful for you. When the first thing out of your mouth on my first day of a rotation is "We like Chocolate" I laugh. You know how to bring a smile to my face on day one. See, you aren't unique. You are a pattern that is as predictable as a Hollywood marriage. When you say that statement, I know the following truths to be true:

1. When you saw WE you really mean YOU like chocolate

2a. Whenever I see you after day 1 you will say "Hey, where is the Chocolate?"
2b. You will most likely add in some threat, wielding your pseudo-power on my grade. Like you can make or break my evaluation.

3. When the pattern is clear that I will not be bringing you anything, you will make a snide remark about my intelligence and how I don't "get it."

See, I understand. Med students also happen to be quite predictable. This kind of crap may have worked for the other students walking through the door, you know, the merit you think you gain by demanding chocolate from the student on the first day. You have been able to convince students that bringing you chocolate is going to somehow make us better physicians and perhaps even get us a better grade which could ultimately get us into the residency we always wanted. So if the poor souls who end up not matching to a residency had only brought chocolate to the demanding nurse, they would have matched? Spread the word! Well, I am kind in some ways. I want to help you out. Here are some truths from my view:

1. Just because you like something doesn't mean saying it out loud will get you anywhere. This isn't facebook, I don't care if you like this photo, this comment, my location, who I am hanging out with, that I just got done at the dentist, that it's time for GTL, and I definitely don't care if you like chocolate.

2. The best way to get something at the end of a student's rotation is to be nice. Introduce yourself to me. Help me navigate the new work environment. Let me in on the unknown rules (Dr. X likes students to do Y or Never do this in front of Dr. X, he hates it). Always have my back. If I am doing something wrong, correct me quietly. If I should be doing something, correct me quietly. If I keep coming to you with questions or asking for help, it isn't because I am stupid, it is because I trust that you have my back and are watching out for me. And most importantly, it is probably because you are always sweet to me. You may know where object A gets placed because you have worked here 10 years, but I understand that if I put object A in the wrong place, it will make your job harder, so I ask, not out of stupidity, but out of respect. That respect should be mutual. By demanding something day one, you automatically lose that respect. Some respect is earned and some comes with the territory, but that territorial respect is easily lost.

3. Saying that I don't "get it" makes me laugh. It doesn't scare me because I know it is coming. When that comment comes...out a room full of people, the dialogue always goes something like this:

You: "Where is my chocolate? You must not get how things work around here. You don't get it, do you?"
Me: "Oh, no. I get it. Loud and clear. You like chocolate and you want me to bring you some."
You: "The last student got it. He brought me chocolate."
Me: "Must have been a third-year. They typically fall for the 'get me chocolate or get an F' gag."

I created a nice flow sheet for you below. Feel free to use it as a tool to help you discern which route to take. Glad we could have this talk. Good luck.

Tuesday, January 10, 2012

A thought

Over the course of the past few years of school I have thought hard and tried to be as honest and non-biased as I can while I wade through the mess and waste that is health care in the U.S.. There have been times where I ask myself a question and try to figure out the why/how of it as it pertains to health care. I think over time medical students see and hear a lot of things and begin to shape their view of humanity based on people who are sick. It may not look fair on the outside, but I don't know of a better way to see people for who they really are. The "right to healthcare" debate is always on the table and there are a lot of people who SEEM to deserve and need it and above all else, APPRECIATE it. But in my experience more who don't.

As a physician you sometimes know more about someone than anyone else and you see them with their guards down. It can go both ways though and isn't always negative. For example, I have seen "gangbangers" teardrop tattoo and all, crying because they are in pain. They may want to cut my throat on the streets but in the hospital they are just as needy as the next person. In fact, one of the most humbling things I have had to do was wipe the butt of a 50 year old prisoner with gang tattoos who had lost control of his bowel and bladder. Twice. He turned out to be one of the most appreciative patients I have ever had and would be so grateful anyone came to see how he was doing.

You see people at their worst in the hospital. People in denial, people who have put things off for too long because of one reason or another, people who find out their 4 year old child has a brain tumor, people who find out they will die...soon. People who have no option but to let down the wall they have had for so long in order to ask for help. It can be very interesting at times. But it always gets me thinking. Here is one thought that has been heavy on my mind at times.

Why do we not take better care of the resources we give away?

As a society we have chosen to provide health care through medicaid and medicare and through our emergency rooms. Right or wrong, we are doing it. Why aren't there stipulations to free things? For instance shouldn't we say "We are giving you this resource for free, but in order to make sure it is used for its intended purpose to the best of its capabilities, you can't smoke, do drugs, commit a crime or have more children than you can afford which is zero due to the fact that you are needing this resource"? And before you start with the "freedom to have children" argument, watch a meth addicted newborn go into withdrawals only to die a few days later. Or listen to someone have to choose between medicine for their baby or food or electricity.

I think the notion is that these resources are permanent cures. Is that what they are intended for? It isn't a green-eyed-blue-eyed situation, it is a fat-skinny situation meaning being the recipient of some free government resource doesn't have to be long-term. But have we created a system and mindset that makes it long-term? If medicaid weren't looked at as a long-term solution, it wouldn't be a "can't have babies" argument, it would be "can't have babies right now" argument. Can we as a society do a better job of "helping" those in need? Should there be some form of reciprocity instead of just a one-way freebie? Always open to thoughts and comments as I am no 'expert' unless I fool you into thinking I am.