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In Defense Of Doctors: Why We Act Like Jerks, And How To Handle Us When We Do

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A Typical Jerk, M.D.

Editor’s Note: This post is meant to be tongue-in-cheek. We sincerely hope that our colleagues are not offended by the use of the term “jerk” to describe physician behavior. If you are a jerk, please feel free to leave a nasty complaint in the comment section of this post. Thank you!

Physicians have a reputation for being, to put it bluntly, jerks. It took me a long time to accept the fact that we are (on average) a disagreeable bunch, and my years of denying that there is a problem has finally given way to acceptance and even some degree of tolerance of “assholitry.” Few of us doctors think that we’re the one with the attitude problem, but I’m afraid that even the sweetest pediatrician can show some mighty claws when backed into a corner.

I didn’t think that I was a jerk until a few days ago when a surgeon made a medical error in the care of my loved one. I won’t go into details here, but let’s just say that evisceration was on the menu. My family member overheard one of the conversations and commented timidly, “I think you’ve probably just successfully alienated yourself from the entire medical community at Hospital X.” Yes, I was a total fire-breathing monster.

But this got me thinking – maybe if I explained all the reasons why doctors have bad attitudes, there would be a little more grace shown to us? Maybe our patients would be less offended and more understanding of our dispositions? I suspect that most people feel that there is “no excuse for rudeness” but I’ll offer a few nonetheless and see if I can’t change your mind. Here are the primary reasons that doctors are jerks:

1. We are afraid.

Being responsible for sick peoples’ lives is a scary thing. There are so many variables outside our control, and yet we believe that we must control the outcomes at all costs. It’s as if doctors somehow absorb the false belief that we can cheat death, and so when our patients don’t experience the optimal outcome from our every action and decision, we engage in some serious self-flagellation or (for those who possess a higher jerk index) we kick the proverbial dog (i.e. you).

Fear of inadvertent medical errors is a real butt-clencher for many doctors, and as science provides us with more insight into disease management we must be ready to do things differently, and to relearn everything we were taught. Keeping abreast of all these changes is very hard work, as there are over 6000 new research studies published world-wide each day. Our fear of failing to know everything we “should” causes many of us to hide behind a veil of toughness. Arrogance is often just a cover for vulnerability, and with so much information that we’re expected to digest, we are at risk for making a bad decision if we aren’t up to date. And when a doctor makes an error, he or she can pay a high penalty, including public humiliation by her peers, loss of her medical license, livelihood, the pain and suffering of legal action, and even confiscation of personal assets and savings.

And then there’s the daily fear of “fire-breathing monsters” like me. At any turn, irate family members, colleagues, hospital administrators, and staff can swoop in and criticize your best efforts.

2. We are hen-pecked.

A Physician With Three Hospital Administrators

The constant juxtaposition of trivial and critical can make doctors seem dismissive and arrogant. This is a subtle point, but one that is really important to understand a physician’s mental state. Imagine that you’re tending to a dying man with a gunshot wound to the chest, and a hospital administrator taps you on the shoulder to ask if you could fill out a form about insurance coding. You would view that request as particularly annoying given the context in which it occurred, right?

This may be an extreme example, but similar scenarios play out in our work days constantly. We are frequently interrupted (in the midst of very grave conversations, for example) with requests for approval of Tylenol orders, coding clarifications for duplicate insurance documents, or updates of no apparent consequence (such as, “Dr. Jones, I just wanted you to know that Mrs. Smith did receive your Tylenol order.”)

The very act of doctoring can make us feel as if we’re undergoing harassment by the hopelessly inane, punctuated by terrifying bouts of near-death scenarios accompanied by the usual fire-breathing monsters. If that job doesn’t turn you into a jerk, then… you probably are a robot.

3. We are exhausted.

Sleep deprivation is a well-known form of torture used by interrogators to extract information from “evil-doers.” It is also used by residency programs to keep whining residents from having the energy to complain effectively or to organize their efforts against their torturers. Then once these doctors-in-training accept chronic sleep deprivation as the new-normal, they carry an expectation of it throughout the rest of their careers. Of course, sleep-deprived people are more likely to be irritable, short-tempered, impulsive, grandiose, and hostile – aka jerks.

4. We were probably jerks to begin with.

Getting into medical school is extremely competitive. Only the very top students make it, and they are generally ranked according to science test scores (not compassion scores or charming personality scores). Successful pre-meds are generally type A personalities with a fierce competitive nature. And what kind of person would sign up for a career where they are harassed, blamed, required to do endless paperwork of indeterminate usefulness, denied regular sleep, and endure hostility from staff, coworkers, family members, and error-prone colleagues? A person with a pretty thick skin and a high tolerance for sadism and/or masochism… also known as a jerk. So, for the few doctors who don’t enter medical school as fully formed jerks already (let’s say they didn’t realize what they were getting into), the work they do will thicken their skin eventually, creating jerk-like personality traits in the end.

A High Jerk Index Surgeon

Is there a jerk scale in medicine? Who are the biggest jerks? Yes, all doctors exist somewhere on the jerk continuum, and you can roughly guess where they’ll be depending upon how likely that an encounter with them will end in your demise. Trauma surgeons, cardio-thoracic surgeons, and neurosurgeons have the strongest jerk traits, while pediatricians, physiatrists, and family physicians are probably on the other end of that scale. There are some exceptions, of course, but actually not many.

What can you do to make the best of having to work with a jerk? At some point, you or a loved one will need medical care (no one gets out of this life alive) so you will probably have to deal with some serious jerks along the way. Knowing that this is in your future, you should probably start planning how you will handle this now. I offer you my do’s and don’ts of jerk management, or how best to ally with your physician:

Don’t:

1. Bring your doctor more trivia. Jerks have a low tolerance for irrelevant details, largely because they are tortured by it daily (such as pages of EMR-generated duplicates of physical exam findings from interns). Think about what you really want to talk about with your doctor and don’t get side tracked with your own personal “hot flash tracker” data or other tangential story that is unrelated to your current problem.

2. Threaten your doctor with legal action or allusions to your “friend the lawyer.” The jerk you’re talking to is already frightened enough about frivolous law suits. If you tap into that fear he or she will just go into self-protection mode and probably harm you with excessive and unnecessary tests, consults, and referrals. Or even worse, maybe they’ll hide information from you.

3. Attack your doctor’s judgment directly. This is a tricky one because your doctor won’t always make the best clinical decision in your case, and you have the right to point that out. The best strategy for getting your way (assuming that you’ve found a true error) is to be friendly about it. Use the Socratic method if you can so that they’ll think they discovered the mistake themselves.

4. Fight fire with fire. You would think that you could get some respect from a jerk by being just as nasty to them as they are to you – and that strategy may work with playground bullies – but unfortunately that rarely helps in medical culture. More likely the physician will become quiet and simply resolve to stonewall you and be extra unhelpful in processing your care needs. You don’t need that.

Do:

1. Be prepared for your visit. Bring a list of your medications, relevant medical history and test results. Write down your questions in advance. Anticipate the questions that your doctor will ask you (if you can) and be ready with focused answers. You will look like a super-star and your doctor will be indebted to you.

2. Be understanding of our lateness. I know it drives you crazy and you feel disrespected by your doctor. But know that lateness can be caused by many things, including ill-prepared patients, really sick people, emergency surgery and golf games. If your doctor is a major jerk and the cause of his/her lateness is golf-related, then at least YOU will feel better if you presume he/she was delayed by a real emergency.

3. Be a “compliant” patient. Once you and your doctor decide upon a care or treatment plan that is right for you, try to stick with it. It’s in your best interest to do so and your doctor will love you for it. Sure, if he’s a big jerk he’ll only love you because your good outcomes make his performance measures (and payment structure) increase, but if he has a conscience he’ll also be genuinely pleased that you’re well.

4. Find another doctor if you need to. Although this isn’t always an option for folks in rural areas, if your doctor is impossible to work with, then you should find someone else to take care of you. Be very polite, get copies of all your medical records, and then take them elsewhere. Don’t be stoic and stick with a total jerk if your care is being compromised by his or her attitude and behavior.

So there you have it. When you have your next unsatisfactory encounter with me or one of my colleagues, please consider that there are some good reasons for our irritability. But being a jerk isn’t always a bad thing, because if your loved one needs a medical champion, then a fire-breathing monster is probably an excellent advocate. You can harness a monster for your purposes if you follow the do’s and don’ts of physician relationship management. I wish you luck with your future encounters with us!

The Primal Games: My Life Outside The Comfort Zone

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This weekend I accidentally stepped way outside my comfort zone. A friend of mine had invited me to compete in the Primal Games – an event that she described as a “fun time for all fitness levels with some guys dressed up as cave men.” Sounded innocent enough. And it appealed to my sense of whimsy, so I signed up without a second thought. A couple of weeks prior to the event I decided to do a little more research and discovered that this competition *might* be a bit more challenging than I had originally thought. The event website was somewhat vague, but alluded to things like “Atlas balls,” climbing over walls, obstacle trail run, military crawls, and medicine ball tosses. Hmmm. I’d never attempted to scale a wall in my life, nor was I too thrilled about the idea of hoisting around beach-ball-sized cement objects. I was getting nervous.

I soon discovered that my nervousness was more than well-founded. As I arrived at the event, the temperature was rising above 90 degrees Fahrenheit as I was greeted by shirtless male competitors (see photo above). Apparently, almost everyone at the Primal Games was on a team of some sort already, and many had prepared for the event for over a year (mostly at CrossFit gyms). As I gingerly approached the registration tent a well-muscled woman wrote a number in permanent marker on my arm and calf. I was branded and there was no turning back, so I decided to spend some time watching the other athletes warm up. I was astonished by some of their capabilities.

Take this guy for example (photo at left). He was able to hurdle the “women’s wall” that I struggled to scale and climb over. I stood there, staring aghast at the fellow like some kind of animal in headlights. I realized that I belonged on the sidelines as a spectator, not a competitor – but alas, I was in it for the duration.

The women at the event were only slightly less intimidating. Some looked like Olympic weight lifters, others were lean, mean, muscle machines. Very few were as old as I was. My fantasies of a day tossing water balloons back and forth with people in spandex and super-hero capes were fading fast.

And so the games began – three individual events arranged in heats, requiring a whole lot of “hurry up and wait.” My first challenge was a 1.5 mile trail run with obstacles. The distance seemed fairly innocuous so I took off at full tilt when they blew the air horn for my group. About a half-mile in I began passing members of the group that started ahead of mine. I wondered if I had misjudged my pace, but figured I’d deal with that later. I navigated jumping over some hay bales (no problem for a former dairy farmer), threw myself into the Army low-crawl and bolted across a boardwalk to come into the finishing stretch. And that is when I hit the wall. Literally.

I had never scaled a wall in my life and apparently there’s some technique to it. I ran up to the 6-foot obstacle, jumped up and grabbed the ledge and then hung there like some kind of limp towel. Nope, that was definitely not the right way to do it. Race officials tried to explain more successful strategies to me as I failed to scale the wall in a second embarrassing attempt. I opted for the penalty Burpees and crawled under the wall… only to face the next, slightly shorter wall. There was no way around it this time – I had to do it. A miss was a disqualification on the shorter wall.

Panting, sweating, and wearing all black in the midday sun, I somehow muscled my way over the short wall in the least elegant way known. I jogged ahead to the water slide, took a hard dive onto my chest and bolted to the finish line with no energy to spare. That performance was good enough for an 11th place finish in my age group (the “Masters women” – which hardly seemed a fair category title considering my lack of mastery of this challenge!)

The second event appeared deceptively straight forward. I had three minutes to launch 6 medicine balls backwards over a wall. But for every 7 feet closer to the wall you got, you had to do increasing numbers of penalty Burpees. I figured I’d be pretty good at this since I’m built more like a water buffalo than a gazelle, but no dice. This event was 70% technique, and figuring out how to get the ball to make the correct-shaped arc (so it cleared the wall) had a steep learning curve. Even the strongest-looking women often missed the wall because their ball ended up going straight up and down instead of backwards. I opted to get as close to the wall as possible and just “gut out” the high reps of Burpees.

I was relieved to see a familiar face in the crowd as I approached my med ball toss challenge. The owner of my home gym had arrived, video phone in hand, to memorialize my event. She was my only fan, and asked if I’d mind if she yelled out encouragements during my event. I agreed hesitantly, both nervous about the permanency of the video that was being made of my potential “flailings” and unsure if her shouts would induce panic or perseverance. Luckily for me it turned out to be the latter. And here’s the video to prove it:

The final event was a true soul-sucker. I watched some of the men compete, and they made it look easy. It was a combination of cement (aka Atlas) ball carries (up and down a field) and tire rope pulls. Again, as a “water buffalo” I figured I’d have an advantage on this one, but here is where I crumbled. As they started the timer, I ran out to the end of the tire pull rope and started dragging it towards myself, hand-over-hand. The weight of the tractor tire was startling, and it moved at about 1/5 the speed of the men’s pulls as I realized that this event was MUCH harder than it looked. I finally got the tire across the line and had to drag it back to the start. I was the slowest in my heat and could tell this wasn’t going to go well.

And then the race official pointed to the Atlas ball that I needed to pick up and put on my shoulder. I had never even touched one before. I squatted down, got my arms under it and used my quads to get it on my lap. The weight (75lbs) took my breath away. I knew there was no way I was going to be able to get this thing up and down the field and I lost heart. Somehow I managed to muscle it up to my shoulder, where it perched on my clavicle ominously. I started taking steps across the field. The weight was crushing. I marveled at the women in lanes next to me who were managing to make it down the field. Time stood still in the 95 degree heat with no shade and no relief anywhere in site.

By some miracle I got that ball all the way up and back, and made it through the next tire pull. Then back to the start again where the official instructed me to pick up the same Atlas ball and do a second lap. I felt the will drain out of my body. There was just no way I could do it. I struggled to get it on my shoulder again and made it on my third attempt but then got about 20 feet down the field and dropped the ball. I tried to get it up again but couldn’t. I tried to carry it like a baby in front of me but it broke through my arm hold. I asked the official if I could take a penalty and get a lighter ball. Nope. That was not an option. So I spent the last few minutes in a futile effort to move the ball down the field and then finally the merciful timer signaled the end of the heat. I was the only woman who couldn’t get the ball back the second time.

And it was at that point that the infamous words of Dirty Harry Callahan came to me, “A man’s gotta know his limitations.” I had certainly found mine, and the humble pie was bitter-sweet. On the one hand, I was pretty amazed that I had not given up and gone home at any of several understandable points during the day. On the other, I was keenly aware of my physical limitations – and had to bow the knee to the truly gifted athletes who won the day. Would I do this again? Hmmm. Ask me once my cuts and bruises are healed. All I can say is that other competitions seem less frightening now, and maybe that’s the best gift that the Primal Games has given me.

In the future when I’m asked to join friends for a half-marathon or similarly grueling event, all I need to ask is, “does it include Atlas balls?” And if the answer is, “no” then I’m in! Thanks to the Primal Games my comfort zone has permanently expanded. I hope you’ll join me in the zone sometime, my friends! Misery loves company, after all. 😉

P.S. The team winners of the Primal Games:

Why Do Mosquitoes Bite You More Than Others?

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Are you one of those people who’s been singled out for constant attack by mosquitoes? Ever felt like the designated bug decoy at a party? It does seem that those pesky biting insects have a preference for certain individuals, so the real question is: why you?

I wish there were a simple answer, but scientists have only isolated a few potential causes. It is likely that the full story remains to be elucidated – and may be related to small genetic variations in human odor. However, we do know that mosquitoes are attracted to carbon dioxide (that we expel as we breathe), and warmer skin temperatures. So I guess if you’re a heavy-breathing, hot-blooded person then you might need an extra layer of DEET? Or maybe hold your breath and wear a scuba suit when you’re in the presence of mosquitoes? Just kidding.

Interestingly, one small study notes that mosquitoes are more likely to land on people who are drinking beer. Since alcohol tends to cause vasodilation of blood vessels, the enhanced skin warmth could be a mosquito attractant. Others have postulated that tipsy people are slower at swatting off mosquitoes and are therefore more likely to be bitten.

My personal suspicion is that some of us react to mosquito proteins (injected when they bite us) more robustly than others. That means that while a mosquito’s bite may leave only a tiny, fleeting mark on one person, another might develop a large red hive that itches intensely. So if your immune system is hyper-reactive to mosquito proteins, you’re likely to suffer more from each bite that you receive. That alone could make you feel as if you’re being singled out by the nasty insects, when the reality is that others are being bitten just as frequently.

I guess the take home message here is that insect-repellent is still the best defense against mosquito bites, although some might argue that keeping a heavy-breathing, sweaty, beer-drinking guy nearby might provide an alternative decoy?

Enjoy your summer – and don’t scratch yourself to death!

Check-In Kiosks At Your Physician’s Office: It’s All About Efficiency

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The airline industry was a lot like physician practices several years ago.  Costs were  rising all around them while stagnant revenue caused declining margins.   Well, this is America, not North Korea.   How did the airline industry survive and thrive (except for American Airlines)?

  1. Efficiency
  2. Add on revenue opportunities

Physician offices are just now catching on.  What can doctors learn from the airline industry?  Here’s picture proof of efficiency in action.

Text from Sister Happy: Here’s how I just checked in at my orthopedists…it’s all by kiosk now.  Have to say…they were faster and nicer than many receptionists.  Only problem is… Read more »

*This blog post was originally published at The Happy Hospitalist*

The Reality Of Being A Doctor

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Lest the students out there get disillusioned, it is probably a good idea to be upfront about the reality of being a doctor:


Maybe it’s not always this bad, but in the ER there is a real ring of truth to this.

From the marvelous Saturday Morning Breakfast Cereal

*This blog post was originally published at Movin' Meat*

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