Defense Mechanisms

Part of my Sunday tradition involves reading Postsecret.  Having just gone over defense mechanisms yesterday while studying for psych, I realize that a lot of the secrets are perfect examples...(some are more of a stretch of course)

Denial

You're just a DEA number

Yesterday I found myself sitting in group therapy for addicts- no, not what you're thinking- as part of my psych rotation.

No one had given me a heads-up about what I would be doing, and the first few minutes were a blur.  I was snapped out of it by an older gentleman pointing his finger at my face (I soon figured out he was moderating the group).

"YOU.  Tell us WHY WE SHOULD LET YOU STAY HERE. IN 10 SECONDS."

I'm still not sure what I said, but I know I stuttered through my name like 5 times, and that I was a student.  I wasn't really nervous, so to speak, I just had no idea what was going on and what was about to happen.  Was I going to have to get up and sing and dance next?

The others obviously understood my embarrassment and they all voted to let me stay.  (Otherwise I may have had to sit outside the classroom for three hours.)

Experiences like this are an untapped resource in the battle against the lack of empathy in medical students.  I walked into an AA meeting my first year, thinking it'd be interesting to see what kind of patients I would eventually treat.  I walked out of the meeting with the feeling that I had mentally exposed and scrubbed raw every single one of my personality flaws.  Ironically, it was absolutely cathartic.

Not that I have any "addictions" as defined by society- drinking, drugs, etc.  But everyone has dysfunctional ways of dealing with things in life- whether as simple as ignoring a problem or as serious as shooting someone.  Being in the group yesterday, and being forced to participate in my own way, made me really face my own deficiencies.

Medical students have terrible coping skills, in my opinion.  Not that we don't know what is appropriate, it's just that with the amount of constant stress we're under, everything else seems trivial.  It seems ok to use nicotine patches or caffeine pills (at the LEAST!) for marathon studying, or not finding time to eat and hydrate your body during a busy admitting day.  Those aren't necessarily addictions but they're definitely dysfunctional.  During the meeting I had to come up with my own "denial statements," or reasons you give yourself to justify your addiction, like "I'm not going to drive after I drink" or "I had a bad day" or "No one else will know."  Medical students' denial statements would be something like, "Everyone else is doing it..or worse," or "If I don't, I'll fall behind," or "If I fall behind, I'll be a bad doctor and might hurt someone later."

Dysfunctional is an understatement.

I also heard stories of how the healthcare system failed these people, which broke my heart.  How the doctors who gave them their first prescription suddenly abandoned them when their medication regimen exploded into full-blown prescription drug addiction.  How no one had explained to them how bad life could get.  And how families, hurt and betrayed by addiction, stayed quiet in the background feeling helpless to save their loved one, at the time they needed support the most.

The facilitator again walked over and looked down to me sternly, telling me, "YOU'RE JUST A DEA NUMBER." I'm still trying to figure out if he was suggesting a deeper meaning, possibly a reminder that physicians are merely pawns in an era when reimbursement has more impact on clinical practice than outcome.

There are a million lessons to learn here, but at the least:

It's important for us as students and future doctors to realize how we are judging addicts and non-compliant patients for the same poor coping mechanisms.  I would advocate requiring med students attend similar meetings at least yearly, both to be reminded that addiction has a face, a family, and a story, but also to remind ourselves that we can't be the best clinician possible until we fix our own issues.

Personality Disorders

In honor of my last rotation, psych, beginning tomorrow:

Not for the faint of heart

Comments from a cnn.com article written by a doctor arguing that physicians are NOT overpaid, in response to the recent public outcry regarding physician discontent with salaries. I had to stop reading after 2 of 12 pages because it was so infuriating.

I've heard sooo many people argue here that doctors are under "so much stress!!" –

If that's true, then what good are they? I mean seriously, I thought our medical schools weeded out these weaklings in the first place. Secondly, I thought that after "all of this training" and school, doctors would know what the blanky-blank they were doing, no matter what.

If doctors still feel "so much stress" after making it through the selection process and 12+ years of school, then one thing is for certain: the med school chose the WRONG PERSON!

If performing medicine, surgery, or what ever is stressing you out after all of the riggors of traininng, then get a clue: the job is beyond your natural capacity and somehow you squeeeeeked through anyway. You should resign yourself to picking weeds out of gardens instead.

Doctors are not the only professionals who are forced to work for free. Attorneys can be ordered by a judge to take pro bono cases. Teachers often spend 20 hours per week of their own time planning and grading papers; they also typically spend a week or more of their own unpaid time prior to the beginning of the school year preparing classrooms and lessons.

I began working with doctors 9 months ago. Before that, I had a good opinion of them. Since that time, my estimation of them has dropped significantly. The childish behaviors – I was once a teacher – I found astounding. They would often leave the doctor's dining room worse than I ever saw children leave a cafeteria. We – as a society – have put doctors on a pedestal and it isn't working. Even as residents, they except to be treated as "special" instead of realizing that they are part of a medical team. I think we need to stop expecting doctors to work miracles and be perfect. We need to limit the awards on malpractice insurance and then expect doctors to act like people. They deserve respect but no more or less than anyone else.

There is a lot of people pulling the same hours and stress for less money. Doctors do earn their money but when someone complains of not making enough money when they are in the 99% of earning professions it rubs everyone the wrong way.

Shoot if I earned just a fraction (per year) of what these Docs do, I wouldn't complain one bit. When you are used to earning less than 20k while supporting 2 kids, even 5k more per year sounds grand.

Response: If you earn $20K a year, you obviously haven't put enough time or effort in training to enter into a more lucrative career, or you don't have the intelligence to practice in a highly skilled field. Look at all that time and $ you haven't spent–you got to start earning a lot earlier. Hence, average or below intelligence, or little effort applied, and no education above high school = $20K /year. Quit whining about how little you earn –they only hand out free, unearned money from the welfare lines. Why moan about people who do work hard to earn their money and then begrudge them that?

The symptomatic treatment of incurable conditions is the ultimate business. You never need to market, never need to worry about lack of customers, or the end of disease. Its the perfect most sound proof business model. The profit stream is endless, the only problem is there are too many cups in the river and the docs are mad. 


This story is wrong on so many fronts. I mean especially when you consider that I have never met a doctor that wasn't driving a mercedes or a BMW. I don't want to sound like a dick but you could easily have reasearched the field you were entering and not done it if you thought the compensation wasn't fair. So i guess every doctor should take stock in there career and decide why they became doctors? Was it to help people and promote the general welfare of the population or did they become doctors to fleece society and make a ton of money and play golf all the time. In todays economy I am sure there are a million people who wouldn't scoff at the meager 130,000 dollar income. As far as saying well you should have gone to college who can afford 11 to 16 years of school on my meager 30,000 dollar a year salary or the meager salary of my parents?


Quit your whining. I was premed at an Ivy League college and went the route of business. Life is about choices. If you don't like your path and how much you make, quit and become a banker. Let me know how much you'll like working 19 hours a day 7 days a week and travelling all the time and having clients yell at you. I've never read a more pathetic whiny post.


2) Don't expect your patients to thank you. YOU should thank US. You have chosen a profession in a service industry. We are your customers. We should be thanked for bringing our business to you. No different than a banker or lawyer.''


I love it when I have my blood checked every 6 mos. for cholesterol levels and then have to see the doctor for the results. Am there for perhaps 3 mins. while she reads off what it says and then Medicare is billed $245 for something that could have been sent to me via mail! However, am told they will not do that and I need to come in. There are doctors out there that are really abusing their profession.

Think medicine is bad? Try architecture. 5 years of undergraduate work, 3 years of graduate work, 3+ years of internship, 1-2 years to pass your exams. Tens of thousands of debt. Less than a third of new graduates finding work right now. Starting salaries (if you are lucky enough to find a job): $35,000. 50+ hour work weeks are the norm, all-nighters common.

While the statistics for doctors are bad, they aren't even close to having a monopoly in the undercompensated, overworked department. Stop whining guys – compared to the rest of the middlle class you are princlings.

MD Response: Your profession is not equal to medicine, your argument is flawed... You do not save lives, your liability is unequal, you are not in a service sector, to name just three.

Rebuttal: Really Bob? "You do not save lives" – What do you think architects do? Spend 12 years learning how to build buildings that fall down? They prevent doctors from having to save more lives. "Your liability is unequal" – perhaps you should research this. Architects also are liable for their work & can be & are sued. They do have to take licensure exams & have liability insurance. "You are not in a service sector" – Who do you think architects design buildings for? Architects serve private & public clients everyday. Where do you think the hospital came from? An architect designed it. 

I have an idea why – medical doctors really aren't that smart. I see them as cogs in the wheel; technicians at best, if you will. Show them a medication and they'll prescribe it like it's going out of style. Show them an implant and they'll put it in without question. Then, when it proves deadly or harmful, they say, "oh........well that can't be our fault!"

Show me the last disease stricken from Earth and I will show you a team of Ph.D. researchers that made it happen, not M.D.s. Medical doctors never cure anything. They simply use what other fine minds have designed and then hey extend no credit whatsoever. Nacissistic parasites doctors are. It's always, " I " suffered, or " I " saved the life, or " I " did this, that, and the other. It's never, "Hey, that nurse saved the patient's life when I was away." Or, "Hey, without that lab girl finding my patient had an abnormal pap smear, I wouldn't have caught that cancer in time." Or, "Hey, I sure am glad someone else designed this life-saving medication, so I can have the pharmacy get you some."


Doctors take credit for everything (biggest narcissists ever) and claim they're not in it for the money.....right. Three trillion dollars in U.S. healthcare each year is going to fall off a cliff and the doctors have the most to lose. Rightfully so – their selfish greed knows no bounds. 

How many doctors could actually perform their own MRI? There own microbiology from a wound culture? Know where to begin for meds? The hospital would grind to the same halt, just as if there weren't any doctors.

BUT, even though others are just as crucial as doctors, it is the doctors who GET PAID. They are greedy narcissists who believe they are the only important critical part of the health system. They'll suffer the most in our looming economic downturn.

"Medicine is also the only profession where its members are required to sometimes work for free." I hate to break it to ya buddy...But I work in Medical Sales, right next to you guys, and we do everything from service to device evaluations where we don't get paid a dime for our time *or* for many of the products *you* surgeons love to demo. So, I hate to break it to you, but that statement might require a minor revision. 


There will be a time soon, when our country stops the insanity of $3 trillion per year for health care and then you'll be told to stop whining when doctors like you are only paid $65,000 like so many M.D.s in other countries. If anyone's salary will fall in the coming years, it's medical doctors. Get used to it.

Doctor Response: Funny! You are right, if my salary falls to "$65,00 per year" I'm retiring to a cabin in the woods and spend my days fishing and I am only 42! So will about 3/4 of all U.S. physicians. That's ok, you can diagnose yourself with a Google search and put in your own chest tube, spinal tap, etc. etc. That is hilarious! Say good bye to healthcare in the U.S. Maybe we can outsource it. LOL

Rebuttal :Good, then we can all assume if we cut salaries to $65,000 per year, we'd finally be rid of the money grubby physicians that bilk the system with superflous visits, meds, tests, tests, and more meds.

 Doctors are more crooked than not; mixed in with a spot "saved life" here and there. By and large, you're ordering tests, meds, tests, meds, tests, meds, over and over and over and suddenly we're at $3 TRILLION. That's 3,000 Billion Dollars every year, because you "need" to make $200,000+

 I'll see to my own health, eat right, exercise, treat myself with over-the-counter items, and stay away from doctors. In fact, I'm 43 and haven't needed a "life saving" doctor yet. I skip my yearly physicals, blood work, and haven't had an x-ray in all my years. Oh, yea – I've never been prescribed any meds. Don't want them. I think most of our $3 TRILLION is spent on so many unnecessary items, it's unreal.

 Hope you enjoy the econemy taking a whack at your salaries. You deserve it. Hope your funeral provider gouges your family for an $800,000 casket – you deserve that, too, you price gouging lunatic.

Best refute from a physician:
It's so sad to see the decline of American Medicine. It's also disconcerting to see how much animosity the public has towards physicians in general and their salaries. The system is broken, and there is unfortunately no easy fix. Whether people like it or not, altruism only goes so far, and if you want to attract the best and the brightest, you have to pay them accordingly. There's obviously a breaking point in terms of salary, below which, the best and the brightest will opt to go into other career fields. And I say best and the brightest, because when it's you or your family member that's having a medical emergency at 2 am, who do you want attending to you? It's sad to see the public constantly trying to devalue the services that physicians provide. As physicians, at least we provide a valuable service to our community. What are the wall street & hedge fund guys doing to better their communities? The writing is on the wall. Unless things change, medicine in this country is doomed. Why would anyone want to jump through all the hoops and the BS that is required to become a physician and practice in an environment as dysfunctional as the one that exists today? Look at the time committment and opportunity cost of becoming a physician in comparison to what awaits you in the end these days. Anywhere from 11-16 years of college, medical school and residency/fellowship training while accruing over $200K + Debt, Working upwards of 80hrs/wk in training, no work hour restrictions as an attending, frequent call, life threatening emergencies at all hours of the night in many fields, frequent time away from family, exorbitant malpractice premiums, constant fear of litigation, constant threat of declining reimbursement, non-compliant patients, insurers that deny and delay payment, patients that steal from you without thinking twice. It's great. Really it is. What young, intelligent, highly-motivated college student wouldn't want to sign up right now?

Neonatal (a)musings

It's my sixth (and final) week of my pediatric rotation, and as my boyfriend reminds me daily, after Wednesday I won't have to examine another child, at least in an academic setting.  I've dreaded this rotation since the beginning of the year, but I've found that it's not dealing with the kids themselves that is most frustrating, it's often parents (which makes sense but it was for a different reason than expected).

I also found that I have several weird tics. I am not a baby person, and don't have any desire to pet (yes, that's what it is, people) or hold anyone's newborn baby. Second edit: I don't actually think many babies are "ugly," so to speak, but I think that, rather, lots of people ooh and aaah around babies and tell mom how beautiful and cute the baby is, and I know I'm not the only one wondering if we are seeing two different things. I think babies' looks are functional (it's a tough transition, I'll say), and a few happen to come out looking pretty darn good. I just think that it is genetic that all moms believe their baby is the most beautiful.

So back to the tic thing, I swore I'd never lie to a mom about her baby being cute.  A classmate suggested using "your baby looks very healthy," which I thought was brilliant.  But every time I got into a situation where I had to say something, "your baby is SO CUTE!" would just spill out; I couldn't help it.  I don't know what came over me- I didn't necessarily feel the baby was cute either (no maternal stirrings brought that out).

The other one is my "distract-or-make-the-angry-child-smile" facial expression.  I had many moments were I was standing silently behind a long-winded doctor, facing a bored or angry child.  Whenever the child would start to make the I'm-about-to-take-5-years-off-your-hearing face, I would have this uncontrollable urge to prevent it, which turned out to be me scrunching up my nose and face.  I know it's probably a pretty scary expression but I think I freaked out enough kids that they forgot about their plans to let out a scream.

I think my favorite experience was telling a kid his ear tubes were no longer green, that they were now rainbow-colored, and then watching his mom have a brief meltdown because she believed me too.

And then finding this doctor kit (on sale on Etsy!), which is the EXACT same one I had as a young child...this could very well be what started my lifelong dream of becoming a doctor! (It's labeled as "vintage," which blows my mind, as I'm in my mid-twenties.)

The MS3 Desert

As third year draws to a close (I feel like a broken record, I think I've said this for the past month and I still have 7 weeks left), I'd like to share some funny stories that have been the highlights and memorable moments.  It has been- by far- the toughest year in my life, but luckily our minds were designed to block out traumatic memories and I am left with mostly pleasant memories (though sparse) from this past year.

A pictorial demonstration:

• The last day of my geriatric psych selective when I was doing a mini-mental status exam and the really old guy tried to grab my butt while repeating "no ifs, ands or buts" (the source of the blog title)
• Offering to carry a full 24-hour urine jug to the lab during my OBGYN rotation so I could get off the L&D floor for a bit- taking the long way even though I got a lot of weird looks
• Watching a fellow student practice a rectal exam (on a "professional patient" during a "hands-on" lecture)- even though he had a broken middle finger
• Calling ICE and the department of homeland security on one of my rotations...no, I wasn't trying to deport a patient!

Ok, thought I could think of more but right now I can't (definitely a desert). Will add more if I think of any.

Citracal Calcium Gummies

I have recently discovered an amazing thing in medicine.

I'd like to preface this by saying that unfortunately I am not receiving any money or other benefits from this endorsement, but if you or someone you know works for Citracal, I would be more than happy to do so.  In fact, I'd be very happy with free calcium gummies.

Mmmmmm!

When my mom handed me the bottle last week I burst out laughing.  These calcium supplements are  cartoon-looking, like maybe something you'd see in Wonka's chocolate factory. I couldn't imagine they tasted very good (I'm 25 and to this day I will steal all of your cherry flinstone vitamins), but I tried one for my mom, who looked pretty desperate to help (that's a topic for another day- my diet consists primarily of starches and occasionally Chinese takeout). 

Anyway, biggest surprise of the year.  They taste REALLY good! They're sweet on the inside with a hint of sourness on the outside to make it seem like you're eating candy.  I actually want to take more.

Anyway, if you can tolerate the regular calcium supplements, by all means keep doing that. I just get sick of big vitamin pills so I take them for a few days and then stop for a few months.  

I prefer small, tasty gum drops:

to these:

CALL 911! I've got a cold!

Doctors train for a very long time: four years of undergraduate, four years of medical school, at least three years of residency.  Doctors train to bring people back from the brink of death- working tirelessly to not only know how to save a life, but to learn the intricate details of every aspect of medicine.

So why, you ask, do many doctors seem like callous, skeptical, resentful jerks?  To be honest, I wondered the same thing before I started school.  I often asked myself, do physicians take a class during med school, or do people with a propensity for jerkness tend to choose medicine more often than warm, empathetic people? I worried because I didn't feel like I was a jerk beforehand, and didn't want to become one either.

Well, it took almost three years for me to figure out the answer.  I've literally poured blood, sweat and tears into my career with the goal of saving lives.  I am now coming face-to-face with pure disillusionment with regards to my original picture of what I thought being a doctor meant.

This is honestly meant to be humorous, but enlightening.  Next time you go to a doctor and you feel like you've been "brushed off," put it into perspective.  Have you gone to the ER for a sprained ankle?  It's painful, and you can barely walk, but to an ER doctor trained for gunshot wounds and rollover car accidents.  Now I am in NO way discouraging you from seeking medical care for an injury or other concern, but I'm just trying to give the other side of the story here.

Some examples of ER/office visits that doctors did NOT go to medical school for (these are all examples I've seen THIS year):

• Chipped baby tooth
• Swollen toe
• Common cold (by far the most frequent complaint)*
• Runny nose in child
• Stomach bugs
• Toothaches
• Gas pain (it can be horrible, but it's quite embarrassing to leave with this diagnosis)
• Cuts, scrapes and bruises (paper cuts are a pet peeve)
• Babies spitting up milk after eating
• Mild headache
• Chronic problems (in ER): last week I saw a patient who'd had the complaint for over a YEAR
• Going to the ER because you don't have insurance/primary doctor/don't plan on paying
• Insect bites or stings (except for anaphylactic reactions of course)
• "I thought I'd be seen quicker at the ER than by my doctor"
• To get a medical report after an incident you plan to sue for even though you weren't hurt
• Stomach soreness after doing crunches (no joke, transported this to the hospital as a paramedic several years ago)
• Going to the ER for medication refills, to sober up or for retrieval of an object from a child's ear/nose

*Speaking of common cold, ANTIBIOTICS DON'T CURE COLDS!  Antibiotics kill BACTERIA like those that cause skin infections (cellulitis), ear infections, pneumonia, bladder infections, etc.  COLDS are VIRUSES!  It's funny because people will argue that "last time" a doctor gave them an antibiotic for a cold and it went away.  Well, viruses last 5-10 days.  If you go to the doctor, it's usually around day 3 or 4. You start the antibiotic and the virus has almost been cleared, and viola!  Patients think the antibiotic cured their cold.  Unfortunately, busy doctors often find it easier to write the prescription than to discuss this with their patients.  Just remember, there are lots of downsides to using antibiotics for no reason (c-diff diarrhea, organism resistance, etc) so think twice when you're handed that scrip.