Who wrote this?

As someone who spends a substantial portion of his professional time teaching medical students, I can tell you that this kind of attitude-that physicians are gods, not mere mortals, and wield power over other human beings that no one dare question-is inculcated in them from the very beginning of medical training. It is an ugly secret of our medical training system. And the more prestigious the institutions where physicians receive their training, the more overweening is this attitude.

Anything that a physician calls a “joke” or “for the patient’s benefit” simply is that, and how dare anyone question that judgment!

Surgeons are the worst, they cut people’s fucking asses open with sharp knives, and they are basically used to functioning as dictators in the operating room. These leads to the development of attitudes which makes perfect sense in light of the practical demands of surgery. But they do not work well in other areas of life. Put a surgeon in charge of any enterprise that requires leadership through persuasion or consensus, and you are totally fucking fucked.

I know, you guys are saying, Gary Null, or Joe Mercola, or maybe the Health Ranger Mike Adams. But you would be wrong, actually this snarling little piece of anti-doctor slander came from someone within our own community. Not only that, it came from someone who teaches medical students at a major academic university. This is, of course, PhysioProf. Now, if anyone knows me, and what I write about, what I really care about is standards for arguments. As a member of the scienceblogs community, it is understandably upsetting to see a evidence-free rant, based on bigotry, from a scibling that tars a group of people that I know to be some of the most caring, the most thoughtful, intellectual, careful and conscientious people I have ever had the pleasure of working with.

What to do about this I wonder? What solution is there to this problem of such a fool in our midst, spouting such hate and nonsense at others? What can we do about someone who holds medical students and doctors in such contempt, when he himself teaches them daily?

I admit I’m torn. The rant itself is beneath contempt. It is quite simply a slander. It is a data-free attack on a wide swath of people that includes myself, my co-blogger Pal, my mother, my father, sciblings like Orac, many of the adults I knew growing up, and most of the people I interact with on a daily basis.

The incident in question involved a surgeon who during a procedure put temporary tattoos on a patient. People might think, “big freaking deal.” Well, no. This isn’t just an innocent Little Mermaid stamp on a little girl’s arm to give her a distraction from an illness or painful procedure. No. This was a rose tattoo, on an adult woman, placed in a private area (below her pantyline). It was creepy, inappropriate, and weird.

A sensible person would take this incident and say, “sheesh, what a creep, I hope he loses his license and gets taken to court.” Only a moron with an axe to grind would then use such an incident to castigate a diverse group of people as sexist villains with a god complex. For one, medicine includes many men and women (52% women in my medical class). Doctors are a varied bunch, tend to be highly educated, very thoughtful, very conscientious, and rather than ignoring patients they are specifically trained to be respectful to all patients, no matter their race, sex, class or religious beliefs.

I also can’t believe how stupid this attack is from someone in PP’s position. Only a complete moron would hazard their job on the tenuous anonymity of the internet, and insult the people he interacts with on a daily basis. I know who PP and DrugMonkey are in real life, as do many other bloggers, not because they’ve told us, but because it’s impossible to maintain a truly anonymous internet presence.

In medicine, we take attitudes like this towards students and doctors seriously, and the only reason PP gets away with this crap is because he abuses anonymity. Anonymity can be a good thing, and I hope the internet becomes a place where it can be used reliably so people can feel safe speaking honestly. But when used like PP uses it, merely to be able to say indefensible nonsense about good people, it’s just cowardice and I hold him in nothing but contempt (and have for some time). DrugMonkey is little better, and as Pal has pointed out, he knows about as much about the actual practice of medicine as he knows about selecting decent co-bloggers.

Further, I know from personal experience just how wrong this characterization is. I have never known a doctor that fits with this embarrassing caricature of a monster with a god complex. Maybe TV characters like House, or Alec Baldwin in Malice have behaved this way. I’ve seen surgeons, especially ones dealing with the high-value real estate of the brain or the chest act as dictators within the OR, sure. But after seeing what they do first hand, you’d be crazy to ask for anything less. And universally, despite this behavior under pressure they tend to be sweethearts in other contexts, and wonderful with patients. Doctors are people, and surely different specialties will attract different personalities. And within such specialties you might see a trait more commonly than elsewhere. But this kind of specious and angry generalization is far out, is based on total ignorance, and only really demonstrates PP’s personal deficiencies. I don’t know where he gets his ugly resentment for MDs, but this rant says very little about actual doctors and volumes about PP.

I believe in standards of argument. I believe that doctors are a group of people that, with rare exception, put their patients’ needs first and foremost. When they fail, like this surgeon did, they deserve to be “struck from the list” as they say in Britain. I also know that doctors don’t think they are gods, and will tell you, each and every day, how much they don’t know, how much they struggle, and fight to understand the complexities and difficulties of medicine. Medical students, if anything, have the opposite of a god complex and constantly strive to build confidence, expand their knowledge and do better each and every day because one day they will be given the enormous responsibility of caring for other human lives.

I believe PP has failed to make an argument based on anything but bigotry and hatred towards a group of people I have consistently found to be the opposite of what he describes. I believe PP has no place within our community. He also has no place within his institution teaching medical students, and I’m quite sure when they find out this is what he thinks of them, he will have to answer for this slander.

Comments

  1. #1 Brian
    July 24, 2008

    As the brother of a doctor who has gone through his schoolin’ recently at a major academic institution (and got his PhD in the process), I think the argument goes beyond slander. Among the many lessons he learned in the process of becoming a doctor was to learn how to communicate with his patients. A substantial portion of his training was entirely based on squashing the notion of the “physician as god” in favor of “physician as peer” (and, often, “physician as collaborator”).

    Either PP is a great fool, a terrible physician, or overstates the stature of his institution. It frightens the hell out of me to think I may some day encounter a doctor that he has instructed.

  2. #2 Will K.
    July 24, 2008

    During college, I kept a part-time job as a phlebotomist at the local hospital. I didn’t have an enormous amount of interactions with doctors, but I did have some (and was also witness to their interactions with others). Through my several years there, never once did I meet or even come to know of any doctor resembling the megalomaniacal god complex misanthropes PhysioProf claims they are.

    Sure, everything I’ve said is only anecdotal, but the anti-doctor rant isn’t any more objective. I think the fact that I was treated very nicely and with respect by doctors is quite telling, actually. I was neither their professional equal nor a patient in their care, just an underling sent out to collect blood. Nobody had to be nice to me, and yet everyone was. Strange …

  3. #3 anon
    July 25, 2008

    I gave up reading PP a long time ago as I found that sort of attitude and persistent potty-mouth to be more poisoning than enriching.

    Not surprised to see such a rant come from him. Not worth the time digging through the muck for any jewels that might be found.

  4. #4 hootenanny
    July 25, 2008

    So PP loves to overdramatize to make a point? Well, so do many sciblings, including you. I think the tone of the “anon” comment above confirms that you led off with a pretty appalling tone yourself and thereby created an environment in which no exchange is possible. Wise up and realize: ALL of you tend to do this, and ALL of you sometimes create a rotten atmosphere for discourse. Can I make another sweeping ALL statement? Let’s see… I’m unsubscribing to ALL of you for a while because the screechy monkeys appear to be taking control of the blogs, not just the comment sections.

  5. #5 Martin
    July 25, 2008

    @Hootenanny: There’s a line between dramatic writing, and then just offensive ranting, and it’s one that over on DrugMonkey they cross time and time and time again.

    It’s not that I disagree with DM and PP, or that they use colourful language, or that they debate loudly that bothers me. It’s the sheer lack of intelligence in so many of their posts, and in their replies to questions and comments. It’s something I very nearly wrote a post on a few days ago myself.

    The recent Sizzle post is a good example. In the comments, a reader asked PP if he had any advice on what career development workshops to attend. The reply? “I think they’re a total waste of fucking time.” That was it. Obviously PP really cares about changing attitudes in medicine given the contempt with which he treats his juniors.

  6. #6 Martin
    July 25, 2008

    Sorry, just to clarify above, obviously I do disagree with them over this nonsense – I meant my problem generally.

  7. #7 PhysioProf
    July 25, 2008

    I care very deeply for my medical students, and spend a lot of time and effort on effective teaching. I also have great affection for them, and wish them only the best in their future medical careers. It is unfortunate that you have failed to recognize that pointing out a weakness in the medical profession and its system of training is wholly consistent with this.

    The unhinged responses I have received from physician/surgeons to my pointed criticism is, perhaps, relevant to the question at hand.

  8. #8 Sam C
    July 25, 2008

    I wonder if television (and, to a lesser extent, film) is relevant here? As a fairly healthy person living in a quiet area, my contact with medics and emergency services is very small, but I see a huge number of fictional doctors, nurses, policemen, firefighters, etc. on television. I see the occasional real one on the screen, but they’re usually talking about something connected with their job rather than doing it.

    The occasional time I do visit a hospital, it can take a moment to acclimatise to the fact that it is not tv’s ER, and I’m not about to be whacked by a patient whizzing by on a trolley with a doctor kneeling on top punching his chest with a load of other doctors running alongside shouting “chem seven lights action roll’em cross match stat pepperoni panel chest tray!”.

    But whether doctors are quite as sensitive and angelic as some of these anti-PP/DM posts paint, I don’t know…

  9. #9 Martin
    July 25, 2008

    @PhysioProf: Since you’re cutting and pasting the same comment onto every blog that disagrees with you, I’ll just do the same.

    Don’t play the innocent victim. You made a statement calculated to get peoples’ backs up, and now you’re complaining that the responses are “unhinged”?

    If I published a post on my blog saying that, “given the way firemen are trained to believe they are gods who function on a practical and ethical plane that is above mere mortals, this kind of shit doesn’t surprise me one bit”, then I would be pilloried for it, and rightly so.

    And don’t pretend that you were “pointing out a weakness”. If you were genuinely interested in doing that you would have published a much more considered, contemplative post, looking at whether incidents like the above were common place, and talking about the case for perhaps improving training. That would have been constructive… but given this and some of the other incidents I’ve see on your blog, somehow I get the impression constructive isn’t your strong point.

  10. #10 MarkH
    July 25, 2008

    Hootenanny. While I appreciate the “I’m taking my ball and going home” argument, please tell me when I use hyperbole equivalent to PP’s here. I need to see an example of what you describe, because I’m lost.

    PP, the “I really do love my medstudents” gambit will not save you this time. You have insulted your colleagues, students and peers on a freaking blog. How dumb are you? Didn’t you read the manual called “things never to do on the internet unless you’re completely insane”?

    Some of us think that words matter. Some of think that defending medicine, which is routinely attacked by cranks matter. I defend medicine here, it’s one of the things that I do. Why should PP be exempted?

  11. #11 Jamie
    July 25, 2008

    Mark, while I don’t necessarily agree with what PP’s saying, I think it’s a little daft of you to accuse anyone with criticism of the medical profession as not “defending medicine”. PP obviously feels that to truly defend MEDICINE, a criticism of DOCTORS is needed. Whether or not you agree is a personal choice, obviously you seem to disagree, but lumping him in with alties attacking scientific medicine as a principle is ridiculous.

  12. #12 Maslan
    July 25, 2008

    The “rant” was not rant.

    As a student, I know whereof he speaks, and it is quite true. The arrogance rampant among the students is rampant.

    And you see it in the younger doctors as well; of course they get cut down to zize pretty quickly after their first tangle with a LAWYER!

    Who ya kiddin, sport?

  13. #13 tonyl
    July 25, 2008

    Yeah, cause you science bloggers never use one example of extreme behavior to generalize about an entire category of people, like say Catholics. I’ve come to expect the same idiocy from science bloggers that I see from everyone else.

  14. #14 Orac
    July 25, 2008

    Yeah, cause you science bloggers never use one example of extreme behavior to generalize about an entire category of people, like say Catholics. I’ve come to expect the same idiocy from science bloggers that I see from everyone else.

    Well, actually, i’ve considered weighing in on that issue, but when it comes to his attitude towards Catholics, PZ is possibly even more irrational than PP is with his attitude towards physicians.

  15. #15 PalMD
    July 25, 2008

    Yeah, cause you science bloggers never use one example of extreme behavior to generalize about an entire category of people, like say Catholics. I’ve come to expect the same idiocy from science bloggers that I see from everyone else.

    I think it should be pretty clear by now that Sb is not a monolithic thought-community.

    At this blog, I don’t know what know what my blog mates think of crackergate, but I wrote my own piece.

  16. #16 CC
    July 25, 2008

    I know, you guys are saying, Gary Null, or Joe Mercola, or maybe the Health Ranger Mike Adams.

    I have no idea who these people are, but surely it hasn’t escaped your notice that disdain, and sometimes outright loathing, for premeds, med students and MDs isn’t exactly rare among PhD researchers…? You’re telling me you never got any negative vibe from your professor and TA in orgo or intro physics?

    In that case, here’s some news for you: ask PhD researchers their view of MDs and it will be quite a while before you hear anything like “the most thoughtful, intellectual, careful and conscientious people”. (I’m not endorsing that view, just alerting you to it.)

    I didn’t laugh out loud, though, until:

    As a member of the scienceblogs community, it is understandably upsetting to see a evidence-free rant, based on bigotry…

    Ummm, I thought that was the whole point of ScienceBlogs!

    In your defense, though, it struck me as completely obvious that you weren’t excusing the tattoo thing at all. Obvious after the first time you explained it, let alone after the eighth.

  17. #17 factician
    July 25, 2008

    I have worked (as a scientist) in 3 large medical schools in the last 15 years. Two of them (the better two, as it happens) are places that have cultures of learning, and I saw many examples of fine human beings learning to become excellent physicians. I count many of my closest friends amongst these people. Both of these are top-ranked schools in the U.S., and I have nothing but respect for the majority of people that I know there, or who have gone through these schools.

    The third medical school is probably the lowest profile of the three. This school created a culture of bowing and scraping. The medical students were expected to kiss the ass of their resident. The residents were expected to ass kiss at the attending. I think it created a poisonous culture (and yes, a God-complex culture). A friend of mine went through that system, and he is a different guy from the guy I knew 15 years ago. As way of example, he introduced his friends who had travelled to come to his wedding. All of us with doctorates were introduced as “Dr. and Mrs. Smith”, mixed in between the Bob Smiths and Bill Jones. Why use our titles in that setting? What does it matter?

    I’ve never seen that kind of behavior outside of this one medical school community. I wonder if PhysioProf, in his crass screed, is describing this type of setting. And MarkH is defending one of the better two.

  18. #18 Brian
    July 25, 2008

    The problem isn’t that PP is “attacking medicine,” but rather that he’s doing it like a two year old, using a single example and falling victim to the fundamental attribution error.

    There’s a word for an example that differs from the norm. It’s called an “outlier,” and PP apparently doesn’t know what those are. THAT’S why I’m afraid of being treated by one of his doctors.

    The inability to determine “what’s going on” from “what I’m seeing” is a big problem for a doctor. If PP can’t do it, he can’t teach it.

  19. #19 CC
    July 25, 2008

    There’s a word for an example that differs from the norm. It’s called an “outlier,”…

    I thought MDs call that a “case report”, and subsequently a “publication”.

  20. #20 ildi
    July 25, 2008

    “…but when it comes to his attitude towards Catholics, PZ is possibly even more irrational than PP is with his attitude towards physicians.”

    Not raised Catholic, or still a practicing one, I suspect.

  21. #21 minimalist
    July 25, 2008

    Bahaha. That’s mean, CC, but it made me laugh. But I fear we are now reinforcing the perception that Ph.D.’s look down on MD’s.

    I have no clue who PP is or where he teaches, but I do hail from MarkH’s institution, and my PI was a medical school instructor. I had plenty of exposure to medical students (and pre-meds as an undergraduate), and I am reasonably certain that any “god complexes” that develop are 90% the product of the student’s own personality: usually aggressive type A sorts. A good institution will overcome that; a poor institution will allow it to fester, or even nurture it.

  22. #22 Orac
    July 25, 2008

    Not raised Catholic, or still a practicing one, I suspect.

    Yes, raised Catholic. No, not practicing anymore, but not hostile to Catholicism either.

  23. #23 minimalist
    July 25, 2008

    Oh wait, you weren’t being mean. Har. I’ve seen too many overgeneralized case reports to see the connection to “outlier” as anything other than snark.

  24. #24 Randy
    July 25, 2008

    I agree with Orac regarding PZ and physioprof.

    Unfortunately, scienceblogs has many wonderful and useful posts, but also has many posts that are full of shit and a waste of space, and more unfortunately, it is these that bring “fame” to the bloggers, thereby reinforcing shitty blogging over good blogging. mmmm, like cable news networks and talk radio. So look to those media to see the future of SEED’s science blog adventure.

  25. #25 PalMD
    July 25, 2008

    Randy, I’m much less nihilistic. I’ve never read a blogger on this site who is consistently crappy. All of us post stinkers from time to time. I think in general this is a great place to read science blogging, and as a blogspace rather than traditional media, it allows people to “see the sausage being made”.

  26. #26 randy
    July 25, 2008

    Pal,

    I hope so. I still go to PZ’s page. He still is a great communicator of science, writes wonderful reviews of cool literature that I can send my students to read. But, fame is addictive (as are martyr complexes) So time will tell.

  27. #27 Anonymous
    July 25, 2008

    I can tell you that this kind of attitude-that physicians are gods, not mere mortals, and wield power over other human beings that no one dare question-is inculcated in them from the very beginning of medical training.

    I don’t know where PP teaches, but my experience with med school was quite different. My impression was that the profs (most of whom were MDs themselves) spent quite a bit of time explaining to us that we were not and were never going to be gods, that medicine had its limits, and that an arrogant doctor was a doctor asking for a lawsuit.

    On the other hand, I’m pretty sure my mostly PhD undergraduate professors thought of themselves as sub-dieties. Perhaps the difference between a private pseudo-ivy and a state school? Be that as it may, when it comes to arrogance, professors are right up there with doctors. (And I say that as an MD who is about to start a professorial position. And yes I am quite aware of my limitations, thank you.)

  28. #28 Dianne
    July 25, 2008

    The above post was mine. Sorry about that. What was that about not being omniscient, again?

  29. #29 Dianne
    July 25, 2008

    when it comes to his attitude towards Catholics, PZ is possibly even more irrational than PP is with his attitude towards physicians.

    Without either agreeing or disagreeing with the substance of this point, I would like to point out that PZ is not in charge of teaching young Catholics how to be good Catholics, does not work at a Catholic university, and does not claim to love Catholics. Unlike PP on each point. Therefore, PZ’s opinion of Catholics worries me rather less than PP’s opinion of doctors: it is easier to ignore or blow off as a nutcase a random blogger than one of the people sitting in judgement of you (i.e. who will determine your grade.)

  30. #30 daedalus2u
    July 25, 2008

    I think factitian has the scenario. There can be institutions that foster this type of behavior. Such institutions should be shut down if they do not change.

    My mother who was a RN and certified nurse midwife who worked in Frontier Nursing in Kentucky spoke of a horror story she knew of. This was ~60 or more years ago. One of the other nurse midwives developed appendicitis and during her surgery, the surgeon decided that her uterus was too small and was never going to be functional, so he removed it, in a never married woman in her early 20’s. The woman was Catholic, so becoming infertile meant she was not marriageable and never did get married. It destroyed her life. My mother always spoke of the arrogance of that surgeon.

    I think the problem derives from the truism that “power corrupts and absolute power corrupts absolutely”. The way that med students are treated (or perhaps used to be treated depending on the institution), as peons and as slave labor by those supervising them fosters the kind of power that corrupts. Hazing as a way of relating to newbies is characteristic of military and paramilitary-type organizations. Hazing fosters a destructive and competitive type of hierarchical power structure. Arguably useful in the life and death struggles of war, but quite dysfunctional in what are now ordinary day-to-day occurrences.

    I think it invokes the feudal-type power structure of the alpha male in charge of everything and who can do no wrong because he will kill anyone who says otherwise. It is very easy for males in positions of power to default back to the alpha male-type power hierarchy with the alpha male at the top and everyone else there to serve him until he loses in a fight to the death to the next alpha male. All of us are descended from many thousands of generations of such alpha males. Compromise and cooperation are inconsistent with that type of power structure. What is “right” is imposed by the alpha male by killing everyone who disagrees.

    This is the problem with the alpha-male type power structure that most governments have. Success is measured by getting and maintaining power, not by making good decisions. I am afraid that the way that health care is funded is going to exacerbate these types of problems. Any type of pyramid power structure where money, power, prestige simultaneously narrows as you go up the hierarchy is going to lead to the kind of power that corrupts absolutely.

  31. #31 Colugo
    July 26, 2008

    “I believe PP has no place within our community. He also has no place within his institution teaching medical students, and I’m quite sure when they find out this is what he thinks of them, he will have to answer for this slander.”

    Shame on you, MarkH. Why do you muster more righteous indignation for PP’s rant than for the sick bastard who left a territorial calling card on a patient’s body? You defensively circle the wagons and bring up your wonderful physician heritage instead of baying with outrage against your renegade fellow MD.

    “A sensible person would take this incident and say, “sheesh, what a creep, I hope he loses his license and gets taken to court.””

    Sheesh, you’re sure maintaining your calm composure when contemplating this scumbag compared to the white-hot rage your have for PP.

    To quote my response to a post by PalMD on the matter:

    “A lot of MDs are cool – I know some – but the fact is that a not insignificant number of them are smug, arrogant pricks. (No wonder people turn to alterna-quacks.) That was even more the case a couple of decades ago. MDs, especially surgeons, used to be one of the “priesthood” professions, a caste of entitled males who viewed themselves as above the herd.”

    Ooo, is that slander? I don’t think so.

  32. #32 MarkH
    July 26, 2008

    @colugo,
    I’m surprised at your reaction here Colugo, but let’s address your points since I know you’re a good guy.

    Shame on you, MarkH. Why do you muster more righteous indignation for PP’s rant than for the sick bastard who left a territorial calling card on a patient’s body? You defensively circle the wagons and bring up your wonderful physician heritage instead of baying with outrage against your renegade fellow MD.

    I did attack him. I said that he should be drummed out of the profession. I said he should lose his livelihood, and no meager one at that as an orthopedic surgeon. I said he should have to pay monetarily for the harm he did as well. As far as jail time, I’m not sure of how criminal law would deal with this instance, but I would be ok with him losing his freedom for a little while too.

    How the hell is that “circling the wagons”. If that’s circling the wagons, I’m the most incompetent frontiersman ever. You don’t think a guy losing the right to treat patients, losing his money, and losing his freedom isn’t enough? What should I have suggested, medieval torture? I can’t quite figure what I left out. The guy is a total creep, creeps shouldn’t be allowed to be MDs. What more is there to say? What article were you reading?

    “A sensible person would take this incident and say, “sheesh, what a creep, I hope he loses his license and gets taken to court.””

    Sheesh, you’re sure maintaining your calm composure when contemplating this scumbag compared to the white-hot rage your have for PP.

    My white-hot rage towards PP is for four reasons, elucidated in the piece. He shares my network, he is attacking me personally, the accusations are false and he is in the field of medicine training medical students. I’m angry about the surgeon, but this is far more personal to me. That’s why I’m riled up. What will the anti-medicine cranks like more than such a jackass as PP who says he works in the system saying that all their most paranoid delusions are actually true! If this came from Gary Null I’d say, “typical, what a looney”. When this comes from a scienceblogger, a scibling, a medschool professor, I think it’s understandable that I’m pissed.

    To quote my response to a post by PalMD on the matter:

    “A lot of MDs are cool – I know some – but the fact is that a not insignificant number of them are smug, arrogant pricks. (No wonder people turn to alterna-quacks.) That was even more the case a couple of decades ago. MDs, especially surgeons, used to be one of the “priesthood” professions, a caste of entitled males who viewed themselves as above the herd.”

    Ooo, is that slander? I don’t think so.

    Colugo, it certainly isn’t slander, because for one thing it’s true, and for a second, it’s not defamatory, unlike what PP said. For one, did you miss the past tense? Did you miss that Pal said that just a portion of MDs were jerks (no shit sherlock) and not all of them like PP did? Can’t you see the difference between medical school=god complex training facility, and “some people are jerks.” You could say what Pal did about almost any group and it would be true. Not an insignificant number of doctors, lawyers, engineers, PhDs, plumbers, bull-fighters, and nuns are jerks. So what? How can you not see the difference in validity and degree between these two statements?

    Do you understand yet why I’m pissed?

  33. #33 Dave L
    July 26, 2008

    What to do about this I wonder? What solution is there to this problem of such a fool in our midst, spouting such hate and nonsense at others?

    What to do? I suggest you take a pill and chill out. Funny, despite your great offense that you, Orac, and apparently most of your family have been ‘attacked’ by him, I don’t see any reference to your names in any of his comments. Are you really justified in assuming that he really said *all* doctors and surgeons are smug and arrogant and have god-complexes? Is that really what you think he said? You certainly assumed it, instead of asking for clarification or, more sensibly, share your opinion and data that he’s incorrect.

    Among other things, I do computer programming. Now when someone says, ‘computer programmers are nerds’, I don’t rant and whine just because I know plenty who are not nerds; they didn’t say *every* computer programmer is a nerd, and frankly there are many who are so it’s not as if they have no point whatsoever. Why don’t I complain? Because I’m a grown-up and at some level, the complaint would be anal.

    I think PP can be annoying, and his vast overuse of the word ‘fuck’ is juvenile. But frankly, your response to this suggests that PP was not so off-base after all. I didn’t really get the ‘hate’ coming off of his posts, unlike your unhinged rants, and it’s not like you’ve provided any counter-data to his assertion to show how way off he is.

  34. #34 Dave L
    July 26, 2008

    “Did you miss that Pal said that just a portion of MDs were jerks (no shit sherlock) and not all of them like PP did?”

    Where did he say ‘all’? Where did he attack Mark Hoofnagle personally?

    You did provide some more reasonable clarification of why you’re so pissed in your post to Colugo, and points taken. Do you really think PP has no point at all though ? In your experience, have you met more smug vain plumbers or doctors?

  35. #35 Colugo
    July 26, 2008

    MarkH:

    Let me try to dial back my own rhetoric a bit and survey what is going on. Both the tattooing MD creep and PP are identified with you, one as an MD and another as a science blogger. But as you mention PP is closer, has more links to you. With PP it’s more personal; I’m guessing that feels like a betrayal, in fact.

    But take yourself the equation and consider this question: Who is more effectively defamatory of MDs: PP or the tattooer? That’s an easy one. It’s similar to “What is more defamatory of Islam: Dutch cartoons or Islamic terrorism?” Or in the case of Catholics, “PZ Myers desecrating a host or pedophile priests?” and so on.

    There are, unfortunately, jerks in every profession, but only in some are these socially powerful jerks (doctors, politicians), not just jerks with temporary leverage (like auto mechanics or plumbers). And jerks who belong to the medical profession have been entrusted to do invasive procedures. And jerkishness has historically been a big problem in the medical profession. Therefore the safeguards against abuse should be greater, the sanctions more severe, and the inculcation of contrary attitudes even more of a priority.

    That inculcation – of humility, of respect for patients – has made great strides in the medical profession in recent decades (partly due, incidentally, to the decline of the prestige of MDs). But it is not complete. PP happened to put it in a different, and stronger, way than I did.

    Every blog has its own style. In this blog you and your co-bloggers are not just representing yourself, you are defenders of rationalism, and in order to claim such a role you demonstrate expertise and fairness (not neutrality, that’s something altogether different from fairness). Your disproportionate and highly personalized response to PP makes this about you, and risks squandering some of the social capital you have earned. If you, PalMD, ChrisH disagree with my assessment, that’s fine, but that’s how it looks from over here on the other end of the intertubes.

    I suppose we all ought to take a chill pill (metaphorically!) at this point.

  36. #36 MarkH
    July 26, 2008

    Hopefully I can address this without reiterating the entire post. here is what PP said:

    As someone who spends a substantial portion of his professional time teaching medical students, I can tell you that this kind of attitude-that physicians are gods, not mere mortals, and wield power over other human beings that no one dare question-is inculcated in them from the very beginning of medical training.

    Inculcated in them. Them includes me. This is also a falsehood. Medical schools, if anything, emphasize the opposite of this. If his medical school is doing something different, it’s an outlier.

    It is an ugly secret of our medical training system.

    Here he generalizes to my hospital and my university. I know these things to be false. I also have worked in many other hospitals and been to many other universities where this is false. I also know medical students and professionals from all over the country and they believe this to be false. Orac, Pal and I aren’t crazy, this is a ridiculous lie.

    And the more prestigious the institutions where physicians receive their training, the more overweening is this attitude.

    I consider UVA to be pretty prestigious, we’re usually a top 25 medschool. We have several departments that are world-renowned. We’re a top 100 hospital in the country, and have many of the best clinics for certain diseases in the world. Again, an attack on me, my profession, my institution.

    Anything that a physician calls a “joke” or “for the patient’s benefit” simply is that, and how dare anyone question that judgment!

    A physician. Anything a physician calls a “joke”… Sounds like he’s talking about all physicians doesn’t it? What grammar to you operate by?

    Surgeons are the worst, they cut people’s fucking asses open with sharp knives, and they are basically used to functioning as dictators in the operating room.

    Surgeons. Wow, that sounds like the plural of all surgeons. It’s also kind of disturbing, does he think surgeons are just psychopaths because they use a knife (or a Bovie)? Or are they doing what’s necessary to fix someone, usually as a last resort (excluding of course things like cosmetic or elective procedures)

    Put a surgeon in charge of any enterprise that requires leadership through persuasion or consensus, and you are totally fucking fucked.

    Sure sounds like he’s talking about any surgeon doesn’t he? He’s gone and attacked my colleagues again, and surgeons almost always have to work as a team, or with other medical teams, and do operate all the freaking time through persuasion and consensus. Another falsehood, another lie.

    Sounds like he was insulting me and the people I care about pretty consistently.

  37. #37 Dave L
    July 26, 2008

    Don’t get me wrong, I can understand why you would be ticked, but not enough to say stuff like,

    I believe PP has no place within our community. He also has no place within his institution teaching medical students, and I’m quite sure when they find out this is what he thinks of them, he will have to answer for this slander.

    Sorry man, but you ducked right into the ‘god complex’ punch, at least that’s how it comes off to me. With all your absolutely valid criticism that PP doesn’t provide any data for his over-assertion, you turn around and provide zip that PP’s teaching ability is in any way impacted by what he spits out on a blog. To be consistent, I’m assuming you’re demanding that PZ be ousted, for what would happen if a Christian student went to his blog and found out what he thought about them. You could just be pissed and show how lame his statements were (which they are embarassingly so as evidenced by the rapid apology and total lack of any evidence to support his statements), without this data-free attack calling for his ouster.

    As far as the grammar parsing, I guess I question to what extent it’s valid to assume the words ‘all’ and ‘every’ when no other modifier is given. A quote from a recent post:

    But for some reason, in Gloucester, it seems that they have, when young women feel the only way they can have hope for the future is through having a baby, to the point of seeking out the homeless for sex.

    How insulting to all the young women in Gloucester. But you didn’t mean ‘all’, even though you didn’t clarify it, and it would be obviously stupid for someone to assume ‘all’ and accuse you of slander.

    You’re right about the references like, ‘Put a surgeon’ commonly implying ‘all’, and those statements are definitely over the top. I do believe that if you’re going to accuse someone of attacking you personally though, they should have called you by name; I’d feel silly saying that Al Qaeda attacked me personally on 9/11 because I’m an American and they attacked America. PP did not attack you, your hospital, and your university; if anything, he attacked ‘all’ doctors, hospitals, and universities. And I certainly didn’t automatically read it that literally, because taken to that extent is such a stupid statement that I assume that that of course is not what he really meant. I wouldn’t take what he said and say with absolute confidence, “PP thinks that each and every doctors is a vain, smug asshole”, for to do so, I’d have to believe that someone would say something so idiotic and to accuse him of such, I’d want a pretty much exact quote.

    I do dig your posts, and to be honest, I think what ticked me off was your response to his apology on his blog. Yea, you have every right not to accept his apology and call him scared (evidence please), but whether you agree or not, I think by doing so you lose some of the high ground and it could come off as if you think you’ve never said something hyperbolic and plain stupid before. I just think your response would be more appropriate if he had attacked you personally, but he really did not.

    Consider the chill pill taken though, and I’m not really trying to defend him; he said some stupid shit. In a way, I do hope that you’re right and maybe this did scare him a little, because I do like some of his postings and comments when they have content and avoid some of the lamest use of profanity I’ve ever seen anyone indulge in.

  38. #38 Dave L
    July 26, 2008

    Actually, I just read a couple other comments/insults on your blog from DrugMonkey and it appears that there’s some bad blood between, well it looks like your whole blogs. I guess disregard what I wrote, I didn’t realize that I was actually watching a pissing match and that apparently ‘there’s more to it’ than just these posts.

  39. #39 CSP
    July 26, 2008

    Let’s see. Women who dress in skimpy attire before a night on the town are asking to be raped, blacks are lazy and criminal-minded, Jews are skinflints who have dysfunctional relationships with their mothers, and Catholic preists like to cornhole altar boys.

    Do these statements arouse anyone in a negative way? Well, if so, shut the fuck up and crawl back under your rocks, because nowhere did I say anything about ALL women, ALL blacks, etc.

    “Yea, you have every right not to accept his apology and call him scared (evidence please)”

    Evidence? Come on, Dave, how would one even define, much less produce, evidence for the fear of someone cowering away at a distance?

    That said, try this on: It seems clear that PhysioProf is afraid of being outed. Anyone can be contrite when his feet are being held the fire. PhysioProf is a serial prick who resembles a Tourette’s victim lacking variety his in outbursts, and it seems more appropriate to regard him simply as a moniker, a gag gone bad, a Web gadfly with a handle, than as someone with an actual name.

  40. #40 Dave L
    July 27, 2008

    Do these statements arouse anyone in a negative way?

    I thought of examples like that also, and I’m just raising the question to what extent it’s valid to provide our own modifiers. If someone says, ‘birds fly’, are they idiots because not every bird flies? That doesn’t analogize entirely to your examples, but to my knowledge, unlike women, Jews, blacks, and Catholics, doctors have not been a historically oppressed group. I’m Irish, and I wouldn’t take such offense if someone said, ‘Irish are drunks’ for example; it certainly is not the same thing as saying that I personally am a drunk.

    Would there be such a reaction if PP had merely put the words ‘some doctors in my opinion’ in every sentence he wrote disparaging them? Are you sure that isn’t what he really meant? I don’t disagree that a reasonable interpretation of his words, absent a qualifier, is to insert the word ‘all’ or ‘every’, but it seems I see ambiguous statements like that a lot, especially on blogs and specifically for hyperbolic effect, but I never assume ‘all’ because the resulting statements are usually so ridiculous, since there are always obvious exceptions, that I wouldn’t think of confronting the person. The major exception to that are racists and sexists of course, but I’m assuming, maybe mistakenly, that PP isn’t truly that irrationally prejudiced against MDs as that, especially since he associates with him. My point is not to defend PP, I could give a shit, but I don’t want to read the words ‘in my opinion’ in every sentence so everybody’s ass is covered.

    PhysioProf is a serial prick who resembles a Tourette’s victim lacking variety his in outbursts, and it seems more appropriate to regard him simply as a moniker, a gag gone bad, a Web gadfly with a handle, than as someone with an actual name.

    Can’t really disagree with that.

  41. #41 MarkH
    July 27, 2008

    @Dave L,
    One does have to be careful in condemning groups and I probably failed with the Gloucester teens. In that instance I was trying to describe a problem of a minority and my language served to indict them all. That was an error. The whole post was dedicated to my concern of a problem in the town, and that I hoped my impression was wrong however. Subsequent info from that episode in particular have provided conflicting evidence about a systematic problem afflicting teenagers in that town.

    As far as the bad blood, it is a long-standing problem that I’ve noticed an anti-medicine/anti-medical student take from the DM blog. I don’t think they belong here with us on the science blogs. Not just because they use their anonymity to attack others in a vulgar and puerile fashion, but because I think their writing in general is substandard. This post is not occurring in isolation. I dislike the DM posts in general, and this was just one among many I have felt don’t belong here. Eventually we may have to move beyond this network as it seems to be tolerating behavior I consider offensive more and more frequently. I believe in standards and SB lately has been sub-standard. It is upsetting to me.

  42. #42 MarkH
    July 27, 2008

    @dave L again.

    As far as qualifiers, one would have sufficed. But the real offense comes from the fact that from within the medical training system someone made what I view as a crank argument. It’s just so much worse to see one internally acting like a Gary Null or Mike Adams. It makes my job harder trying to take on the anti-medicine cranks when one of our own acts so carelessly.

  43. #43 Dave L
    July 27, 2008

    One does have to be careful in condemning groups and I probably failed with the Gloucester teens.

    Actually, it was clear to me from the context that you meant ‘some’ teens, and I would have railed against someone who would have read it as ‘all’ and taken offense. PP’s statements are admittedly different in that they were repetitive and as you said without any modifier at all. I guess when I read things of the structure ‘nouns are whatever’, many times I think the words ‘many’, ‘most’, and maybe weakly, ‘in my experience some’, can also be validly placed in front of the noun (again, with racist exceptions). But even if PP meant just ‘some’, after reading other stuff, yea, I agree that he seems to have definitely included you in that group.

    I don’t mind DM’s posts as much, and haven’t read that many of PP’s. DM has taken on a few controversial stances and attempted to defend them (is the war on drugs working for instance), so I give him some credit for that. Now that you mention it, I really don’t know what the mission statement is for SB. I like the freedom bloggers have to write about anything they like, but sometimes it seems that things get out of balance; I’m sure PZ’s Crackergate posts have dwarfed his almost always excellent science posts by a large margin as far as hits and attention. One of my favorite SBers is Ed Brayton (sure he can also say things may find offensive, but very rarely does he not back them up with good arguments, and I have seen him apologize when he’s wrong), even though many of his posts do not concern science. It’ll be interesting to see if SB evolves into something more strictly science related, but I’d bet that the SB overlords are just happy with the hits.

  44. #44 bmoc
    July 27, 2008

    MarkH, keep digging. With each additional crazed hypocritical tirade, you further reinforce your emotional and intellectual kinship with the “cranks” you rail against.

    You keep throwing around the legal term “slander”. Ask your brother to explain to you what it means, and why it (and libel) are utterly inapplicable to PP’s completely non-individualized general observations of the medical profession. While your own emotional weaknesses apparently lead you to personalize even the most general statements–perceiving them as direct individualized attacks on you and your family–your brother can explain to you the legal realities.

    Do you think your obsessive over-the-top crusade is going to look good to your medical school, as a sign of your calm, rational approach to potentially stressful situations?

  45. #45 Abel Pharmboy
    July 27, 2008

    I don’t think they belong here with us on the science blogs. Not just because they use their anonymity to attack others in a vulgar and puerile fashion, but because I think their writing in general is substandard. This post is not occurring in isolation. I dislike the DM posts in general, and this was just one among many I have felt don’t belong here. Eventually we may have to move beyond this network as it seems to be tolerating behavior I consider offensive more and more frequently. I believe in standards and SB lately has been sub-standard. It is upsetting to me.

    Mark, just a thought in my following this episode: there appear to be about as many commenters across all the blogs involved that would feel the same about your behavior; i.e. that you have reacted to the post in question in an initially understandable manner that has grown but disproportionate in magnitude relative to the offense. Community is interrelational and some might perceive your own reactions as a threat to the community. With a wife who is an MD, a colleague and friend several surgeons, and having spent all of my PhD and postdoc training in clinical depts/divisions at the bench with research-minded MDs, I have both expressed displeasure with PP’s original sweeping generalization but am also mystified by how personally you appear to have taken this as a moral insult of some sort.

    wrt to your contention that the writing on DM is substandard, I’d consider qualifying that statement. Say what you will about the manner in which PP uses profanity to emphasize a point. I submit that the career development, grant-writing, and mentoring posts on DM are uniformly among the highest-quality I have ever encountered in the scientific blogosphere. Their support of women and minorities in the sciences is exemplary. And while you may perceive their writing as having an anti-medicine slant, I would also consider that they routinely take to task PhD scientists who are terrible, exploitative mentors and leeches.

    I understand that you are emotional about this episode but perhaps we can all take a deep breath and examine objectively everyones’ contributions, positive and negative, before making absolute comments we may come to regret.

  46. #46 MarkH
    July 27, 2008

    Crusade? Now who’s being hyperbolic. I’m not using slander in a legal fashion, but as a shorthand for defamatory, false statements. Granted, it’s imprecise. I don’t particularly care.

    But I wasn’t the only one who saw this was an attack personally. Pal and Orac similarly saw this as somewhat personal. Pal as an MD, Orac as an MD in a surgeon and both sciblings of PP. I took it personally as a medstudent, a future MD, a future surgeon and an anti-crank to see someone on my network, and within the medical system spouting anti-doctor nonsense. When I first saw it I was mind-numbingly angry. I also did call my brother and ask him what he thought of PP’s post, and got his lawyerly advice. When I had calmed down adequately I tried to write a post describing why I don’t think PP should be among us anymore. Why he is substandard as a scienceblogger, and why his behavior was offensive to me, unprofessional and foolish.

    That being said I think I’ve actually been quite kind to PP. I haven’t used my knowledge to wield power over him (as apparently I have been trained to do by my medical school). While he thinks I’m being threatening, I’m not. I’m glad he’s had a scare. He needed one, because frankly he’s playing with fire when he insults his colleagues with nothing but the tenuous protection of internet anonymity to keep him safe. I think the inexplicable thing is why I did him such a favor, when I personally dislike him. There is no denying that.

    As far as a risk to myself in this crusade? I doubt it. People have sent things I have written to my dean before, I after all operate without anonymity. His response has been that I am usually either being misunderstood or misquoted, and that either way I have a right to free speech that should not be infringed as long as I don’t breach professional ethics. Being personally angered by another person, while not setting myself up as a cool Vulcan crank fighter, is quite human and quite OK I think.

    Orac is the cool-headed Vulcan anti-crank. I always thought of myself as the one who was willing to fight a little more dirty, and more willing to be confrontational. I didn’t realize I had this reputation for cold eyed rationality to defend.

  47. #47 bmoc
    July 27, 2008

    scare…safe…scare…safe…scare…safe

    You have the emotional dynamic range of a six-year-old. It is frightening that you are going to be allowed to treat patients.

  48. #48 MarkH
    July 27, 2008

    I love the “you’re a bad doctor” gambit. Like Orac and I don’t get this crap all the time. And hypocritical? Where have I been a hypocrite?

    The only one showing irrational rage is you bmoc.

  49. #49 xyz
    July 27, 2008

    While he thinks I’m being threatening, I’m not. I’m glad he’s had a scare. He needed one…

    I don’t know, that sounds awfully paternalistic to me. :P

  50. #50 MarkH
    July 27, 2008

    Ha!

  51. #51 CSP
    July 28, 2008

    @ Dave L:

    “Would there be such a reaction if PP had merely put the words ‘some doctors in my opinion’ in every sentence he wrote disparaging them? Are you sure that isn’t what he really meant?”

    The problem with PP’s assertion isn’t that he’s calling anywhere from one to some to all surgeons or doctors at large arrogant; he’s claiming that this is a veritable expectation within the broad field of medical practice, that it is a desired outcome of the way in which MDs are educated. He’s saying that arrogant medical professionals have an interest in producing carbon copies of themselves and in maintaining god-complexes. He ought to know better than to fling out ideas that he himself demonstrably — I mean, he does work at a medical school — has little reason to believe.

    Mark is right to balk at this and has provided counterexamples to PP’s generalization, and his vehemence can be excused, I think, because he is targeting a known asshole with his posts and comments. He’s not responding in kind and escalating this to a docs-versus-PhDs war, a very trite and overly mined battlefield.

    If he can be criticized at all, it’s in even bothering in the first place; anyone familiar with PP’s style might view his characterization of MDs as trivially silly, since PP has made such silliness a signature of his off-the-wall, vulgarity-laden outbursts. (And make no mistake, despite what some might say, vulgarity isn’t an inherent drawback. It’s helpful when it’s coupled to useful, tangible observations and claims.)

    Viewed in this light, it doesn’t really matter what the range of his target physician demographic includes, because he is, in effect, stating that docs who are not arrogant (if in his mind they exist) have actually reached such a station in spite of their training. This is incorrect and not at all reasonable.

    @ Abel Pharmboy:

    “Mark, just a thought in my following this episode: there appear to be about as many commenters across all the blogs involved that would feel the same about your behavior; i.e. that you have reacted to the post in question in an initially understandable manner that has grown but disproportionate in magnitude relative to the offense.”

    Drawing on what I wrote above, there is a huge difference. Mark responded to one person and one person only. Had PP been inspired by an example of physician arrogance and chosen to examine how medical education can produce it, that would have been one thing, even had he gone on to spuriously generalize from this example (and his generalization was spurious in any case, following from nothing rather than following from arrogance).

    But it strains credulity, to say the least, to propose that the tattooing surgeon did what he did as a result of what he as taught n medical school to think would fly. This practitioner evidently has one or more personality disorders because it’s unclear what else would drive anyone to do such a thing.

    If people agree that PP is sufficiently off-base to merit being called out, then why do some of those same people insist that Mark is overreacting? This is like pretending that ripping into a creationist for spreading lies about biology and biologists is no better than the creationist’s own behavior.

    Use your heads, folks. Stupid, toxic blogging merits harsh responses.

  52. #52 John Beaty
    July 29, 2008

    Anytime you want a series of real-life examples of what PP is talking about, GO ASK SOME PATIENTS, and then come back and kiss his ass.

    I can give you at LEAST 10 examples from the last 5 years of MD’s and esp. surgeons with a “god complex”, i.e. don’t ask questions, everything you say is irrelevant, etc. etc. until I throw up.

    This is consistently reported as the the single most important patient issue, and you folks are acting like it doesn’t exist.

    Go read “100 Days” by Steven Biro, “Surgeon Under The Knife” by William Nolan or ANY OTHER F%^@#$%^& doctor-turned-patient book for examples.

    Good god.

The site is currently under maintenance and will be back shortly. New comments have been disabled during this time, please check back soon.