Respectful Insolence

You know, it really annoys me when I see idiocy as idiotic as the idiocy of this surgeon in New Jersey:

In a lawsuit filed yesterday, a Camden County woman accused her orthopedic surgeon of “rubbing a temporary tattoo of a red rose” on her belly while she was under anesthesia.

The patient discovered the tattoo below the panty line the next morning, when her husband was helping her get dressed to go home after the operation for a herniated disc, her attorney, Gregg A. Shivers, said in a phone interview yesterday.

“She was extremely emotionally upset by it,” said Shivers. The suit, filed on behalf of Elizabeth Mateo in Camden County Superior Court, seeks punitive and compensatory damages from Steven Kirshner, a board-certified orthopedic surgeon with offices in Marlton and Lumberton, both in Burlington County.

Kirshner does not deny placing the tattoo – and has left washable marks on patients before to improve their spirits, his lawyer, Robert Agre of Haddonfield, said last night. He said none has complained.

“What’s offensive about this complaint is that it suggests something he did was intended to be prurient, and nothing could be further from the truth,” said Agre. “It was intended just to make the patient feel better.”

Let me just say: Dr. Kirshner is a twit. A surgeon can’t ethically do something like this. He just can’t. It’s a violation of trust and of the doctor-patient relationship. Worse, it was placed on what is considered private anatomy, which is normally covered by panties, a place that would heighten the sense of violation, especially in a female patient. That many patients apparently didn’t mind or were even amused by Dr. Kirshner’s warped sense of humor is irrelevant. He deserves whatever he gets.

Unfortunately, a fellow ScienceBlogger has, in a blast of ridiculously overblown rhetoric, decided to use this particular incident as a convenient springboard from which to generalize Dr. Kirshner’s apparent attitude towards his patients to all doctors and indulge in that favorite pastime among all too many, doctor bashing, and in particular surgeon-bashing (warning: this particular SBer loves exuberant profanity; don’t continue reading if you don’t want to see it–that’s why I put it below the fold). Let’s start with the doctor-bashing:

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!

My response will certainly not be as polite and restrained as that of Dr. Bates, and it may not even be as restrained as that of my much more sarcastic bud PalMD. PalMD may want to try to restrain his justified anger. On the other hand, I don’t know that I’ll manage to reach the stridency of condemnation that Mark Hoofnagle has.

I don’t know what medical school PhysioProf teaches at. Well, actually, I think I do, although I don’t know his name. What I definitely know, though, is that PP doesn’t have clue one about clinical medicine or the training of physicians outside of his narrow area of basic science classes. If he does, he’s never shown it. Moreover, his contempt for physicians is legendary. Everything he says is skewed by that, and what he describes does not resemble any medical school I’ve ever attended or been faculty at. Of course, my fellow SBer will probably retort with something as moronic as his generalization above, such as “You can’t handle the truth!” or “You’re a doctor and a surgeon; of course you would never see it.”

Such responses would be just as much bullshit as his careless and ignorant generalizations about physicians and his use of the bad behavior of one surgeon as an excuse to bash surgeons and physicians in general.

As an M.D./Ph.D. I’ve straddled both worlds, spending long periods of time exclusively in the world of basic scientists. Indeed, there were times when I seriously considered quitting surgery residency or clinical medicine to pursue nothing more than basic science. I know PP’s world. I’ve lived it. Maybe not as long as he has, but long enough. I still straddle both worlds and live his world to some extent, only now at the same time as being in the clinical world. And, having done so, I can with great confidence tell you that PhysioProf’s claim 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” is a hot, steaming, stinky, drippy turd laid on the blogosphere–rather just like PP himself, come to think of it.

In fact, the opposite has until recently traditionally been true. If anything, before the last decade or so, medical training has resembled the military to some extent, especially internship, with the apparent goal being to show trainees that that they are stupid and worthless, the lowest form of life–scum not worthy of the great responsibility of taking care of patients. I exaggerate a bit, of course, but certainly the attitude that physicians–or even surgeons–are gods is not one that is inculcated in anyone who didn’t already have that attitude before going into medical school. And, sure, certain specialties probably attract certain personalities, but such fact-free, biased, and brain dead generalizations do not even try to describe this. They exist only as an expression of extreme contempt, and deserve nothing but contempt in return.

Yes, as a profession, we physicians and surgeons have our share of arrogant morons. So do Ph.D.’s in the medical schools where I’ve worked, and I’ve seen no evidence that such people are any less prevalent among our basic science colleagues, the nasty, arrogant “gods” among whom abuse graduate students and postdocs instead of residents and the hospital staff. I think I can guess what’s going on here with PP too. I’ve seen his type before: Big time researchers with multiple R01s who consider it so very far, far beneath them to be required by their medical school to lower their golden selves to teach medical students basic science and ultimately come to resent it and them, particularly infuriated that medical students tend not to perceive the utility of science that they won’t ultimately need for patient care. Another thing that might be going on here is that perhaps PP is faculty at too high and mighty of a prestigious medical school, and, if he really is observing a sense of entitlement in the medical students to whom he deigns lower himself to give scraps of his great and awesome scientific knowledge, perhaps–just perhaps–it’s a class issue rather than a medical student issue. Perhaps if he’d come slumming with me and PalMD at the mid-tier medical schools where we’ve been faculty he’d get a different picture. Certainly we have.

But then we’re doctors, and no doubt PP will simply dismiss our retorts simply because of that. It will never occur to him–not for even a second–that he is the one who has no clue. Here’s one last observation for PP: If you give off the attitude that you think medical students are arrogant twits with attitudes of entitlement, not only will you interpret all their behavior through the lens of your own bias (ever hear the term confirmation bias?), but you’ll probably unknowingly provoke the very behavior that you anticipate based on your bias. Listen up. You probably don’t realize this but clinical faculty have exactly the same sorts of issues to deal with, but we don’t decide that all medical students must be twits. For example, the vast majority of students who rotate on the surgery service will not go into surgery. Some of them make it very clear that they don’t have any interest in surgery and are just doing their time because they have to, just as I’m sure that some of them make it clear that they don’t care about your precious physiology lectures any more than to learn what they need to pass their boards. Instead of viewing them as being parasitic arrogant wonders with a sense of entitlement, we accept that when we took our jobs as faculty at a medical school it became our responsibility to train all medical students, not just the ones going into surgery, with the surgical knowledge that is considered necessary to being a good general physician, and we do just that.

Now, as I’m just warming up, here’s where PP really shows my profession the love and brings home the stupid:

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.

PP is so utterly clueless about this that I can’t even work up any anger anymore. Instead, I’m laughing at him. Yes, in the O.R. surgeons are the “captains of the ship.” It has to be that way. If a patient’s condition goes south in a hurry and something needs to be done immediately, we expect and need to have the O.R. staff do what we need them to do when we need them to do it. The patient deserves no less. However, emergencies aside, that power is not dictatorial. Perhaps it was in the past, but no longer and not for some time. Indeed, I highly doubt PP has ever actually hung out in an O.R. for any length of time. These days it’s a highly collaborative effort between surgeon, anaesthesiologist, techs, nurses, residents, and sometimes many others. Here’s another clue: Surgeons aren’t in the O.R. all the time. In fact, we’re in the O.R. less than half the time, if that. The rest of the time we’re in the clinic seeing patients, rounding on patients in the hospital, serving on committees, and doing a variety of administrative jobs. For most surgeons, time spent in the O.R. is nowhere near the majority of their time. There’s a lot more to being a surgeon than just operating.

As for surgeons not being able to lead through persuasion or consensus, give me a break? Where does PP get his ideas of surgeons? Scrubs? House of God? The guy can’t seem to spout anything other than the most simplistic stereotypes about doctors and surgeons. Rare is the department chair or division chief these days who doesn’t have to lead through consensus. The days of the dictatorial department chair are long, long gone.

You know, the really sad thing about my having seen PP’s rant is that his other posts about grantsmanship, running a lab, and writing papers are generally really quite good. I recognize this precisely because I straddle both worlds, basic science and clinical surgery. The guy could be a lot better than his idiotic rant on Feministe and his own blog. Sadly, he chooses not to be. More’s the pity. That leaves me with this question: If PP has such utter contempt for physicians and the medical students who will ultimately become physicians, why on earth does he continue to have anything to do with them?

Comments

  1. #1 John Lynch
    July 25, 2008

    Nice post, Orac, on yet another example of PP being full of it.

    I’ve had the pleasure of teaching med students (in Ireland) and pre-meds here. I’ve also seen them once they have come out of the training and count them among my friends. PP’s rant is just that – the rant of the ignorant. I can only hope that he never finds himself in an OR/ER with the sort of caricature of a surgeon or doctor he presents.

  2. #2 Heraclides
    July 25, 2008

    I think you’re missing an tag!

  3. #3 Bob O'H
    July 25, 2008

    I don’t work in in medicine, so I hope you don’t mind if I start making some popcorn? PhysioProf’s reaction could be entertaining.

  4. #4 DrugMonkey
    July 25, 2008

    Wow. An orchestrated MD puppet attack on the PP, no wonder PalMD was “anticipating” a flamewar!

    Interestingly Orac you got just exactly one part of this right, your expression of the stereotype of ‘big time multiple R01 researchers’. Trade one over exuberant ranting and over generalization for another, fair enough.

    but this? what, you’ve never had your delicate feathers ruffled before? never had anyone suggest that maybe your profession ain’t all gilded that?

    this would come of so much better if you simply gave your experiences that doctors-to-be are never arrogant little twits (Which I doubt) or that the training process later down the line beats it out of many of them (which I suspect is very true) or whatever.

    fwiw, my experiences are 1) TAing as a grad student for several years and experiencing the pre-med crowd (many of whom went on to med school) and 2) taking classes and socializing (as a grad student) with current med students (and of course 3) as a patient). guess what? little bit of truth in what PP was saying. guess what else? little bit of truth in what y’all offended doctors are saying.

    gee, think the reality lies somewhere in the middle? I do. It usually does.

  5. #5 Heraclides
    July 25, 2008

    And I think my comment is missing the text version of the tag I so carefully converted to HTML character entities… it was fine in Preview… eaagh.

    I can understand where you’re coming from, Orac!

    DrugMonkey: Orac already said there was a grain of truth in it: start from “Yes, as a profession, we physicians and surgeons have our share of arrogant morons …” and read on.

  6. #6 DrugMonkey
    July 25, 2008

    DrugMonkey: Orac already said there was a grain of truth in it: start from “Yes, as a profession, we physicians and surgeons have our share of arrogant morons …” and read on.

    if that’s the case, what’s the point here? so PP spread with a broad brush, so what? not the first time a blogger or pundit has been known to do that, is it? probably one could find many examples of ol’ Insolent one doing that his own self. so why the fireworks?

    when I see over the top reactions like this I think gee, maybe that hit a little close to the mark, eh?

    and then there’s the part where you start getting a little vomit taste in the back of the throat. some surgeon gets caught doing something pretty horrible, both for patients and for his profession. commentary on this event reveals that there have been other incidents of surgeons caught leaving more permanent signatures on patients. this was new to me and none of it was linked to anything so I don’t know if it is urban legend or what. but here’s the thing.

    not one of these outraged Sb doctors blogged that situation. oh, no, they only got outraged when someone else pointed it out! and that makes me just a little sick to my stomach…

  7. #7 PSC
    July 25, 2008

    If I might make a comment from personal experience:

    I’ve generally found surgeons and registrars who’ve been in the game for a little while wonderful. I particularly remember overhearing a senior surgeon who I know had shown up to work at 7:30 that morning, in the late evening gently coxing a poor woman with mild dementia who’d had a fall to try to work out what medications she was on. He was obviously exhausted beyond belief, he could have handed this task over to a nurse or junior doctor, but he worked solidly at this, and it’s not “heroic” medicine. I also remember a surgeon similarly repeatedly visiting a poor man with bad bedsores to monitor his condition. Not heroic medicine, but very necessary. There’s lots of this “non-heroic” stuff being done all the time.

    My view of those who haven’t been at it for so long is not as positive. Interns can be incredibly arrogant and obnoxious sometimes.

    I suspect dedication to patients’ welfare is something that is substantially learned by experience.

  8. #8 Pinko Punko
    July 25, 2008

    Since everyone is on their hyperbole-wagon, I’m not going to get too much into it.

    My random sampling of interactions with med students suggest that they rub grad students the wrong was as being profoundly un-academic on average. I have in fact been insulted to my face about bench science by a resident treating me at the time. I do not use this to tar all physicians.

    I find this entire argument to be kind of dumb. I expect if Orac went back through his rant here with a calmer eye, he would recognize a large amount of strawmen. I think I can’t really say anything about PhysioProf’s rant- it was his standard hyperbole. I wonder why a lot of people feel this way about physicians? Some of it is the same assholes we all went to college with that were pre-med did in fact become doctors. A lot of the assholishness I don’t think is innate, I think it relates to the scene and culture.

    Are there Ph.D.s that are horrible cobags? Certainly. Does this suggest an equivalence. I don’t think so.

    Are all basic scientists jealous of their MD brethren? I don’t think so. Is there resentment? I would say there is. I will hypothesize as to some perceptions (whether true or not) that lead to such resentment. This could stem from the fact the MD’s doing research even if primarily at the bench have a much higher pay rate. MD fellows working in labs are so burdened with clinical obligations at many institutions that their research efforts may not appear to be serious, yet their pay for such research is astronomical compared to a post-doc that will likely be burdened themselves with training and mopping up after an MD Fellow that is only in the lab because she/he is forced to do it (of course this is a generalization- there are total MD superstars out their, sadly, most of them know who they are, and those who aren’t think they do).

    Finally, in my personal experience with MD/Ph.D. students, a fraction of them were just totally awesome, while a larger fraction of them fit the exact stereotype of just wanting to go to medical school for free while getting a Ph.D. Lite. This certainly breeds resentment between classes. Some of this is perception bias. A grad student the resents other shitty/lazy grad students will not condemn the entire category because they are a member of that category, and are less likely to generalize the nature of grad students from negative examples. Likewise with surgeons. Nobody is gonna burn their own house down, but it is all too easy to use the ol’ broad brush on those outside our little cliques.

    I do find it amusing that even other physicians routinely joke about all surgeons being pricks and primadonnas, so it is odd that PhysioProf kind of going with the rote “surgeon asshole is example of asshole surgeons” drew this response.

    I’d say the surgeon in question was much worse than a twit. I’d also say PhysioProf’s rant while touching on PhD/MD whatever really gets to a visceral response that is true for many patients and how they view medical care. It is more often than not something they don’t understand, are fearful of, distrustful of, frustrated with, and likely patronized by. Just as we blow off steam on the internets by calling other people idiots, I’ve heard doctors blowing off steam about patients in language that would drain the blood from any patient’s face. What I don’t think some doctors understand is that fear/resentment from patients is part of the business and they are paid well enough to take it.

    I declare this entire thing to be totally stupid.

  9. #9 Pinko Punko
    July 25, 2008

    I just want to add that just as I have scientist role models, I also have physician ones. I generally respect the hell out of Orac and what he does to communicate with the world outside of medicine. I guess I wish Orac hadn’t risen to the bait.

    My Shorter Hypothetical Orac:

    “Wow, PP seems like he’s pretty pissed off. I’m not going to touch it, save to condemn the surgeon and attitudes in question leading to the assault discussed, as it truly was a form of assault and gravely unethical. As the attitude of surgeons, well I can assure you it is not mine or that of my respected colleagues. Yes, we certainly have the stereotypical types PP derides, but it isn’t the norm, and I suspect PP’s own house includes just as many. Now, let me discuss my favorite Tom Baker Doctor Who episodes.”

  10. #10 wackyvorlon
    July 25, 2008

    In my limited personal experience, I don’t believe that I have ever met a doctor with a god complex. In my opinion, to become a doctor requires such an amount of effort that no amount of remuneration can truly compensate for it. The doctors I have known work insane hours, must constantly learn huge amounts of information, and are forever working half-blind. Humanity does not yet completely understand how the human body works, any effort to affect repairs in inherently frustrated by this fact.

    As well, the cost of error is incredibly high. It can literally be life or death. If you want to play god, there is no good reason to become a doctor to do it. You can get work at McDonalds as a manager and play god every day, for less effort. I cannot fathom a motivation for becoming a doctor other than the desire to help people. It’s simply too much work, too much heartache and too much money.

    That being said, as someone who has relied upon the help of doctors, I thank you. Your sacrifices are appreciated.

  11. #11 Dr. R
    July 25, 2008

    Arrogance should target disease not the patient.
    How about a temporary tattoo course for surgeons? A tattooing procedure should always added to the consent form.

  12. #12 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.

  13. #13 Martin
    July 25, 2008

    @PhysioProf: 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.

  14. #14 Legal Eagle
    July 25, 2008

    Cry about it all you want, but the surgeons insurance carrier is going to pay a bundle, and his rates will go up
    CONSIDERABLY.

    He committed an assault, and he is going to pay bucks for it.

    The lawyer will also cry about it…all the way to the bank! LOL!

  15. #15 Steve
    July 25, 2008

    I work with a lot of doctors, and none of them think they are God. They do, however, think they deserve God’s parking space.

  16. #16 bsci
    July 25, 2008

    PhysioProf regularly talks in overblown generalities about everything from grad students to politicians. People regularly take him to task for this. Have you ever been bothered or responded to his over-generalizations before it was about your own profession.

    Part of the issue here is that he did strike a nerve and there is a vein of truth. Many surgeons do think they are god. I’m not sure this is always a bad thing, because it takes a bit of a god-complex to think you can slice open a human being, rearrange their organs, and put them back together not much the worse for wear.

    There are a few fallacies in your comments. First, you decide to compare medical training to the military. The trouble is that surgeons are the equivalent of officers and, by the time you reach that point, you are very used to having lives in your hand and having everyone else follow your every order. There are many cases of officers have trouble adjusting to civilian life.

    The other mistake you make is saying surgeons are caring human beings you put their patients before everything therefore, they don’t have a god complex. I’ve known surgeons who treat everyone they work with poorly BECAUSE the patient comes first. They will give the patient as much time as necessary, but abuse everyone else if anything is less than flawless (even if it involved reading the surgeon’s mind to get things exactly how the surgeon wants it).

    I’ve also heard an academic who works on computer guided surgery say that he was never able to get surgeons to sign on to work with him if he listed the flaws and complications of a procedure. He had to start with the assumption that everything was perfectly fine and his help would merely make things slightly more perfect.

    Sure I’m generalizing too, but just because one surgeon assaulted a patient, doesn’t mean that SOME other surgeons don’t have god complexes in different forms. Critique PhysioProf for over-generalizing, but recognize that he is talking about more than a few MDs he has met. If YOU want to be constructive, how do you think training should change to make improve surgeons behavior towards both patients and staff?

  17. #17 Orac
    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.

    If you really “care deeply” for your medical students, as you claim you do, you sure do have a most unusual way of showing it. Ask yourself this; What would those medical students you claim to care for so deeply think if they found out what you’ve been writing about them on blogs?

    As for the whole “unhinged” responses bit, that’s about as lame as it gets. (That goes for your coblogger DrugMonkey, too.) It’s also particularly hilarious coming from you, whose rants often define the word “unhinged.” This gambit is, in fact, nothing more than what one blogger terms “doggerel.” By that standard, when I respond to an attack by quacks or anti-vaxers with my special brand of not-so-Respectful Insolence, they must have “touched a nerve,” eh?

  18. #18 Orac
    July 25, 2008

    not one of these outraged Sb doctors blogged that situation. oh, no, they only got outraged when someone else pointed it out! and that makes me just a little sick to my stomach…

    Give me a break.

    I can’t speak for others, but I didn’t even know about this incident until I saw PP’s unhinged rant about it, and I’ve written about surgeons and doctors behaving badly before.

  19. #19 Annie
    July 25, 2008

    Longtime (older than dirt and pre-computers in practice era) nurse here. I’ve had experience with growing up as a granddaughter of a surgeon who was schooled pre-Flexner Report (Yikes – you don’t know from Flexner? Read some history, kiddo!), then worked through high school and collitch as a nursing assistant, practicing in critical care as a clinical nurse, obtaining doctoral level education in nursing, working as a nursing administrator and working with physicians on many (ad nauseum) interdisciplinary teams – M&M, patient safety, quality and safety, patient flow, bed capacity, critical care, emergency department clinical operations, Joint Commission, etc, etc,. In all that time, I’ve been threatened by three physicians: a urologist for reporting his week long failure to see a patient s/p-penile implant whose penis was grossly infected, edmatous and necrosing; a trauma fellow who when asked in the trauma bay if he had performed the initial abdominal assessment on an unresponsive patient who was known to be a nurse, grabbed a handful of belly skin, smiled and replied “yeah, baby” – and then stalked me through the hospital for weeks as well as making threats to other staff that he was going to “get me good”; and finally, a surgeon who was angry that his demand for an immediate bed for an elective patient transfer from a rival surgeon’s practice couldn’t be accommodated due to over a dozen ED boarding patients waiting for any beds – he was going to have my job, and by gawd, he did.

    But that’s over 25+ YEARS working with hundreds of physicians. Those outliers always remain in memory in vivid detail simply because they are outliers – they are not representative of the norm.

    I also worked with the “norm” – surgeons who are intelligent, committed, passionate about their work, assertive, sometimes aggressive (in the OR, that’s an attribute – I don’t want a timid trauma surgeon dithering about a clinical decision, thankyouverymuch), and are not so different from other physicians practicing across specialties.

    I agree with PalMD and Orac’s points that what needs to be kept above the radar is what standards of care and practice are for patients undergoing surgical procedures and who are being sedated or anesthetized, and how patients can advocate for themselves.

    Now if we could turn our attention from PPs meltdown (it’s hot in the city in the summer) and work toward reclaiming autonomy and control over physicians’ and nurses’ practice and working conditions, I think that we might be able to do some good.

    Sorry PP – I admire your work, but don’t understand the vast generalization, unless it was for dramatic effect and you were using your poetic license – I think you scored some points on that license. *grin*

  20. #20 pinkunicorns46
    July 25, 2008

    I am sure that the issue of arrogance has been blown out of proportion on both sides. However, what concerns me is that surgeons like this are out there at all. Many of the med students I know are quite full of themselves. I can write this off as part of the mid-20’s “I’m gonna be a doctor” complex. What I can’t stomach is that several of the male med students I know have made quite disparaging and/or misogynistic remarks about their female patients. I find this deplorable and this tattoo-placing surgeon reminds me that there are doctors out there with no respect for their patients’ privacy or emotional well-being.

  21. #21 Becca
    July 25, 2008

    PP does this (repulsive sterotyping) to everyone, surgeons/physicians aren’t special (that’s the point!)

    If PP had said “Military commanders have to make life-and-death decisions for thousands of people. This leads to the development of attitudes which makes perfect sense in light of the practical demands of war. But they do not work well in other areas of life. Put a general in charge of any enterprise that requires leadership through persuasion or consensus, and you are totally fucking fucked.”
    I would have been inclined to agree.

    I think military style hirearchy, where you get acoustomed to everyone following your orders all the time without first questioning it, can lead to a “God-complex” in a certain subsegment of the population.

    Furthermore, I think going through misery while you are low-status can actually exacerbate any asshat tendancies when you get to the top of the food chain.

    My grandmother was a nurse, and her mother, and several extended family members. My mother definitely holds the sterotype of some surgeons and physicians as arrogant, from the stories her mother told her. You imply the military-style hirearchy may have decreased somewhat. If true, maybe the surgeons of today really are less arrogant than the surgeons of yesteryear. But rest assured, there were plenty of surgeons and physicians that ordered nurses around (and not in an OR emergency context).
    Of course, the reason the issue may have chafted so badly that it is carried through generations later may have had something to do with the women in my family being exceptionally bright, and barred from being at the top of the food chain by their gender, but that is neither here nor there.

    If “surgeon arrogance” is really totally untrue now, you’ll just have to outlive the sterotype. But to be perfectly honest, you don’t come off as having a surplus of humility (except, perhaps, in comparison to PP- who’s a cocky SOB).

  22. #22 Katharine
    July 25, 2008

    Man, having been a pre-med and currently being a pre-PhD student, this is an interesting discussion.

    In my experience, both sides have their assholes, and every stereotype has a high degree of ignorance – sometimes some things are lost in communication between doctor and patient or professor and students. Stereotypes are generated from ignorance. I am not fond at all of people who bash physicians and surgeons, nor am I fond of people who bash professors.

    I think the better tactic is to investigate why these stereotypes propagate themselves and to stress 1) more mindful patient care in some physicians and surgeons and 2) more efficient teaching methods in some professors in order to eradicate those stereotypes.

  23. #23 Jason W
    July 25, 2008

    I’ve had to visit a lot of surgeons in the past eight years or so, and yeah, no complaints. The only bad doctor I ever had was a GP, and I don’t think he was representative.

    Most of the people I hear make these sorts of complaints about doctors are ones who were, themselves, putting too much faith in a doctor, and was surprised that the doctor could be wrong (i.e., be human).

    I will say, as far as students go, I *have* seen a lot of assumed entitlement, especially among white, middle class and up students. But I’ve always assumed that’s an issue with being young and privileged more than anything else.

  24. #24 Shygetz
    July 25, 2008

    Yes, as a profession, we physicians and surgeons have our share of arrogant morons.

    I have to quibble with you…you have more than your share of arrogance, but less than your share of morons, just like most highly-trained professions.

    I disagree with PP that the medical profession crafts arrogant twats…I actually think the medical profession attracts arrogant twats, and then does its best to squish the arrogance out of them, with moderate success. Coming from someone that has taught/worked with pre-med and med students, as well as with MD and PhD colleagues, it has been my impression that MD students (and pre-meds to a lesser extent) are more arrogant than your typical post-graduate student of similar academic skill. After about six weeks, I can pick med students from PhD students in a mixed basic science class based on their in class behavior with about an 75% success rate (and pre-meds/pre-pharms are even easier, not due to arrogance, but due to their focus on grades uber alles). Actual practicing doctors are neither more nor less arrogant than their PhD faculty counterparts–the successful ones sometimes let their successes go to their heads, and some of the less-than-successful ones occasionally have an inflated sense of self-worth. Just as I have known some MDs that think they are gods when in their hospital, I have known equally many PhDs who think they are gods when in their department/lab. As far as the students go, I would imagine that either residency or life beats some of the arrogance out of most of them, which is why you don’t have even more arrogant prick MDs than you do.

    I do think the average MD is held up on a pedestal by the general population (in terms of esteem and compensation), and this does rub a bunch of the PhDs the wrong way (including me, I’ll be honest–if I have to hear “Well, you’re not a REAL doctor” one more time I’ll scream), but most MDs seem to not let this general adulation get to them. I cannot speak as to the differences between surgeons and other medical specialties, as the pre-meds and med students I work with are not yet specialized, and I don’t work with or personally know any surgeons.

  25. #25 Orac
    July 25, 2008

    if I have to hear “Well, you’re not a REAL doctor” one more time I’ll scream

    If I hear “Well, you’re not a REAL scientist” one more time I think I’ll scream too. :-)

  26. #26 Prometheus
    July 25, 2008

    I believe that this is a “Hasty Generalization” fallacy combined with what seems – to this amateur psychologist – to be a large dose of “physician envy”.

    To be sure, what this particular orthopedic surgeon did was immature and – legally speaking – an assault. At the very least, he needs some disciplining (from the Medical Board and the Medical Staff Office) and a nasty lawsuit. No doubt, he will get them.

    To then generalize from this one, small sample to “all surgeons” and even “all physicians” is a fallacy, plain and simple. That “PhysioProf” felt the need to do so speaks more to his/her own “issues”.

    I, too, have worked at a large university medical center and seen the arrogance of some physicians. I have also seen the hours they work and the stress they’re under. Compared to that, worrying if my DNA ligation is going to work seems trivial. Also, I never get a call in the middle of the night telling me that I have to forsake my soft, warm bed and go check on a bacterial culture that “doesn’t look good”.

    Would I prefer that the physicians in the university were – on average – less arrogant? Yes. Would I also prefer that the senior faculty members in my own department (none of whom are physicians) were less arrogant? You betcha!

    Physicians, in my considered professional opinion as a biologist, are human. And like most humans, their physical and mental characteristics fall along a spectrum. Some are arrogant, rude and condescending (so are a number of tenured non-physician faculty) and others are self-effacing, polite and considerate (ditto).

    That surgery may attract relatively more of the arrogant type is a hypothesis that remains to be tested, although my perception is that it does. This may be due to the amount of courage needed to actually cut someone open to fix them.

    Anyone who hasn’t had to make that decision (operate/don’t operate) and then live with the results shouldn’t be too hasty to judge. I’d prefer an arrogant surgeon who can make that decision to a polite one who can’t [note: “False Dilemma” fallacy] any time.

    As for “PhysioProf” – he/she should seek out some professional help to resolve his/her issues (a PhD psychologist would be a good choice).

    Prometheus

  27. #27 AnnR
    July 25, 2008

    Reminds me of a scene from “Love in the Time of Cholera.”

  28. #28 Samia
    July 25, 2008

    I like how the surgeon’s lawyer called the woman’s complaint offensive. That tickled me.

  29. #29 Rakky
    July 25, 2008

    I’m a chemistry research fellow who has wandered into more medical research in the last couple of years and now finds herself working with as many MDs as PhDs. Far from feeling any resentment, I feel pretty lucky to have two sets of skills to draw on for help and resources. And to be able to combine the two in the way Orac does must be both fantastic and bloody hard work.

    I’ve certainly met doctors who thought they were above ‘mere mortals’, though oddly, they were generally the ones whose skills I didn’t rate. I’ve also met plenty of basic scientists (indeed I worked for one last year) who were convinced *they* could cure Alzheimers and all these MDs were just missing a trick that we scientists could uncover as we didn’t have to waste our time with patients.

    What irks me most is that I would hope that we were all trying to achieve the same goal, that being discovering something that might potentially save or improve the quality of people’s lives. The pay in my field is poor, the job security is tenuous and my chances of ever having a normal family life grows ever more unlikely by the day, but I wouldn’t swap this job for anything. In-fighting like this does nothing to strengthen the public’s trust in science or medicine.

    *runs off crying “but why can’t we all just get along…”*

  30. #30 amhovgaard
    July 25, 2008

    There’s a lot of chronic, annoying-but-usually-non-fatal illness in my family (mostly allergies, asthma and autoimmune conditions), so I’ve met many MDs… and I’d have to agree that, in my experience, on average, they are somewhat more arrogant than most. But (again: in my experience) surgeons are a lot less arrogant than primary care MDs. In fact, I can’t recall more than one or two I would describe as arrogant (out of 20-25) – probably below the population norm! I suspect this may have to do with the fact that so many of their patients are very ill, and they can’t always save their lives. Whereas those in primary care have to spend a fair amount of their time telling people like my 75 year old mother-in-law that they don’t have AIDS or the bird flu or whichever cancer is most popular this week.

  31. #31 Dianne
    July 25, 2008

    If Kischner’s action proves that all doctors are arrogant twits, does this incident prove that all EMTs are racist twits?

  32. #32 Jon H
    July 25, 2008

    DM and PP tend to act as though they themselves are specimens of optimal human behavior in terms of career choice. For instance, DM’s opinion that if you’re a scientist, and you opt for a career that is short of DM’s lofty heights of achievement, then you must not have been any good as a scientist.

    I think their angst against doctors is due to the rest of the world failing to agree that DM and PP are the Platonic Ideals of human achievement.

  33. #33 Sandy
    July 25, 2008

    I just find it amusing the righteous indignation displayed by Orac, et al, regarding the “ridiculously overblown rhetoric” of their fellow SBer… It really seems to have touched a raw nerve, eh? heh heh heh…

  34. #34 DLC
    July 26, 2008

    Re: the fool with the rub-on tattoos: I wouldn’t go so far as to call it assault, even though it was an unwarrantable liberty. It’s one thing to stick a cartoon-character bandaid over an injection wound, it’s quite another to stick a tattoo down near some woman’s privates. In the future, the surgeon concerned should stick with the batman bandaids.

    Re: PhysioProf’s reaction: A bit overblown if you ask me.
    Every profession has it’s share of primadonnas and petty gods.
    The ones in medicine seem to get noticed more often.
    (The TV drama “House” comes to mind)

    Re: Orac’s reply to PP’s rant: I think you’re right to point out that it was somewhat overdone.

    I’m not a “Real” scientist. I could explain why, but not in a public forum.

  35. #35 Orac
    July 26, 2008

    Sandy,

    See my response to PP and DM re: the “hit a nerve” gambit.

    In other words, it’s doggerel, and lame doggerel at that.

  36. #36 Phoenix Woman
    July 27, 2008

    Lemme guess: Somebody read some of Richard Hooker’s M*A*S*H books and as a result thinks that all surgeons are deeply sexist hyperconservative egomaniacal jerkwads?

  37. #37 themadlolscientist, FCD
    July 27, 2008

    If I woke up from surgery to find I was sporting a tattoo, even a fake one, I’d totally FREAK.

    [1] I don’t understand why anyone would want to draw anything permanent on themselves. (Writing a note to myself on the back of my hand, yes. I do that fairly often – but that washes off.)

    [2] I know from experience that if I were still groggy from the anesthetic, I’d hardly be in possession of enough of my senses to realize the thing was fake.

    [3] What Orac said about “private anatomy.” Tattoo goes WHERE?!?!?!?!?!?!

  38. #38 Phoenix Woman
    July 27, 2008

    Welcome to the killfile, Sandy. Thanks for playing!

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