* * Anonymous Doc

Tuesday, July 6, 2010

Okay, new theory. The road to becoming a doctor is like a crash course in corporate hierarchy. Usually you don't go from floor-sweeper to middle management in a year-- and with no time to adjust. And, who says the people who are good at doing stuff are necessarily going to be good people-managers. The reason a lot of my residents were hard to deal with is because being a resident is a silly job that doesn't have a lot to do with how good a doctor someone is, and how much medicine they know. Okay, it has something to do with it-- you're going to be a terrible resident if you don't know your medicine and you can't make the right calls about your patients and what needs to be done. I guess I'm just saying that the medicine, while necessary, is by no means sufficient. A week ago, I was spending my day taking orders and executing. Now I need to spend my day doing things like "keeping my interns motivated" and "being a good leader."

A week ago, I would complain the job was too much like being a secretary. Now, it's too much like being a summer camp counselor. I brought cupcakes for my interns! Cupcakes! I am a grown man, and I went to a store and bought cupcakes just so I can be the "favorite" resident and the interns will like me. You know why? Because I had to spend all day yesterday listening to the interns complain about how mean my co-resident is (it was her day off) and how they hate her. And I don't want them to spend my day off complaining to everyone about me. "She made us draw blood on our first day!" Yeah, drawing blood sucks, and the nurses should do it, but they don't. And not that I love my co-resident, but she's fine, and she doesn't deserve to be bashed all day. And, yeah, back oh so long ago when I was an intern, sure, I complained about the residents, but, ugh, I'm bribing them with cupcakes. Is this what doctors should be doing? Buying cupcakes?

I think maybe I'm more tolerant than my co-residents because it's not as if I came in as an intern with a ton of confidence about my clinical skills. I expect the interns are going to be slow and know nothing. I expect their instincts aren't going to be right yet. I'm much more competent than I was a year ago. I don't expect my interns to necessarily be better than I was, so I'm not surprised when they're not. I don't expect them to know things I didn't learn until 6 months in, so I don't care if they don't, and I'm happy to teach them. I think my co-residents expect fully-formed doctors on day one, and don't know how to babysit and train. And on the one hand, good for me that I can manage my expectations and do the job of a camp counselor. But on the other hand, it doesn't make my co-residents bad doctors because they don't know how to teach. No one taught us these skills, no one gives us a handbook, we're not evaluated for residency based on how well we're going to teach the people below us.

And that's maybe a problem with the system. In medical school, you're taught by teachers. At least nominally, the doctors teaching us are actually teachers. There has been some weeding out process, some self-selection about who goes to a teaching hospital and teaches med students, and some hiring and evaluation process. If you're not interested in teaching, you probably end up somewhere else. Good, fine, doesn't make you a bad doctor. But then in residency there's no less teaching going on-- it's just that your teachers have no experience, training, or, in many cases, desire to be teaching. EVERYONE has to have a residency to be a doctor. So EVERYONE ends up having to teach people below them, no matter what you want to end up doing, no matter whether you're a great doctor/mean person, or anywhere on the continuum. So the system is screwy. Intern year sucks because most of the people who are supposed to teach you aren't good teachers and don't want to teach. And then residency sucks for all of those bad teachers, because they're forced to spend most of their time teaching instead of doing.

I hate cupcakes. I really do. They're so sickeningly sweet, I don't know, it's not that I don't like dessert, but cupcakes are so one-dimensional. But people like them, right? It makes me the good cop if I bring them cupcakes while my co-residents yell about blood draws, right? And I get to feel nice and smug that I'm the good resident and my co-residents are the enemies. Should be a fun month!


  1. The floor sweeper to middle management scenario you describe is very much how it was at Genentech in the early days: I worked there in the early, early days, before they even had a product approved. My co-workers were former nurses and my bosses were MDs (oncologists). I was neither, and I remember thinking to myself, WTF??? in terms of how the place was run, "team leaders", "team players" and other bizarre and arbitrary hierarchical constructs aimed at getting the job done. I survived it by basically ignoring it. But since it was the clinical research department, I think it was modeled on the hierarchy you describe. And yes, there were always cupcakes. . . It helped somewhat.

  2. Usually you don't go from floor-sweeper to middle management in a year

    Ah! Based on your reports, I was mentally starting to think of doctors as some kind of highly paid slaves with working conditions worse than a McDonald's worker. But it's all going to change, isn't it?

  3. I've done middle management. Cupcakes are never really about cupcakes. It's a way for you to say 'I am willing to make the effort to listen to you.' Maybe it also says 'Hey, I may not communicate as well as I'd like, but I'm trying', but the main message is 'Willing To Try'.

    By the way, Home Baked is better than Store Bought and Store Bought on a nice plate or serving dish from home is better than Store Bought right out of the package. Both of these say 'I think of you even when I don't need something from you'.