The Hierarchy of Medicine & Minding The Gap

Medical careers have always had somewhat of a tough, rough and tumble appeal.  It’s difficult to get accepted, get through school, residency, fellowships, boards, etc etc. We’re all these type A, rise-and-grind people. Whatever your particular career may hold, whether you are a nurse, doctor, PA, NP, Pharmacist.  The culture of medicine is BRUTAL and our jobs are difficult enough, so I pose the question: why are we making it more difficult on each other?

Who remembers being a PA/RN/Medical Student and being terrified of Residents or Attendings?  Allow me to raise my hand first. I cannot help but think how backwards this is.  Think about it, we are in a field that most people would say they enter to “help people”.  That is what we write in our personal statements and tell admissions committees I guarantee it. So, if we are truly in the business of helping people and “working as a team” why am I getting yelled at for calling an on call Fellow Physician at 2am? Why do I hear providers yelling at nurses? Confession: I’ve done this. Second confession/further information: Don’t page me “Pt has a fever.  Please advise” when they already have Tylenol ordered. (If I had a dollar…)

Ok, anyways I’m getting off track. When did medicine become a culture of “I’m higher up than you so I can yell at you/treat you like crap?” Back to that 2am call to a Fellow Physician: If you do not want to be woken up, don’t be a GI doctor– it will require call. Second, since when did I have to apologize for waking someone up because I have a patient that truly needs you to get your ass up and come in and do something?  You chose this, you wanted to pursue this career and help patients.  Get up. Put on your shoes and get your ass to the hospital. No, I didn’t say this– but I thought about it.

Perhaps the greater question is: Does this behavior and interactions harms patient care?  Especially in a hospital setting at teaching institutions where environments can be quite cut throat and hostile.  Residents fighting for cases, PA’s trying not to get their ass chewed out by fellows and attendings, providers getting pissed at nurses, nurses getting pissed at CNA’s. etc etc.

Like I said, have I been guilty of being an asshole when I’m dead tired and can’t handle another trivial request? Yep, sure have. Am I proud of this? No.

Listen, the reality about medicine is that you deal with people all day and it gets rough and sometimes you lose your shit.  (I hope I’m not alone here) Have I let this realization alter me for the better?  Sure have.

I’ve been reading a lot of Brene Brown’s work lately.  In one of her books (I think it was “Daring Greatly”) she talks about how you are not who you say you are or who you want to be.  You are only what you do.  The difference between this, she refers to as “minding the gap”. The space between who you are/what you actually do and who you want to be/what you actually do. 

Everyday I look at my fridge where I have a dry erase board that says “Mind The Gap”. And I think about the person I want to be in the present and how I want to become better every day.  Am I perfect? Hell no.  Am I trying? Hell yes.

 

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