Young doctors gathered around the beer machine

Originally published in MedPage Today

by Charles Bankhead

From time to time, I hear a “mature” person lament the sad state of affairs of the “next generation.” Sometimes I wonder whether the same concern should apply to the next generation of doctors.

Young doctors gathered around the beer machine I was at a cardiology meeting, and my schedule included a breakfast program. As I headed toward the meeting, I passed some vending machines at my hotel. I heard a commotion, and turned to see a half dozen or so young men gathered around one of the machines. At medical conferences, as you’re no doubt aware, different categories of registrants wear name badges that have distinctive colors or ribbons. Members of the press usually get gaudy-looking badges that stand out in a crowd, so other people can spot us easily and run. From the color of the young men’s badges, I surmised they were residents and fellows.

As I moved closer for a better look, I saw the object of the commotion: a vending machine that dispensed canned beer. The conversation went something like this:

“Dude, look! A beer machine!”

“No way!”

“I’m not *****ing you! It’s a beer machine!”

“Awesome! I gotta have some of that!”

As I watched, one of young men deposited some money in the machine and pushed a button. The machine made a kind of whirring noise, and I heard something akin to a door opening. The young man bent over, and when he returned upright, he held up a shiny can of cold beer for all to see. He popped the top and took a long swig, as his companions stood around him, eyes and mouths agape.

“Sssweet!”

Much oo-ing, ah-ing, and whoa-ing ensued, followed by a mad scramble among the remaining young men to find alms to offer this deity of hedonism.

One by one, the men repeated the ritual, until each held his very own can of beer. As they drained the cans and vowed to return often to worship at this altar, something told me this wasn’t the first time they had consumed beer before breakfast.

And then a thought occurred to me: One day I might have to entrust my heart to the care of these young men.

I found the thought unsettling.

On another occasion, I interviewed a resident about some good deed he had performed. I’ll remain vague, so as to protect the innocent — namely, me. I asked whether he had had any help with the task. He replied, “No, I was the onliest one there.”

I looked up from my notepad, and to make sure I had heard him correctly, I asked, “You were the onliest one there?”

“That’s right,” he replied, “no one else but me.”

Well, I thought, I guess the verbal portion of the MCAT really isn’t all that important to being a doctor.

Finally, no tale of medical misadventures would be complete without a trip to the hospital. My wife was in recovery following a day surgery laparoscopic cholecystectomy to rid her of a troublesome gallbladder. I was sitting at her bedside reading, when a young man in scrubs and with a stethoscope around his neck strode confidently into the room, clipboard in hand. Without a word, he walked to the bed, pulled back the sheet, lifted the bottom of the drape covering my wife, pulled it back, and peered underneath.

Judging from his gaze, I knew he wasn’t looking high enough to check the incisions for the gallbladder procedure.

“Who are you?” I asked.

For the first time, the visitor looked at me and replied, “Dr. So-and-So, Chief Resident.”

“Well, chief,” I said, “you’re looking in the wrong place.”

“Are you a doctor?” he asked, with the slightest of smirks.

“No. I’m her husband and we’ve had three children together, so I know which end is which, and you’re looking in the wrong place.”

The chief looked back at his clipboard and then at me. “This is Mrs. Jane Doe in Room 307.”

I couldn’t tell whether it was a question or a statement. “No, I said, it’s Mrs. Bankhead in Room 407.”

The chief looked down at the clipboard again and began tapping his pen on it. When the pithy comeback he sought didn’t materialize, he turned quickly and walked briskly out the door without a word.

By this time my wife had awakened, and she asked, “Who was that?”

“The tribal chief,” I replied.

Just as I was beginning to think that I should die before one of those doctors does me in, something happened to restore my faith in the “next generation.” I went to New Orleans recently and found that the city, including its healthcare services, is still recovering from the effects of Hurricane Katrina, more than five years after the fact. I learned about remarkable acts of generosity, compassion, and selflessness. I learned that some of the very first healthcare providers who returned to New Orleans were residents at Tulane University Medical Center. They set up makeshift clinics anywhere they could find the space. They cared for patients who had nowhere to go. Hospitals in the area were closed for weeks.

The residents who staffed these street-corner clinics, sometimes with no more than a table and a few chairs or a tent, were principal care providers for weeks. They handled scheduling, coordinated supplies, performed whatever triage was possible under the circumstances. They did all of this when most of them had no place to stay, no ready access to food or water. By all accounts of faculty members who pitched in, the residents ran the show and did whatever was necessary to provide care to patients in need, and they did it without complaints or self-pity for their personal situations, which were as dire as those of many of the patients they saw.

The clinics provided the impetus for a citywide network of neighborhood clinics to care for people who once received primary care at a hospital ER or outpatient clinic. Physicians, medical students, and students in other healthcare fields have regular rotations through the neighborhood clinics. Though the term has become almost a cliche in medicine, the efforts of those residents in the early days after Katrina led to a new paradigm of healthcare delivery for much of New Orleans.

The story of the Tulane residents is not an isolated incident, I’m sure. I hope I can remind myself of that the next time I see a group of young doctors gathered around beer machine.

Charles Bankhead is a staff writer at MedPage Today and blogs at In Other Words, the MedPage Today staff blog.

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  • http://amanzi-mtoti.blogspot.com amanzimtoti

    If they were at a conference and not actually at work, I don’t see what the problem is. Most doctors, especially residents, hardly ever get time out to just let loose.

  • ninguem

    Beer machine? WTF? Where was this?

  • Susan

    I work at a very prestigous medical school . . . I will not soon forget commencement day a couple of years ago . . . standing on the light rail platform were many graduates, in full cap and gown, one of which was swigging his budweiser in plain view at 7:55 a.m. Pray to god he never treats any of my family.

  • Matt

    @Susan: why does the way that someone celebrates or relaxes, when celebration or relaxation is appropriate, have any bearing on how someone practices their profession? You would have to prove first that said graduate was drinking at 7:55am prior to practicing medicine for there to be any concern about his ability to separate drinking and working. I think you are being too harsh. I admit that his display may have been unprofessional, but that does not imply incompetence.

  • Vox Rusticus

    Susan,
    On this medical student’s graduation day, after finishing something more difficult than most people have ever done, you begrudge him a little celebration What made you think he was on duty? In a cap and gown, no less?

  • Bill and/or Ted

    The story about the beer isn’t about drinking, it’s about the residents acting like they are 14 years old. Getting excited by a beer machine?

  • Peter

    Let’s not take everything so seriously. Doctors are human. If one comes into a treatment room reeking of alcohol, by all means walk out and report him but not if they’re off-duty

  • TrenchDoc

    If you can party all night then you can work all night. It is and will remain survival of the fittest.

  • jrm

    Residency is the world’s most absurd prolongation of adolescence. And you’re surprised that a bunch of residents would act like 14-year-olds when they’re off duty? No one who hasn’t been through it has the right to say a word about it.

    Those Tulane residents are heroes. Reminds me of the sign in the lab of the pedi clinic at the old Ben Taub hospital in Houston in the ’70s: “We have done so much, for so long, with so little, that we can now do anything with nothing.”

  • http://www.consentcare.com Martin Young

    I agree with the comments of support about the beer drinkers. The chief resident’s impersonal behavior however is unethical and unforgiveable. Because a realy bad attitude towards patients is shown!!

    We do difficult jobs in imperfect situations. If we compensate with overexuberace in our non-clinical time, so be it!!

    it’s time for everyone, senior colleagues included, to cut young doctors, the real workers, some
    slack!

  • Bill and/or Ted

    “Residency is the world’s most absurd prolongation of adolescence.”

    So residency doesn’t steal your childhood like everyone says?

  • PAUL MD

    As a middle aged ex-animal house frat guy from a state school where “work hard play hard” was the unwritten motto, I was delighted to hear of the simplistic jubilation of some of my soon to be peers enjoying some downtime while at a conference.

    The beer machine is just a unique but arbitrary alter to practice one of the most treasured aspects of any intense training or situation: cammeraderie.

    The best gift that this beer machine could give would be to find its clones in other places (see hospital physician staff meetings) to jump start some cammeraderie among the now all too bitter and contentious medical staffs across the country.

    Never trust anyone over 40 is crap. I would never trust anyone who would pass by a beer machine without at least a grin and a contemplation to enjoy its gifts with friends.

    The behavior of the resident at the bedside, however, is appalling. No beer for him!

  • joe

    “Residency is the world’s most absurd prolongation of adolescence”

    Actually having done both I would say it is closest to military basic training (without the exercise and the rifle).

  • Hospitalist

    Bill and/or Ted – not one said it steals your childhood. Just your young adulthood.

    This reminds me of some of my friends who went to the military academies having difficulty in social situations because of the four years they spent doing what everyone told them to. They used to joke that they were always going to be 4 years behind in fashion.

  • alex

    Honestly, if you get heart palpitations from the idea of late 20s male doctors finding the idea of a beer dispenser awesome, I don’t want you as my patient any more than you want me as your doctor. Thankfully, by making sure all your doctors are over 60 we can both be happy. See, no need for further screeds!

  • Bill and/or Ted

    ” Thankfully, by making sure all your doctors are over 60 we can both be happy.”

    So we agree. I prefer older doctors. I believe it is a generational thing. They seem to care more and provide better care. I dread the day I have to deal with the next generation of doctors.

  • researcher

    Although I have not conducted any rigorous study to show this, as a health professional observing this type of behavior over the years, it has been my experience that this type of “childish” behavior (getting excited about a beer machine and drinking DURING a conference) generally does spill over into practice. For years, I have observed young residents and found those that engage in this type of behavior (constant partying, college type pranks, bragging about their conquests, having fart contests, etc) are the same ones that laugh and make jokes about patient’s private parts, spend more time discussing their extracurricular activities than the medical case at hand, ogle young nurses or other medical staff, generally show disrespect to both patients and staff, and laugh about the misfortunes of others. Yes, their technical skills (diagnostic skills, surgical competence, etc) are generally not in question, but other medical staff generally do not like to work with them and more than one patient has taken offence (even more would if they knew how these doctors were using them as the butt of jokes). These residents are immature and although it does not necessarily make them less competent, it does make them less human, imo.

  • ninguem

    Heck, I’m “excited” by the beer machine. In that I’ve never seen one before. Guess I don’t get around.

    How does the machine owner, and the location where the beer machine is placed, get past liquor control laws, underage purchasers and all that?

  • Craig

    There is no excuse for poor behavior regarding patients. But when it comes to down time, I think it is sad that the public assume doctors aren’t human. If a doctor doesn’t find a healthy way to let loose, I would be worried. The fact that someone wouldn’t go to a doctor because there is a picture of them with a beer during graduation (one of the few times even people who don’t even drink, drink), is totally ridiculous. I bet this same person who expects so much from his or her doctor, still doesn’t even follow his or her advice to stop smoking, eat right, and exercise.

  • Rxlady

    Wow, you think this is bad. You should see how PharmD candidates party at one school in north after 6 years or 8 years for those who transferred in. You have been under such constant stress for so long, you are entitled to let loose and have some fun when it is all said and done.

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