Reminding medical students and residents to shake off the cynicism

Attending physicians have great responsibility. We have ultimate responsibility for patient care and for medical education. Medical education involves sharing facts, the thought process and bedside manner.

Recently we had a “frequent flyer” admission. For a few years, the housestaff labelled this patient as non-compliant – and even wrote it in his chart. He is young (less than 30) and has a chronic disease. He had multiple admissions and often left against medical advice. Several years ago I saw him and realized that he in fact was doing everything he could to manage his disease and convinced the residents to treat him with more respect.

He does not get admitted as often these days, but here he was on my admission list. I like this young man, and have connected with him in the past. Prior to seeing him I told the students and residents the story. I explained that he had an understandable reaction to feeling disrespect.

As usual he and I connected. I view him like a son. I like this young man, and I believe it shows. Too often we assume that “frequent flyers” are responsible for their readmissions.

But it is not our job to blame. We have a responsibility to take each admission and do the best we can for the patient. We have a responsibility to do our best for the patient and to imagine ourselves or a loved one in that patient’s shoes.

So I treated him with the respect he deserves. And his responses as usual were kind.

Later that day I had a discussion with an intern. He thanked me for reminding him to understand and shake off the cynicism. Students and residents often become cynical, but we who function as role models can modulate that cynicism. We can help – and helping them work through the tendency towards cynicism is our responsibility to residents, students and their future patients. We have to try – and sometimes we even succeed.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

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  • Margalit Gur-Arie

    This is also good advice for government, and other learned pundits, who arbitrarily label readmissions as wasteful and punishable by fines and public shame…

  • dsblanchard

    My recently-graduated primary care physician still hasn’t been able to shed his cynicism and God complex. If I were younger and had more energy, I would be up for the challenge, but I really need a caring and compassionate physician right NOW. Thanks for the ‘right-on’ piece.

  • Rob Burnside

    A good, and very valuable post. Familiarity breeds contempt–sometimes!

  • jere14

    Every fat person gets treated with disrespect by physicians. There is a good reason why fat people fail at dieting. It is happening to all your fat patients but do you care to look beyond the common accusation that fat people are gluttons and have no will power. When someone restricts calories the body thinks there is a famine and adapts appropriately by becoming hungrier than ever to prompt that person to add additional weight when food is available. The research is there if you are willing to look carefully and discard all of the scientific misconduct that exists.