Wednesday, June 30, 2004
McMed School Full of Sociopaths?
Towards the end of my first year, I experienced one too many shopping-cart-left-in-the-middle-of-a-parking-stall-type incidents (done because you're bags are in the car, you're leaving and are not currently looking for a parking space, somebody else [one of the servants] will move it, and nobody's going to confront/punish you. A primitive ethic derived from a superficial/punishment-avoidance/pleasure-seeking/play-everything-on-the-margins paradigm, as opposed to a more developed/civilized/meta-cognitive/greater-good paradigm) with my class mates, which led to the following rant:
Uncle Reemus tells a story where acting out on one's outrage can get one completely stuck in a tarry trap. My writing this is an attempt to get a little clearer about all of this, and not just haul off and punch the "Tar Baby."
That being said, I, naively enough perhaps, bought a bill of goods labelled "ethics" all over. Well, I'm here and I feel instead like I'm working in the Enron Accounting Department in the late 90's. At-large, everything seems like a cynical game; there doesn't appear to be a commonly held notion of voluntary, intelligent activity for the greater good; and it appears that service that doesn't get you something - C.V./Dean's letter entry, a letter of recommendation, etc. is for "suckers;" if no one's looking some will just take the copy of the past test from the copy room rather than make a copy for the next person; classmates take semi-guarded stuff even if someone is looking with incredible gall (mostly food intended for event attendees, or worse food for interviewees away from home); Medical Ethics as a course is openly held in contempt; etc.
My attribution is that the average medical student is a selfish, entitled, disingenuous, corner-cutter. My main concern is that if they indulge themselves to limited resources set aside for the vulnerable, e.g., take food for traveling interviewees, what stops these same people from talking patients into unneeded proceedures, abandoning them, or copping a little feel. If poeple don't have the equipment to refrain from minor unethical behavior with small rewards, what makes anyone think the same people have the equipment to refrain from unethical behavior with larger rewards?!
I am aware of the peer review apparatus; I have just submitted my first concern and I'll see how the process works in pratice. I have watched these phenomena wanting them to be isolated, aberrant anomolies. I didn't submit any of the unethical incidents I witnessed, while I took in the lay of the land. The creepy part is since nothing has changed for the better, I suspect virtually no one else has either. I have a growing sense that the collective process has been to allow, by degrees, the lowest common denominator to plumb the depths of the outrageous, while the group normalizes the sub-standard, and then no one seems sure if any particular outrage before their eyes is really outrageous enough to report - a very slippery slope. And if you do report will you be dismissed as a whiney prude at best, or a "rat" at worst for reporting a "normal" behavior?
A complication in my discernment and subsequent activity is that I come from a military background. And while there are problems brewing at all times, everywhere in the military, they tend occur in pockets, often hidden from view. However, military types won't put up with their boss lacking integrity - makes for the led becoming cannon fodder for a crooked, careerist boss, and everyone knows it. When subordinates figure out their leader is not to be trusted, the train comes to a surprizing, abrupt halt, and the offical processes of bypassing the chain-of-command are activated. When in doubt, people get administratively relieved of duty; military justice issues are a little trickier. When a boss finds out a subordinate is crooked, action is usually swift; if not, the boss who doesn't act is at grave risk of "going down" too. For instance, while I could be wrong on this one, I am fairly certain that many more heads, than the press will ever know about, have and will roll over the Abu Ghraib scandal. I struggle with having lived with what seem like noble standards that are just too high for the civilian context. And so, I often second-guess my attributions as contextually inappropriate.
For over 10 years, I have been acculturating to the seedier, "real" world. However, to my mind, the physician vocation has similarities to the military vocation at the wider, cultural level. The vocation is imbued with status, perrogatives and power along with reciprocal trust, expectations and responsibilities. Yet, I am aghast at the collective ethic of my peers. It seems like the game is get the goodies, and if one absolutely has to, then make minimum token gestures at the reciprocities, but get the goodies at all costs, before someone else beats you to it - very late Roman Empire.
Police departments psychologically screen applicants for sociopathy, etc. If the profession is at-risk, as it seems to be, is there a prohibitive risk-benefit ratio of instituting a similar apparatus for medical school applicants?
Did I join the wrong club? I am at a loss as to how to negotiate what appears, at least to my eyes, at present, to be a disappointing sham.
Uncle Reemus tells a story where acting out on one's outrage can get one completely stuck in a tarry trap. My writing this is an attempt to get a little clearer about all of this, and not just haul off and punch the "Tar Baby."
That being said, I, naively enough perhaps, bought a bill of goods labelled "ethics" all over. Well, I'm here and I feel instead like I'm working in the Enron Accounting Department in the late 90's. At-large, everything seems like a cynical game; there doesn't appear to be a commonly held notion of voluntary, intelligent activity for the greater good; and it appears that service that doesn't get you something - C.V./Dean's letter entry, a letter of recommendation, etc. is for "suckers;" if no one's looking some will just take the copy of the past test from the copy room rather than make a copy for the next person; classmates take semi-guarded stuff even if someone is looking with incredible gall (mostly food intended for event attendees, or worse food for interviewees away from home); Medical Ethics as a course is openly held in contempt; etc.
My attribution is that the average medical student is a selfish, entitled, disingenuous, corner-cutter. My main concern is that if they indulge themselves to limited resources set aside for the vulnerable, e.g., take food for traveling interviewees, what stops these same people from talking patients into unneeded proceedures, abandoning them, or copping a little feel. If poeple don't have the equipment to refrain from minor unethical behavior with small rewards, what makes anyone think the same people have the equipment to refrain from unethical behavior with larger rewards?!
I am aware of the peer review apparatus; I have just submitted my first concern and I'll see how the process works in pratice. I have watched these phenomena wanting them to be isolated, aberrant anomolies. I didn't submit any of the unethical incidents I witnessed, while I took in the lay of the land. The creepy part is since nothing has changed for the better, I suspect virtually no one else has either. I have a growing sense that the collective process has been to allow, by degrees, the lowest common denominator to plumb the depths of the outrageous, while the group normalizes the sub-standard, and then no one seems sure if any particular outrage before their eyes is really outrageous enough to report - a very slippery slope. And if you do report will you be dismissed as a whiney prude at best, or a "rat" at worst for reporting a "normal" behavior?
A complication in my discernment and subsequent activity is that I come from a military background. And while there are problems brewing at all times, everywhere in the military, they tend occur in pockets, often hidden from view. However, military types won't put up with their boss lacking integrity - makes for the led becoming cannon fodder for a crooked, careerist boss, and everyone knows it. When subordinates figure out their leader is not to be trusted, the train comes to a surprizing, abrupt halt, and the offical processes of bypassing the chain-of-command are activated. When in doubt, people get administratively relieved of duty; military justice issues are a little trickier. When a boss finds out a subordinate is crooked, action is usually swift; if not, the boss who doesn't act is at grave risk of "going down" too. For instance, while I could be wrong on this one, I am fairly certain that many more heads, than the press will ever know about, have and will roll over the Abu Ghraib scandal. I struggle with having lived with what seem like noble standards that are just too high for the civilian context. And so, I often second-guess my attributions as contextually inappropriate.
For over 10 years, I have been acculturating to the seedier, "real" world. However, to my mind, the physician vocation has similarities to the military vocation at the wider, cultural level. The vocation is imbued with status, perrogatives and power along with reciprocal trust, expectations and responsibilities. Yet, I am aghast at the collective ethic of my peers. It seems like the game is get the goodies, and if one absolutely has to, then make minimum token gestures at the reciprocities, but get the goodies at all costs, before someone else beats you to it - very late Roman Empire.
Police departments psychologically screen applicants for sociopathy, etc. If the profession is at-risk, as it seems to be, is there a prohibitive risk-benefit ratio of instituting a similar apparatus for medical school applicants?
Did I join the wrong club? I am at a loss as to how to negotiate what appears, at least to my eyes, at present, to be a disappointing sham.
I wanna play, too!
So, my narcissism has gotten the best of me. I fancy myself having the insight, discpline and time to blog about my experiences as a med student. We shall see. I am older than most med students and have seen and done many things before embarking on this quest. I volunteered for this, but I am fairly disappointed in what I see around me. So, the themes I anticipate emerging are disappointment and disillusionment. Hopefully, in this process, I'll be able to withdraw my projections, own my Shadow, and make peace with a process of, by, and for people.
