Oops.

Some of you may be familiar with the stereotypes of medical specialties (nicely illustrated by Michelle Au over here). Surgeons are mostly loud people who love ‘doing things’, internal medicine docs will agonize over 0.01 change in obscure lab values, psychiatrists are hippy softies etc.

While part of this is making fun of ‘the others’, knowing a bit about each specialty helps you to properly frame requests and also to know what someone will or won’t do. ‘He’s a typical surgeon’ tells you that he won’t hesitate to act but doesn’t enjoy lengthy thinking about labs and differentials. Surgery is not going to manage someones insulin so you should make a plan for them and not expect them to learn how to do it themselves. ‘Maybe we should hold off on the internistic thinking for a while – what do we actually know about this patient’s social situation?’ would also be a valid contribution to grand rounds. The day to day use of these descriptives is so ingrained in my daily practice that I sometimes forget that the lay public has a very different perception of all of this.

‘I’m most definitely not a surgeon,’ I told the people who were going to host me during my final rotation. ‘Not my kind of people,’ – it’s true, I’m introverted, less brash. This got us off on the wrong foot from the start: their neighbor had just retired as a surgeon in the local hospital and they knew him as a kind man who would often cycle back to work after dinner to visit next day’s surgery patients. I know that that was either poor planning – patients are usually admitted in the afternoon and it’s not very nice to let them wait for hours – or he would just return to the hospital because he was on call. But in their perception, all surgeons were awesome people, so me saying something akin to ‘I don’t like surgeons’ was very offensive for them.

In another instance, I was discussing a case of unexplained illness and I remarked ‘of course, it was a typical internist -‘ and then I was fully reamed out, as that person had a relative who was an internist and they love piecing the puzzle together, searching for a diagnosis – how could I say that about internists because I know they will not give up- well, sorry, yes, they will. If all the labs and tests are normal, a typical internist will insist everything is fine and if you are still feeling ill, maybe a psychologist is a good idea. There are very few doctors who take ‘unexplained symptoms’ as a challenge and feel personally responsible to manage their care. Consult to psychiatry with no follow-up is the common solution, unfortunately.

I work in a patient population which spends years looking for a diagnosis (‘tiredness ”upset stomach’ ‘weird skin rashes’) and then suddenly gets diagnosed with a terminal illness when all the pieces are finally there. So this kind of hit close to home – reality is often far from the ideal world in which all doctors continue to feel responsible to their ‘difficult’ patients. We keep letting patients slip trough the cracks of the system because we don’t understand whats wrong with them. But that only reflects our ignorance!
These two interactions really opened my eyes to be a bit more careful regarding the stereotyping when speaking with lay people – some things just can’t be explained in a short conversation. In both instances I didn’t feel comfortable to try to convey my viewpoint because of the vehement reaction. I know what surgeons and internists are like, I’ve done four months worth of rotations in each plus a half year sub internship – and I want to become an internist myself (but with a special focus on unexplained complaints). I certainly don’t ‘hate’ surgeons  – now I’m not a clerkship student anymore I actually rather like interacting with them. But I’d be lying if I said that I was a typical surgeon (on my evaluation, the head of department wrote ‘not a typical surgeon, good luck in internal medicine’ – end of discussion 🙂 ).

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