Dissent Will Not Be Tolerated
You are about to run the guantlet of the vast subculture in medical education devoted to sensitivity training. Your personal views, the values instilled by your parents, or your religious beliefs are about to be dismissed as detrimental to your functioning as a physician. All of these must be replaced by the latest politically correct memes fresh from the minds of pseudo-educated hacks with way, way too much time on their hands since they achieved tenure.
This training will come at you in various guises. It will be easy, of course, as reflects the shoddy academic credentials of its proponents and if you are hard to intimidate it can be a lot of fun once you get over the the fact that large chunks of your medical education are being wasted on this kind of thing.
You will be taught certain things which are to be internalized as articles of faith.
First, patients are not responsible for anything they do. After all, they didn’t have the advantages that you had growing up with that silver spoon in your lily-white gated community so they cannot possibly be held to the same standards. Therefore you are not allowed either to expect or, more importantly, to encourage your patients to be responsible for their own actions.
If Mr. Jones refuses to buy his blood pressure medications spending the money instead on cigarettes and beer then this is your fault for not motivating him properly. If you could just use the right combination of psycho-babble you might have a breakthrough where the patient slaps his head and says, “But of course! I’m having intercranial bleeds because a systolic pressure of 240 is a tad higher than normal!”
Of all the techiniques used to shut down debate, the assertion that the advantages we enjoyed as children negates our authority is the most spurious. I will grant you that many of my poor, uneducated patients will never amount to much because of poor upbringing or worse education. On the other hand we’re not asking them to work like dogs to get into medical school, work hard for four years, and struggle through from between three to seven years of residency training. We’re just asking them to take a couple of friggin’ pills every day and maybe keep a couple of clinic appointments.
My residency program gets all tied up in knots over how to make our patients more compliant. In fact, the term “non-compliant” is frowned upon and is instead replaced by the less-judgemental “pre-compliant.” Their current holy grail is a system where we essentially follow the patients home and plead with them to take their medicine. I subscribe to a different point of view, something I like to call the “French Hooker Rule” which postualtes that no matter how beautiful, no matter how accomplished the young lady is, she can only give you what she can give you.
You come to the clinic. I spend twenty or thirty minutes with you at every visit setting up your medication regimine, your smoking cessation strategy, and your weight loss goals. I’ll refer you to the appropriate specialist if indicated and I will neither belittle nor patronize you but in the end I can only give you what I can give you. When you walk out of the door you are on your own with nothing but your desire for good health to make you well.
I will certainly not treat any adult as a helpless child. Underneath all of the happy happy, joy joy, kumbayah talk about patient autonomy and respect is the patronizing and often-times racist assumption that certain patients are incapable of making decisions.
The point is that most adults make decisions about their health based on many complex factors the least important of which sometimes is your input as their physician. We might call them bad decisions but some patients enjoy smoking and eating fatty food more than they enjoy dieting and taking their blood pressure medications. Once you lead your horse to water through education it is up to them to drink.
So suggest that personal responsibilty needs to be stressed and watch the fireworks fly.
Let us discuss being non-judgemental. We mustn’t judge. After all, who are we to say what is right and wrong, good or bad? We sure are non-judgemental except of course when we are confronted with people who smoke, drink, eat Big Macs, own guns, spank their kids, watch TV, or don’t want the schools handing out condoms to their fifth grader. In that case we develop a superior attitude that would warm the heart of self-righteous puritans everywhere.
I want those of you who are now worked up to a fine lather of indignation (being highly judgemental, I might add) to step back a minute and ask themselves where it is written that non-judgementalism is the highest virtue of a physician?
Nowhere, my friends. It is merely the residue of the 1960s and all of the psycho-babble that resulted from it now manifested through the establishment who came of age during that idiotic, self-indulgent time.
Naturally your patients will expect and deserve a high level of tolerance from you. This does not mean that you need to subordinate your morality to theirs. If you don’t want to refer a woman for an abortion or put a fifteen-year-old on the pill then don’t do it. Likewise if you think that asking patients about guns in the house is an intrusive bit of politically correct idiocy then don’t do that either.
I don’t belong to the AMA because they are anti-gun and very intolerant of the anti-abortion position. I guess some judgementalism is hunky dory.
Sensitivity is a religion and the sociologists with their fuzzy degree are its priesthood. You will, in the course of your training run up against these happy people who hold nebulous positions in the institutional hierarchy but teach nothing, treat no one, and don’t even administer anything remotely related to patient care. They have fancy titles and speak in a strange language full of phrases like “brainstorming” and “intergroup dynamics” which they bring to bear on fabricated problems which are of no concern to anybody with a real job.
Political correctness is an industry, my friends, which employes an army of bearacrats to try to put a happy, sanitized face on everything. Must be nice to have a job at the Office of Institutional Diversity or some such sinecure from which one may pretend to work at fictional problems for which no measurable results can ever be expected.