Can a Physician have an Opinion?

You No Like?

Although the comments posted by the readers of this blog have been generally positive, you may as well know that I have recieved quite a few irate private communications about my impression of Duke, Duke’s now defunct family medicine program, and Family Medicine in general. I say “irate” but perhaps dismissive would be a better word, the general tone being that as I was just an intern I don’t know what I’m talking about.

Some have even suggested that I am jeapordizing my professional career by publically criticising such a behemouth as Duke. I can’t get this image out of my head of Don Vito Corleone using all of those good empathy tricks to engage me, communicate his interest in me, and make me feel like I was a person worth his time before he had one of his heavies whack me.

I’m not going to belabor the obvious by chanting the mantra about this blog being just my opinion. Of course it is. And of course I am right about some things which makes it both my opinion and fact at the same time. Family Medicine is unpopular among American medical school graduates and the approach taken by Duke is not going to change this. The first statement is objective fact and the second is educated opinion. You can scream all you want, call me ignorant, insensitive, and a know-nothing but the community medicine experiment didn’t pan out, at least from the point of view of physician involvement, and I would suspect that other programs, particularly at my Alma Mater LSU Shreveport, who are either implementing or considering the Duke model are now having second thoughts. Either that or bureaucratic inertia, being the one unstoppable force in this bad old world of ours, is carrying them to their ruin.

As for not liking Duke, well, that is just personal opinion. This is going to sound trite but when I eat lunch with my collegues I like to talk about interesting things. At Duke, all anybody ever wants to talk about is medicine. Hey, I like medicine. It is interesting but it ain’t that interesting. Or rather, listening to somebody pontificating about it is not that interesting, particularly when they start throwing the results of studies at me.

Eyes glaze over. That’s why I do my own reading every day. It is more efficient, I learn more, and I am not trapped in a lunch conference looking at power-points eating organic chicken wraps. What I really like to do for lunch (if all of my patients are taken care of and nothing needs to be done) is drink a Cherry Diet Coke and listen to Rush Limbaugh.

Is that a crime? Just like I believe that sleep should not be a privelege and therefore call blows, I also believe that a break every now and then is not a sign of weakness but merely a desire to refresh the brain by contemplating other things besides work or even nothing at all. Unless you are a surgeon, the day is not so chock-full of activity that we can’t enjoy a pleasant meal together where we talk about sports, movies, or girls we’ve banged.

So the thing I dislike about Duke was that everybody was so obssesive, to the point that it was nearly impossible to hold a normal conversation. I actually witnessed, on many occasions, interns pimping other interns. This happened to me at lunch once when the conversation inevitably turned to medicine and one of my fellow interns turned to me and said, “Hey, Panda, what’s the differential for painless hematuria.”

“Your mother,” was my prompt reply.

Hey, I’m eating here. I don’t want to talk about or contemplate genitourinary issues. Is that too wierd?

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