I Hope This Doesn’t Catch On

Vanilla extract tastes just like schnapps and has almost the same alcohol content, at least according to one of our frequent fliers who finally sobered up enough to tell me why he was shop-lifting the stuff. Not only that but because it’s not considered an alcoholic beverage nobody really watches it in the supermarket. I was incredulous, of course. You’d have to drink twenty or thirty of the little bottles to get a buzz and that many bottles might be hard to steal.

“Nah,” he said, “They sell it in half-pint bottles at Sam’s Club. I almost made it out the door with a gallon of it before security tackled me.”

But obviously not before he had imbibed a huge quantity of the stuff. The room smelled like vanilla and I imagine if he took a crap it would smell like grandma baking cookies.

Sometimes he comes in smelling like almonds and oranges, a couple of other popular extracts. It’s quite pleasant, really, especially compared to the usual urine and vomit smell of the less creative drunks.

What Do You Expect From Us?

Empathy training is the latest fad to hit medical school. Large quantities of your time will be wasted on this sort of thing. I didn’t dislike empathy training. In fact, because it is so non-rigorous and intellectually vaccuous it provided a pleasant distraction from the usual boring lectures. What’s not to like about sitting in a circle listening to some idiot drone on about the wonderful things you are going to do for your patients once you learn to relate to them? It was even more entertaining to listen to the small minority of students who take this kind of thing seriously and wax orgasmic about making a difference and touching the lives of patients.

In medical school they make a big deal about empathy, doing things like throwing you into incredibly unrealistic standardized patient exercises where you have a careful conversation that touches all of the patient’s socioeconomic and psychosocial high points. You will never do this in the real world unless you are a psychiatrist. You don’t have time. Even in Family Medicine, the paragon of empathy, you will only have 10 or 15 minutes with your patient, barely enough time to address the chief complaint.

Why is it important that you care, anyways? I spend my day providing high quality medical service that is indistinguishable from the service provided by somebody whose heart bleeds for their patients. You can get into a deep meaningful conversation with your welfare mothers on how hard she has it are but how is that going to change your treatment? Are you going to find her a better job? Are you going to follow her home and protect her from her abusive boyfriend? Will you snatch the cigarettes from her purse and shame her into eschewing the things forever?

Of course not. This is why all the empathy crap (and “community medicine” for that matter) is so useless. You can feel everybody’s pain and give your patients a shoulder on which to cry but at the end of the visit they are still as fat, unemployed, lazy, ignorant, drug-addicted, and hopeless as they ever were. If you’re lucky you will have at least addressed their chief complaint and they will go home with a UTI on the way to being cured.

When you try ot whip some empathy on them by pretending to care, they may decide to take you up on your caring and then you’re stuck. You can either back-peddle and admit that they’re on their own or you can spend half your day trying to get them food stamps, disability, or whatever they feel entitled too including your time.

What you’re going to do is give them their Ciprofloxacin, look sad and wise, and say, “Thanks for coming, if it still burns when you pee come back and see me.” That’s what all of that idiotic empathy and “caring” indoctrination shoved down your throat in medical school comes down to. You simply don’t have the time to be a social worker unless you are willing to work for nothing. I have worked in clinics giving services primarlily to the poor and even the shiny, happy doctors who make this kind of thing their life’s work can’t do much more than a hoary old conservative like me. And they grow to despise many of their patients, something I don’t because I don’t have as much emotionally invested in them.

A good rule of thumb is to never order a test or ask a question if you are not prepared to deal with what you find out. If you inadvertantly ask a patient if he has chest pain and he says he does, you must either work it up or find some legitimate reason to exlude a cardiac etiology even if the guy only came in with a case of the clap. The same should apply to psychosocial issues. If you can’t help the patient find a job or get her boyfriend to pay his child support then it’s none of your business and asking about it sets up a false expectation in your patient. If all you want to do is offer some sympathy then you are being incredibly selfish by trying to win admiration for your caring without actually doing anything to help.

The big myth of Medical School is that you will be some kind of compassion demi-god who will have a significant impact on the lives of your patients.

You know the question we ask a lot in the Emergency Department?

“What do you expect us to do for you today?”

This is usually asked to somebody with a vague, mostly psychosocial complaint. It takes people aback. What they want and expect is for us to cure them of everything that’s wrong with their lives which is impossible to do.