The Leap Whine Scale

The thing about medicine is this; it’s hard.  Sure, there are some specialties that are easier than others.  If you had the foresight to study hard and be an office dermatologist, bully for you!  Life is going to be pretty chill.

But for most people, engaged in the contentious, difficult, confusing, bloody mess of patient care, it’s difficult.  We spend our days and nights sifting through vague complaints that may or may not be indicative of terrible, deadly illnesses.

So, one would think that men and women engaged in this practice would have realized, from the get-go, that it was somewhat more taxing than working in that quaint little book-store/bistro you so love to visit on your Saturday’s off.  (You know, the one with the perfect Chai tea, and the pretty college student who always says ‘it must be so amazing to be a doctor!’ and gives you free refills while you peruse assorted New York Time’s best sellers.)

I’ll grant, medical educators are sometimes remarkable silent about the icky parts of medicine; they’re too consumed with the glories of science and saving humanity, and duties to serve and the magic of evidence-based medicine.  They’re busily advancing socialism and have little apparent energy left over to say ‘sometimes you’ll hate the people you see, so figure out how to cope with bad people.’  Students are more likely to be reminded that ‘everyone is good inside, and who are we doctor’s to judge them?’

So, I’ll admit that not every physician enters his or her practice with a complete recognition of what the real world is like.  But, most do.  Most of them learned the salient realities in residency from brilliant but appropriately bitter instructors and bitter but seldom brilliant clinic paitents.

Having established this, why do doctors act so surprised that the practice of medicine is difficult?  And further, why are they so whiny?  Lord I’m tired of that!

Case in point:  some nights our busy community hospital doesn’t have a pediatrician on call.  Why is that?  Despite the paucity of admissions, some have decided to take themselves off call altogether, since it was ‘adversely affecting their health and lives.’  Now, if I were running a clinic in the Kalahari, or on an Antarctic research station, I could see not having a pediatrician.  But in a busy town in the Southeast, that actually has pediatricians?  I’m stunned.

Next, the neurology phenomenon.  Apparently, all over the country, neurologists are getting other neurologists in large centers to video conference with emergency departments about treating stroke.  Treating stroke, the Mac-Daddy emergency of neurology, the raison d’etre of neurology, is just too darn icky, annoying, risky and exhausting for neurologists to do it in person.  Someone else needs to do it.

Even surgeons, the ones I used to look up to like Marines, have joined in the whine.  ‘We don’t want to take call; you need to pay us just to take call.  It’s…you know…hard!  I mean, all the patients, the sickness, the phone calls, and the operating!  I mean, how gross is that?’  Or this one:  ‘I know you have a patient with appendicitis; but I have four elective endoscopies and some staplest to take out in the office.  It may be hours…’

The great surgeons of the past are waking from their slumber of death and roaring in the grave.

The cardiologists have joined suit:  ‘I’ll do the cath, but I’m not taking care of the patient.  I mean, what if I miss something?’  By no means all of the excellent heart doctors have gone this way, but a fair number have.  They are, in my estimation, reduced from physicians to highly trained technicians; interpreting studies rather than evaluating humans.

I know, ER docs whine too.  And when they do, I’m ashamed.  We should be be more manly (even our women).  We are the specialty where all the world’s grossness comes to rest.  We are the land of foul foreign bodies, disimpactions, brains spilled on stretchers and ‘I haven’t had a bath in a year.’  We are the specialty of death and chaos.  We have to beg, borrow and plead with other specialites so that they will help us when they really don’t have to do so.  We knew it going in, and we have to deal with it.  Let me apologize for my own whiny colleagues.

Having said all this, I’d like to institute the Leap Whine Scale:

LWS 0:  Does job without flinching or hesitation

LWS 1:  Pause on phone, or in person, a wistful stare into the distance

LWS 2:  Attempts to invoke another provider:  ‘I mean, sure, I can do it, but did you ask anyone else?’  Ultimately does job; may exhibit passive aggression.  ie, consults everyone else in hospital.

LWS 2b:  Refuses to answer page or phone call.
LWS 3:   Openly hostile on phone, in hope that anger and aggression will make caller leave them alone or call someone else.  When in department, openly hostile to patients, who sign out AMA as consultant shrugs shoulders and says ‘they just wanted to go, beats me!’

LWS 4:  Perhaps worst:  Does job, but spends entire time saying ‘I mean, you know how busy my service is?  I’m exhausted.  I’m sick of this.   Why does this always happen to me?  Are you guys trying to kill me?  I know the patients are.’  Whinus Maximus.

LWS 5:  Answers phone pitifully, then begs off with:  ‘I’m just too exhausted.  I’m serious.  I can’t do it.  No way.  Find someone else, can you?  Thanks man, I really appreciate it.’

The LWS scale may be useful in explaining to new physicians what to expect from other conultants.  And remember, as with any clinical indicator, frequent re-evaulation is mandatory for accurate assessment of whiners.

Edwin