UPDATE: This post was also published on KevinMD.com. Since its publication, the Gomerblog article that it references (link below) was updated so it no longer draws parallels between my specialty and Joffrey Boratheon. I take a little, tiny bit of credit for that.
Medicine is plagued by a form of prejudice called “specialism” (yes, I just made up that word, but it fits). In medical school we were united; we were all in the same boat; we were a team making our way through the gauntlet together. And then it came time to choose a specialty.
A satirical article by “Lord Lockwell” circulated on social media recently called, “Medical Specialties as Game of Thrones Characters.” The runner-up character for my specialty was Jon Snow, the bastard of Winterfell. The justification was:
“Because people love to tell you: ‘You know nothing Jon Snow.’”
Can you guess my specialty?
I practice Emergency Medicine.
The first character selection for EM was Joffrey Boratheon because:
“The entire hospital would enjoy seeing you die.”
It’s okay. Laugh. It’s funny.
But what if we changed it to a race or a sex? Just try it.
Not so funny now.
Specialty choice is a big deal and we make it so much bigger than choosing what we like to do. We make it about who we are.
We are told to choose a specialty where we feel like we “fit in.” I did that. I chose the right specialty for my personality, but the wrong specialty for my life.
As an Ob/Gyn intern, I realized that specialties are, in fact just jobs. I had seriously considered Emergency Medicine while in medical school, but didn’t think I fit “the type.” I would rather stay in a 5-star beach resort than a tent in the Himalayas. I’m not an adrenaline-seeking, black-and-white kind of person, but I liked the job so I switched.
Despite knowing my specialty doesn’t define me, the transition still sent me in to a little identity crisis because I didn’t fit the EM mold and someone in power literally told me:
“You’re not an Ob/Gyn anymore. You’re one of us now.”
One of us…
We divide ourselves into factions. We say, “I am a gastroenterologist,” or “I am a plastic surgeon.” Truly our specialty becomes part of how we see ourselves, how we define ourselves. We go from all being in the same boat to separate ships navigating the same long hours and heavy responsibility with less togetherness.
I saw another article on generalizations about physicians by specialty called “The 30 Types of Doctors You Went to High School With.” Ah, high school. Kids. Cliques. Adults are so above that kind of behavior – oh…wait.
The halls of the hospital are lined with chart racks/computers instead of lockers, but packs of grown-ups all dressed alike still round together and are not above making comments about the “other” group down the hall wearing neck ties or surgical scrubs.
I don’t think the general public is aware of how we judge one another. As people who generally revere knowledge and intelligence above all, status climbs with duration of training and competitiveness of the Match. Plastic surgery, ENT, and dermatology held the top three spots for board scores of matched applicants in 2014.
Our colleagues who choose highly competitive residencies secure a lifetime of acknowledgment of their cerebral prowess. This creates unfortunate pressure to choose more competitive residencies (because you can) and also the kind of bias (“specialism”) that leads to unfounded assumptions about our colleagues who choose less-competitive fields.
Physicians are judgmental people. Within seconds, we judge our patients’ intelligence/educations levels, we judge their authenticity/theatrics, their honesty/dishonesty. We judge their emotional stability/psychiatric soundness.
These subjective judgments are often supported by objective information like “this guy is totally crazy because he just peed in the corner,” or “those are alligator tears because I’ve seen this lady’s narcotic record and she was asleep when I walked in the room.” Judgments like these can help us do our jobs when time is limited, but using the same kind of snap decisions about each other is unfair and harmful.
It only takes one time for a colleague to be wrong about something for us to think he isn’t very smart. It only takes one time to hear someone be impatient with a medical student for us to think she’s a total b**ch. We don’t give each other a lot of grace and “specialism” doesn’t help with this.
It is, I suppose, a very human thing to identify with a group and feel superior to other groups because of it. Specialism says, “That Pediatrician didn’t even know the difference between a pilon fracture and a bi-mall fracture.” It takes specialized knowledge and uses it to diminish others. But I have seen the most secure Orthopedist suddenly insecure about treating a DVT in a pediatric patient. I hear Internists deride Surgeons for their inability to handle “simple” medical conditions suddenly uncertain about the management of “simple” pathology on an abdominal CT. We need each other.
When I call you about a patient in the ED, what I’m really saying is:
“Help! I can’t do this alone! Help! This person needs more than me.”
It doesn’t mean I’m stupid or lazy, or give you any right to laugh at the idea of enjoying my death. Specialism is different than racism or sexism because there is some choice involved, but it is not the kind of choice that justifies a lifetime of shallow assumptions. The best way to fight all forms of prejudice is always to make it personal. If an Orthopedist becomes a friend, he is no longer “an insensitive jock.” He’s Dave.
Face-to-face conversations are a good starting point. They help us see each other as people. Because in the end, I’m not an EM doctor. I’m Kristin. I am the mother of two pre-schoolers. I like Game of Thrones and dinners that feel like events.
Even if we don’t have parenthood or outside interests in common, we have a lot in common. At one point we all convinced admissions personnel that we cared about people, that we liked helping people, and for most of us it was easy because it was true. We were all in the same boat once. Remember that? We may have left the short white-coats behind, but we’re still on the same team.
Our jobs are hard enough; why are we making them harder by being hard on each other? We should want to help each other! Our patients aren’t the only people worthy of compassion and respect. We’re people too. Remember?
Photo credits: flikr: Sean and Lauren/cruise ship, Dawn Endico/battle ship, writing added, creative commons license.