Be advised: this thread is not for serious in-depth discussion of weighty topics (we have a link for that), this thread is not for anything Culture War related. This thread is for Fun. You got jokes? Share 'em. You got silly questions? Ask 'em.
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It's winter in Scotland, and you can feel it in your bones and in the heating bill.
A few days back, I groaned at the alarm, rushed to work, and started the ward round with a consultant. A few minutes in, a nurse approached and handed me a handwritten note. She looked genuinely concerned. I took a glance.
It said I'd put my shirt on inside out. Oh.
Ten minutes later, another nurse beckoned me aside and whispered the same thing into my ear. I told her I appreciated the concern, but I'd already got the memo.
When the round wrapped up, I fixed the problem in the loo. White shirt, white buttons, and clearly nobody of a masculine persuasion had noticed.
When I came back, the nurses were joking about it. Then one of them told me, entirely serious now, that they'd been rather worried about me. In their view, I'd only make a mistake like that if I was seriously stressed or anxious. I explained that I'd been too lazy to turn on the lights and had dressed in the dark, and thanked her anyway.
I found the whole thing very funny. Women seem to notice and care about wardrobe malfunctions far more than men do, though I suppose the social penalty is higher when it happens to one of them. I was just confused by how seriously they took it. It's a shirt! I couldn't even tell, and I was wearing it!
On the other hand, I've made a consistent effort to dress well on this placement, resisting the siren call of scrubs. Yes, I regularly wear white in an environment where ending up in blood, urine and feces is a genuine occupational hazard. I'd call it a flex/costly signaling if I cared that much, but I haven't given it much thought beyond liking white shirts and looking good in them. And I'll be damned if I stop wearing pointy shoes. The Great Male Renunciation was a mistake.
Maybe seeing me miss something so obvious made them think I'd finally lost it? I was having a good day! They've seen me on days when I'm visibly on the edge, and it has never shown in the fashion. I suppose that means they'd come to expect a certain standard from me. I hadn't realized anyone was keeping track.
I was on a medical ward, waiting on a consultant while he peered at someone's asshole, with a female med student as chaperone (and clerk, and paid for neither role). It was taking a good while, and I was stuck in the corridor with three other female med students. We struck up a conversation, and I launched into an impromptu lecture.
I offered to teach them how to do Mental State Exams. In theory, the MSE is a structured clinical assessment of a patient's cognitive and emotional functioning. In practice, Liaison Psychiatry refuses to accept referrals unless you have documented one, so the actual utility for a ward doctor is learning how to half-arse it persuasively enough that a psychiatrist will be convinced to do the real work. I explained that 90% of the exercise consists of taking completely normal human observations and gussying them up into High Church Psychiatric Jargon. The patient is not "talking really fast and jumping from topic to topic"; they are exhibiting pressure of speech with flight of ideas. "He seemed a bit off" becomes "affect incongruent, speech of normal rate but reduced volume." You can't skip the Latinate vocabulary. If you do, then they won't take you seriously.
Then I segued into the practical bits they should know: the common drugs psychiatrists would sneak into prescriptions; why they should always blame the SSRIs for GI bleeds, because someone else would anyway and now they could appear smart and proactive ; and how pretending to give a fuck about QTc prolongation would keep pharmacists off their backs, while the vibe within actual psychiatry was that the risks were grossly overrated (but don't let pharmacy hear that).
I was halfway through this random assortment of self_made_human's Clinical Pearls Earned Through Bitter Experience when one of the girls took out her notebook and started scribbling. The other two followed in close succession. I was very amused and a bit proud. In my experience, med students only take actual notes when they think the material is practically useful. I'm the same, and I know the acceptable response to a senior talking shite about an uninteresting topic is to nod politely and thoughtfully while wondering what the cafeteria has for lunch.
I get moments like that quite frequently, when people ask me questions or seek advice and I rattle off the answers from memory. Then I pause and realize that at one point I hadn't known them. Which blood tests to send, and why. Which abnormal results are concerning and which can safely be ignored. Where to even find the fucking results on a program designed in 1999, by aliens. Complaining about NHS IT is a bonding experience second only to complaining about the weather.
I think this is what becoming a senior doctor feels like from the inside? I'm not one yet, but the process has clearly started, the way you often notice you've aged from other people's reactions before you feel it yourself. Nurses have a model of my baseline. Students write down what I say. Intellectually, I knew this was supposed to happen eventually. I just never expected it to happen to me, in the sense of actually feeling it.
Ah, fuck.
I imagined it required a suitable levels of cynicism and misanthropy, or at least detached understanding of the human condition.
This would kill me. I already get very annoyed when I'm mid-professional rant about the technical nuances of some problem and how we should configure the ML model training process to solve it, and someone starts the Teams video recording. It just bothers me, like don't take my off the cuff bitter opinions seriously! I'm just an opinionated autist have a moment in a socially approved way. I definitely don't want them showing that recording to anyone!
Is there some degree of "cynicism" involved? Sure. But it's not all-consuming cynicism, I'd say much of it is becoming better calibrated on what you can trust, and how much weight to put on various findings.
I know plenty of idealistic senior doctors who go above and beyond.
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