Wednesday, April 27, 2011

Shift Mentality – Kids these Days!

"The children now love luxury; they have bad manners, contempt for authority; they show disrespect for elders and love chatter in place of exercise. Children are now tyrants, not the servants of their households. They no longer rise when elders enter the room. They contradict their parents, chatter before company, gobble up dainties at the table, cross their legs, and tyrannize their teachers."  - Plato, 400 BC

Plato probably never said that.  But I love to tell people he did, as wise Mr Douglas told ranting Uncle Charlie in My Three Sons.

If Plato or Uncle Charlie were retiring surgeons today, we might hear:

“These residents have no commitment to their patients, it’s all about lifestyle now.  I tell you, the eighty-hour workweek has lowered the bar, and all we get is shift-mentality residents trying to hand-off their patients before lunch.  And if the Residency Review Committee (RRC) imposes nap time, and cookies and milk, we can just hand over the whole profession to radiology.”

I’m 44.  Old enough to repair a hernia without mesh, but not mean enough to do so except when no mesh is available (on Neptune, for instance.)  I’m also young enough to be down with Twitter.  And if you think being down with and saying, “Down with Twitter,” are the same, well…

I admire the surgeons who preceded me for their commitment to the profession. 

I admire the incoming generation of surgeons more.  Eighty-hour workweek notwithstanding, they have more on their plate than the generations before.

A third are women.  Demanding enough is the daily fare of patients doing badly, upset families, overbooked clinics, late hours, early hours, and politics.  Add discrimination, harassment, working for less money, and if inclined, pregnancy and caring for an infant. 

While nothing compares to the challenges facing female surgeons, I’ll venture that men today have it harder than their XY forebears.  My father had it easy.  Yes, I said it.  In his day, a man could fully dedicate himself to career and not face questions about his priorities until his grown children were in therapy.

Men today in all careers are attending recitals, cooking, cleaning, shopping, changing diapers, taking children for vaccinations, planning date night, and moving the heavy boxes.  This morning I poured my girl’s Cheerios ™, brushed her haystack of a hairdo, filled her Hello Kitty™ lunchbox with applesauce, then captained the neighborhood Montessori carpool.  If my dad, back in the day, had any idea where the Fritos™ were stored, he never let on.  (I’m eager for a reader to explain this cultural shift to me.)  Just as the RRC imposed the 80-hour limit, wives and children invoked the 80-hour minimum.

Remember this, Uncle Charlie:  While Chip may seem awfully eager to dump his patient list on the night float, Chip goes home to completely different expectations from his wife, children, children’s teachers, children’s soccer team,..

When I hear shift mentality thrown about derisively, I think of two of my favorite residents – two very dedicated doctors.  They give a hundred percent, they make no excuses, and they are fierce advocates for their patients.  I wouldn’t hesitate to send my mom to them for her lap chole.  Also, these young men freely admit they plan careers with shorter hours than surgeons of yore – in exchange for more time with family.  I admire their mature priorities.  I expect they will choose reliable practice partners and won’t plan their abdominoperineal resections on game days.  When the unexpected happens and they can’t leave the hospital, I hope their families understand.  Bless their broods, and moreso the kin of women surgeons; I hope their families appreciate the career sacrifices their parents made for them.

I’d rather have surgery in 2020 than in 1990 for many reasons – all of them having exactly nothing to do with work ethics or the eighty-hour week.  Laparoscopic advances, ICU protocols, evidence-based practice, checklists, and new anesthetic agents have done more good than a generation of lazy residents can undo.  And they’re not lazy, Uncle Charlie.

*  Note:  I hold particular admiration for women surgeons of the previous generations.


  1. I would rather endure a little grumbling from old timers and live the lifestyle modern medicine allows, rather than work my tail off in an effort to impress them.

  2. I am impressed by your insights. Certainly our training and practices have improved. Foremost in this improvement is an ability to be involved with our families while becoming good doctors. You have inspired me to write more on this topic....the conversation continues!

  3. Unfortunately, it isn't immediately clear that admissions committees are in agreement with you yet. So, in many cases, medical school applicants are required to feign such an antiquated obsession with their careers whatever the cost, in order to be admitted into medical school. It's really sad - the attitude gap between practicing physicians, that often see medicine in a practical light as you do, and academics, that long for the days of yore, is a real tragedy.