Yesterday I told you about the move to a pass-fail system. Regrettably, the change does nothing to ameliorate the other major stressor of being on the wards – pimping.
Pimping is an old method of Socratic-teaching-gone-wrong where a senior doctor instills his or her worldly knowledge in you by asking question after question until you can no longer answer, then humiliates you by either explaining the answer like you are a toddler or by requiring you to look it up and present the topic the next day. Or hour, if life really sucks.
Thankfully, pimping is a diminishing practice as younger doctors have realized that “I suffered through it so they should have to” is a logical fallacy as well as ending a sentence with a preposition. It still happens, though:
On my second day in clinic, I was paired with a gynecologic surgeon from whom I learned a tremendous amount. I acquired this staggering pile of knowledge because from the minute the first patient walked in the door until the last one left, I was mercilessly and unendingly pimped. In the hallway, I was pimped on my knowledge of Pap screening. In the patient’s room, I was pimped on their past surgeries. While performing physical exams, I was pimped on the sensitivity and specificity of exam findings. It was like being repeatedly and lightly punched in the exact same spot on your face for nine hours, Chinese water torture style. By the end of the first hour you feel a little bruised; by the end of the day you feel like you’ve gone through a hay baler.
Advantage: I learned some tips for coping with pimping.
1. If you know the answer to a question, under no circumstances should you answer it fully.
This sets you up for a next question that is totally unanswerable in difficulty.
I learned this lesson when in the room with a new patient, my preceptor wheeled toward me and asked, with no prompting whatsoever, “Student doctor [disdainful emphasis his] Friedman! Please describe a LeForte colpocleisis, as well as its indications and contraindications, both absolute and relative.”
With this question and only with this question, I was phenomenally lucky. I had just read the previous night about this procedure in my holy review textbook, Blueprints (by Callahan and Caughey, praised be They). I answered his question in full – including the contraindications. Absolute AND relative.
I briefly considered doing the Ray Lewis dance and walking out of the room right there (“HAH! HAH! HAAAAAAAAAA!”), but decided I wanted to at least see what my later rotations are like before getting myself expelled.
Answering the full question was a mistake. With a nod of his head to indicate that I was 1% less dumb than originally suspected, he continued, “Okay. For patients discharged after a LeForte with a suprapubic catheter, what is the standard of care antibiotic, dosage, and route to prevent infection?”
No idea. I received a snort for my presumed stupidity and a directive to look it up later. A wiser student would have originally said “A LeForte is an obliterative procedure,” then paused for the next question – “for treatment of what?” “Pelvic organ prolapse, of course.”
Then you look smart, and it’s LeBron James foam-toss-time again.
2. Saying “I don’t know” is a double-edged sword.
On the one hand, it is the pimping safe word. “I don’t know” is tapping out, and your preceptor will almost always stop asking questions. The downside is that the total silence that follows is so clearly of the disapproving variety that you are halfway compelled to run to the break room and waterboard yourself in shame.
3. On the flip side, guessing is also a high-risk/high-reward maneuver.
Some doctors want you to guess, even though you’re probably wrong, because then they can see that you’re thinking. Others view guesswork as the work of a dull, inferior mind, much like a confused pet rolling over when you are yelling “STAY,” and would prefer you to admit defeat. You’re playing with fire.
4. Not answering the question is not an option.
In the hallway, my preceptor asked me about dermatomes – essentially, what areas of skin are supplied by each nerve. I couldn’t remember the answer off the top of my head, so I asked for a minute to think about it. My request was granted. He continued with his paperwork and we saw the next patient. Fifteen minutes later, without looking up from his computer he barked, “Friedman! I’m still waiting for my dermatomes!”
I eventually guessed. It turned out he is on the “dull inferior mind” side of the fence when it comes to guessing.
5. Unfortunately, it really works.
I take solace in the apparent fact that solidly remembering something requires a blood sacrifice: yelling “push!” in Spanish for three hours, getting a pimp question wrong in front of a patient, or being humiliated in the hallway after guessing wrong.
Pimping gets a deservedly bad rap: it is an anachronistic, paternalistic, empathy-draining exercise in teaching by shame. Students with poor coping skills or other concomitant stressors may handle pimping poorly and can melt down, thus failing to learn anything from the encounter. It’s a major reason why medical students on their rotation year see their empathy evaporate.
But if you handle it okay, it really does work. The rush of adrenaline – the bad kind that makes you want to poop your pants when watching Paranormal Activity, but still – that comes with humiliation helps save information, and the shame makes you more likely to actually look up and learn the information later than if it were kindly suggested that you do so.
By the end of my ordeal, I ended up really liking the guy, although I felt like I had just spent the day in a washing machine set on a nonstop spin cycle. I honestly want to see him work in the OR.
Maybe that means I should be reading Fifty Shades of – nope, no. Not even going there.
As before, I came home, ate Chipotle, and passed out. Of note, I find myself relying more and more on the holy manna of Chipotle and am beginning to resemble a double-meat burrito.
I need to go to the gym, but I have to look up some dermatomes first.