Burger (or Attending) Expectations

Let’s talk about expectations. And I’m talking the Dickens’ kind. When you watch television, the food flaunts itself before you. Tempting you with golden buns and perfectly placed pickles. The models eating those perfectly styled burgers are the same – airbrushed to perfection. Most often, limbs are stretched to unrealistic proportions and curves are molded and erased to fit someone’s view of beauty.

When someone first takes the baby steps to venture into medicine, they expect to find the cure for cancer. They expect to heal the sick and raise the dead. However, all is not as it seems.

The hamburger, and I’m not just attacking hamburgers – but that’s what’s on the menu tonight, is perfectly stacked and delicious appearing. However, when photographed from the back reveals the T-pins, sponges, and wax to make it so. So much more is revealed when the actual food itself is discovered to not be food at all but some substance that takes a better photo. Those ads sell because they appeal to the your (and my) mind’s eye.

pinkMedicine, when photographed from the back-if you could do that, reveals the red tape of unrealistic processes and procedures, coding complications, and the reality of the EMR. The delusional that enter medicine only see the styled front. We see patients. We see disease processes that can be treated. We see magic.

Who among us has not given “the talk” – I’m sorry your loved one is dying – only to see them make a full recovery. Later, they return so you can bang your head against another wall convincing them controlling their diabetes and hypertension could help ward off another heart attack. Who has not seen a patient survive a fatal congenital anomaly to later tempt fate with smoking, drug use, or some other equally destructive behavior?

But the dang ads are so tempting…everyone looks so happy. Not in the cigarette or drug commercials (I already told you those were fake…pay attention) – but the ads that are our experience. Ads that convince us this path is ours. Physicians, innocently, but deceptively coax students into deciding their specialty is the right one. Often, one preceptor can change the entire direction of a student. Recruit them to the dark side – because we have cookies or ice cream – or give them such a strong aversion to the field they determine then and there they will never practice in that specialty.

It is so difficult to then leave that daydream with perfectly proportioned everything and enter reality. Although they have seen some tarnishing of some their ideals, most residents graduate with a fire to still heal the sick and raise the dead. In the first years (let’s be honest weeks) of practice, it’s hard to see the magic. It’s hard to remember that even though the burger is not as pretty as the ad, it is still pretty damn tasty.

One Response to "Burger (or Attending) Expectations"

  • So much fertile ground for comment here, but I will avoid writing a term paper.
    Just because you know the trick, and are no longer fooled by sleight of hand, doesn’t mean it’s not still magical to those who are watching you. Most of the patients aren’t dying, despite their protestations; and this is fortunate, of course, because we do know that our tricks are limited in number and impressiveness. What is magical to them is being cared for; that you study them, worry over them, care whether they take the stupid pills or not.
    The magic is not in the capsules, it’s in the conversation that says “I have heard you, and I think this will help. Please let me know how you do.”
    The magic for you is to be given admission to the lives and stories of these families, and the trust that is given for the maintenance of precious health. It is unbelievable that people let us do what we do!
    The magic you have done is in the laying on of hands, establishing the contract between doctor and patient. It is subtle, usually the small things; the eye contact, the clasped hand, the promise to see each other again. The Mizpah.
    So, reward yourself after a hard day’s work with a big sloppy burger, or a tidy salad, whichever feels best. But be sure to wash your hands first…

    1 Ed said this (September 16, 2014 at 10:32 pm) Reply

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