Thursday, January 24, 2008

Pimping On The Wards

Pimping on the wards is a common experience for most any medical student. I forget what I initially wanted to write this post about, but I was reminded of the contrived haphazard nature of pimping recently. My attending, who was well-intentioned I believe, was aware that I am taking USMLE Step 1 soon. At our previous meeting, he told me I should bring whatever book I was studying from as he wanted to glance at it (he's a foreign medical grad, I believe), so I obliged. After I had shadowed him, we went back to his office. I assumed he'd just ask me a few questions about how the day went and send me on my way. What I got instead was 30+ minutes of him flipping through First Aid for the USMLE Step 1 and asking me random questions while two other students looked on.

Thirty.

Straight.

Minutes.

Now, luckily I've been studying for a while and had a pretty good familiarity with First Aid, so I got most of the q's right (or at least, made some reasonable sounding comment). And, sure, I need to review and study. But... man, I can't imagine what would have happened if he had tried to do that 4 weeks ago. This episode (among others) leads me to wonder the real motivations behind pimping. Sure, people say it's for educational purposes. I agree that when done in a systematic, relevant manner, pimping serves this purpose. However, someone flipping through a book asking random q's is not that. Heck, the attending even said at the end that the session was like Jeopardy, which was a fairly apt description. So, here are what I think the 5 real reasons are:

5. Showing off - Just because someone has 10+ more years of education more than you and more than enough accolades doesn't mean they don't want you to know how much they know.

4. Schadenfreude - Trust the Germans to have a word like Schadenfreude. Part of me can't help but believe that some attendings experience a bit of joy at our squirming.

3. Insecurity - To be honest, I haven't had this be the case at all, but as this post and this NYTimes article note, it can be one reason why attendings pimp in some cases.

2. Tradition - They got pimped, so they feel "obligated" to pass along the "fun." Thanks. No really, thank you sir, may I have another?

1. Because they can - 'Nuff said.

Hm, I guess I sound more bitter than I really am. For the most part, I haven't had that many bad experiences being pimped, but I guess I just fail to see the point most times and would rather enage in an open discussion and have someone ask questions in a non-"put me on the spot" way and then explain concepts vs. just firing q's at me. Anyone have their own outrageous attending pimping experiences? Let's hear 'em!

Worried about being pimped on the wards? Check out: 

4 comments:

  1. Your classmate1/29/2008 11:29 PM

    Heh. Well, the intellectual currency of our profession is knowledge, in the form of often-disconnected facts.

    In the world of math, engineering, and computer science, the same sort of thing happens, but not in a hierarchical framework. The intellectual currency in those worlds is puzzle-solving. Some clever person comes up with a neat puzzle, and he challenges others to solve it. The creator or discoverer of the puzzle can be a professor, but it can also just be another student.

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  2. But, I think I would hold those forms of "value proving" or whatever you want to call it in higher regard because it is simply based on intellectual ability. In medicine, I think there is more of a social, "gotcha!" aspect to it which I think detracts from the education experience at times.

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  3. Your classmate1/29/2008 11:46 PM

    Very true. Like you, I'm also incredibly interested in the social aspects of medicine, and in the acculturation of medical students, and I'm beginning to believe that, at the core, this "gotcha!" aspect is downright rotten and really has no place in modern society. It's a serious expression of seniority, which, as a former computer scientist, I believe to be an obsolete holdover from times past in which society wasn't as equalized (theoretically, anyway) as it is now.

    Essentially, by pimping you like that, an attending is subconsciously putting you in your place. He's implicitly saying: "I'm superior to you. If my team were a pack of wolves and we brought down an elk, I would get first pick at the meat."

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  4. Agreed - the attending is trying to establish their alpha male/female status. In some contexts, this is fine. For example, my understanding is that in the army, establishing such a hierarchy is necessary in order to ensure order, especially in a multi-modal, multi-theater battle.

    However, in medicine, this seems less necessary. Other than the ER, most of medicine occurs in a controlled environment, so the need for 'order' is less apparenent. However, the need for knowledge/understanding is greater, so I think the emphasis should shift away from pimping, which I think it has compared to our predecessors. However, that trend must continue.

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