Tuesday, April 20, 2010

Are dumb people more popular?

It seems like lately, I have been having this problem more and more often. I'm in a weird situation. My current job (hospital aide) is about as low on the totem pole as a patient care job at the hospital can get. I guess it's slightly higher since I work in the ICU, versus the med-surg floor, etc.

Still, I've been working in health care (in the nursing home, and as an EKG tech) for about three years, and I have generally been eager to learn. I like to read and I like to ask questions. I try not to be annoying and drive people crazy by asking questions, and try to limit my quantity of questions.

Still, sometimes I'm really amazed that people don't know the answer to my questions, like the time when I was reading a heart catheterization book and casually asked a group of cardiac nurses:
"What's the difference between sclerosis and stenosis."
This was followed by no one knowing the answer, and having us all look it up together. I was just really surprised. I thought they would know. ..or at least one of them!

Today in the ICU, one of the monitors alarmed. I printed out a strip, and said to one of the nurses, "hey, have you seen OtherNurse? Her patient had a couple little atrial runs."

Nurse then replied "those aren't atrial runs, it's just tachycardia."

"It looks like a string of PACs* to me. When I scanned Holter monitors in cardiac services, we would call any runs of PACs atrial runs."

"You shouldn't call it an atrial run."

"Ok." (It's not worth arguing with her).

The thing is, I really have no idea what her rationale is for this (other than the possibility that she has a mediocre understanding of EKG terminology). It seems like by not being dumb, I always manage to piss some nurses off and get myself into trouble. I sometimes feel like I further inflame the relationship because I want to become a physician instead of a nurse. I generally try to be humble and quiet, but with this situation, I was just trying to communicate. And still, I pissed her off! I can't win.

*Premature atrial complexes (or contractions)


  1. Bottom line: everyone in healthcare is territorial about their area of knowledge. If they think you aren't at their echelon of education you couldn't *possibly* have any insight to offer them. You can't win.

    Many nurses don't see aides (or even LPN's) as part of their team of colleagues. Just like doctors don't see nurses as part of the team (again--what insight could a nurse possibly give a doctor??)

    It is petty and insecure behavior and it negatively impacts patient care, but it is the maladaptive way it works in most places.

    You'll have to get very good at biting your tongue (almost off) especially when you are a medical student. Even when you *know* they are wrong. Egos abound!

    Your background is going to make you an excellent medstudent/doctor!

    Keep smiling! :)

  2. Thanks for this advice. I need to be careful not to get annoyed or indignant, because generally the people I work with are actually really great (including NurseTachycardia).

    One of my favorite cardiologists was reading a difficult EKG one day and talking about it with a nurse. I can't remember the specifics of the EKG, but basically the nurse interpreted it differently than the cardiologist. The cardiologist asked her why she thought it was whatever she thought it was, and then said something along the lines of, "ooh - I didn't see that.. I agree with you."

    Another doctor I really like told me that she loves having med students around as a resource because they often have studied topics more recently than she has and have fresh insights.

    I think it's a good quality to be receptive to the ideas of others, even people "below you." I've also seen it taken too far (one doctor ALWAYS asks the techs "what do you think?" Everyone is starting to think that the reason she asks is because she doesn't know anything!

  3. EG -- Med students are lower than aides.

    And also, what ABB said. Though not all drs (or nurses) are like that, it can be hard to tell so you do have to get good at keeping the mouth shut (not my forte). I have always tried to involve the nurses caring for my patients in the decision making and plan. I have had times as well when I knew something they didn't, and wondered whether they'd think I was an asshole for teaching them. I didn't know what to do then, and I still don't.

    Good luck.

  4. It's always great to work with people who actually collaborate--and I didn't mean to imply that no one does. :)

    The awesome practitioners who are secure in their knowledge base and are always trying to learn are (in my experience) the best ones.

    I figure--if it isn't directly going to harm the patient (like someone about to flush a PICC line with 10x the amount of heparin or something) then probably a bad idea to 'correct' someone. The last thing you want to do is look like a 'know-it-all'.

    You seem to already know how to delicately approach these situations and I am sure you are able to read people very well so you'll probably do better than most! :D

    And yes, I think dumb people are more popular. At least that is what I had to tell myself all through highschool.

  5. Did you mean dumb as in stupid? Or dumb as in mute? If b) then YES, they are more popular. At least among those in authority.

  6. OMDG -- I am always thrilled when a physician takes the time to explain something that I don't know about. Most of the nurses I know love this kind of commentary, too. I wouldn't worry about offending people..I'm sure you can pull it off in a friendly way.

    We rarely have med students at our hospital, but I never thought that they were considered lower than aides! Impressive. I guess that sort of makes sense, just by virtue of being new, usually clinically inexperienced, and not really knowing their way around the hospital.

    And I meant dumb as in stupid, but now that you mention, I agree, becoming mute might be the best solution!

  7. Doesn't seem right does it? Shame on you for knowing what you're talking about when I don't! Rar. Its not fair but that is often the way it is.

    I'm with ABB & OMDG you have to learn to gauge the practitioners you are working with to see if they are open to questions. And as you have seen, they might not always be correct when they do give you an answer. I would recommend finding some reliable references (I just picked up a new pocket reference for clinician's, Wards 101 pocket Clinician's Survival Guide, love it!), looking up whatever you can/learning on your own, becoming an expert observer and interjecting/questioning only when you absolutely have to. Then someday when you are in practice you will be well educated (nice to students :) and you can say whatever you want! (Mostly anyway. I can't wait.)

    Sounds like you are already learning to pick your battles too. If it affects patient care or outcomes, of course you have to speak up whether it ticks somebody off or not. Good patient care is the most important thing to worry about and it isn't worth compromising good care to cater to anyone's ego. In that case you can be secure in the knowledge that you did the right thing and if someone is mad that's their problem (okay it's usually their problem and you shouldn't take it to heart - easier said than done right - but I find its just better not to incite the Pimped By An Aid/Nurse/Med Student Anger if I don't have to).

  8. Well, I have the "privilege" of working in a teaching children's hospital through which med students rotate... and let me tell you, if that was an attending at our hospital and you were anything other than an attending (in the same situation), you would get your butt totally chewed off. Like totally. I disagree with that mentality totally, but that's what happens and it all precipitates downhill. Attendings do it to each other (less often though than anyone else), residents to do it to med students, med sudents do it to each other. Do I call it a "cut-throat" atmosphere that's created and perpetuated by our attendings? Maybe.

    I've been in nursing for the past 3 years, I can tell you that I am just now slowly beginning to understand the "nursing mentality" and a lot of it stems from 99% of the people in the profession being women. Just like you are all up in arms in questioning the nurse, she is all huffing and puffing in questioning you. Neither one of you trust each other, both of you question each other's abilities and skills. And it doesn't end in nursing. I've heard a heated debate of two female surgery residents do the same thing. It's a woman thing, so just don't worry about it, get over it and accept it. Work with men if you want to avoid this (or with someone on a much higher level than you). They won't be all up in arms about things (well, I guess that depends, too), but the dynamic will be very different for sure.

    As far as being pre-med, I can tell you that nurses get jealous of other women pursuing their goals and being "better" in their eyes and higher on the totem pole. Partially because they may not have the character or desire to do it (and just want the "big bucks" as they say) and partially maybe because they know they can't even if they tried. And it annoys them terribly. I don't feel sorry for those people, but I also don't step on their toes. If you don't want to get chewed out and lose out on clinical experiences, save your knowledge for med school. Patient care suffers, I agree with you, but what can you do? By trying to start a revolution, you are only going to make yourself stand out and disliked. And do you need that negativity while you're trying hard to succeed in all other areas?