A silly little blog for me to drop the excrement of my mind.
-or- you gotta know when to hold 'em and when to fold 'em
Published on October 12, 2004 By BlueDev In Misc
Perhaps I am just getting old. Maybe I am just tired. Maybe it's the fact I have children. Or am I just lazy?

Whatever it is, I have learned to be very selective in picking my fights.

Days not too long past I was relatively quick to anger. Never one to let someone step on, over or around me, I made sure everyone knew what I would or wouldn't do, as well as what I would and wouldn't put up with. To be honest, I was really high strung. I made friends, and was comfortable with my friends, but I had no problem making enemies if I didn't like something. And while I wouldn't go so far as to say I enjoyed conflict, I didn't shy away from it.

That has changed though.

For the better or worse, that is the real question. I wasn't acutely aware of this change until last year, my second year of medical school. As medical students we are in a high energy, high stress, and most of all high ego environment. Professionals with years and years of schooling and experience behind them are our mentors and teachers. Residents who, while not that much farther ahead of us, bear significant responsibilities and stresses everyday are our co-workers. At my institution I have had the choice opportunity to labor and learn shoulder to shoulder with some of the world's foremost experts in their fields.

That prestige is not without its price. Egos often seem too large to be contained in the halls of the hospital. Tempers flare as white hot as magnesium in water. And everyone is reminded of their place. Residents are frequently reminded of their status by Attendings, and the residents in turn like to remind us med students of just how stupid we are.

Inevitably, conflicts arise. Fights break out, feelings are hurt, and tempers are loosed.

As a student I have a choice. I can throw my gauntlet down and join the fray. And trust me, if I want to I can fight with the best of them. I am not intimidated easily and have no problem telling someone above me when they are stepping out of line. But most of the time I didn't. I later found out that this had convinced some of my classmates that I wouldn't fight, that I didn't have a spine as it were. This struck me because, having seen how emotional and irrational many of them became when they jumped into the ring I knew that, to be quite honest, if I duked it out with them I would annihilate them. While my emotions will rise, I am usually able to contain them and channel them into my argument in a productive way. But I didn't do that often.

There were a few occasions in which I really felt the need to speak up and in those instances I had no problem standing up for myself and for my classmates, but often I just bore the outburst. I discussed this with one of my classmates. She insisted I needed to stand up to the residents more. I told her that I was just selective in the fights I chose. Most of the time the fights were really just grown up versions of a toddler's tantrum, and I refused to dignify that with a response. I just did the same thing I do with my own children when they throw their tantrums. Ignore them.

Of course, with an attending physician or resident you have to be a bit more discreet. So I stood there, looked them in the eye, and let them have their hissy fit. And while my classmates lashed out against them, I just listened, then walked away and did my job. When you are only going to work with a resident for 2 weeks (at the most) what do you really gain from fighting with them over every little thing? Nothing in my estimate. Far better to do your job, do it well, and pick up the crap they leave for you (otherwise known as 'scut'). Just do that for the two weeks you are with them. You learn more because they are willing to teach (they really don't like teaching the students they see as difficult), they throw fewer tantrums because it doesn't raise your hackles, and the overall experience is much better.

I had fantastic experiences with some of the Attendings and residents who were known school wide as being 'horrible', 'difficult', 'screamers', or 'vicious'. I learned from them because I chose not to fight with them. And in the end I don't really think that makes me weak. I have just lived enough to have learned.

You gotta pick your fights carefully. If you fight every one, you ain't going to make it.

Comments
on Oct 12, 2004
God, you sound like my dad. Must be an M.D. thing.

I try to pick my fights. Sometimes I pick wrong. And sometimes I stay out when I shouldn't. But wise words. As always.

-A.

P.S. Regarding your subtitle, I'm quite good at Poker...just need to figure out how to apply that skill in real life.
on Oct 12, 2004
Regarding your subtitle, I'm quite good at Poker...just need to figure out how to apply that skill in real life.


I'm terrible at poker (never really played it), but I have a pretty good poker face. And I am still learning too.

God, you sound like my dad. Must be an M.D. thing.


Hah, mind if I ask in what ways? That is funny, made me laugh.
on Oct 12, 2004
Hah, mind if I ask in what ways? That is funny, made me laugh.


When I was younger, I was quite a bit more hot under the collar. Didn't help that I went to a Christian boarding school with ridiculous rules like girls having to wear nylons and locking us into dorms at 8 p.m. I heard the "pick your battles" line a lot from my dad, who didn't necessarily disagree with me, but was probably tired of hearing about it.

Looking back now, I know that he (as a private practitioner) got provoked a lot by the local hospital administration, probably because he has a surgeon's ego, and also probably because he didn't share profit with them like many of the other docs who were employees of the hospital. My petty little cares seem silly now.


on Oct 13, 2004
I have realized that there are things everyday that we can fight if we really want to. But sometimes choosing not to fight is the harder, braver, and better decision.
on Oct 13, 2004
Good advice...
on Oct 13, 2004
I think you are truly wise to pick your fights carefully. You, as a houseman, couldn't possibly win against a resident. You could win the argument and still lose because then, the professional is no longer willing to teach you.

I found that the better you get along with your mentor, the more likely they will give you tips no textbook or lecturer will be able to teach you.
on Oct 13, 2004
I found that the better you get along with your mentor, the more likely they will give you tips no textbook or lecturer will be able to teach you.


Absolutely true. I found that as well on numerous occasions. They are much more willing to help and teach if you aren't fighting with them at every turn.
on Oct 13, 2004
Good article Dev.
You will need this with some of your difficult patients in the future too!
on Oct 14, 2004
You will need this with some of your difficult patients in the future too!


Wow, I don't doubt that. I have seen that as well. I think that doctors somtimes forget that you can really only expect a patient to do so much, to make so many life changes, etc. at a time. Instead of burdening them with too many to count and then getting frustrated with them because they aren't doing them, often it is better to prioritize and hit the most important things the hardest. Then build from there.