Why Is Your Pediatrician So Grumpy?

I was worried I had a brain tumor.  That afternoon at work, I began having double vision. I could correct it by tilting my head, but as the day went on I was talking with parents with my head cocked over more and more.  My Fourth Cranial Nerve was malfunctioning, a nerve that controls eye movement, and it was weakening by the hour. I needed an MRI and couldn’t get one where I worked at the time.

The next morning I called my internist to get seen, but the receptionist said, “Go see an eye doctor.”  ”You don’t understand,” I explained, “It’s a cranial nerve, not my eye, and I need to get seen.” She still stalled me until I pulled the “doctor” card, insisting I speak to my colleague.  She put me on hold, then came back on: “He said ‘go see an eye doctor.’” I hung up, not believing my ears.

Coincidentally I had a check-up scheduled that day with Dr. David Fisher, my optometrist. Fortunately, David knew exactly what was wrong. My vision was already recovering, and he explained that that nerve goes funky occasionally, especially in plumbers who bang their heads on the underside of sinks.  No worries about brain tumors, whew!  Then I found a new internist.

Why do doctors, supposedly caring professionals, sometimes act insensitive or downright grumpy?  It starts when applying to medical school.  You need good grades in a tough science curriculum to get in, and nerds don’t always learn people skills, being too busy learning study skills.  Then in medical school you are surrounded by other “medical nerds,” and don’t learn how to relate to non-scientists.

Then comes residency.  My father was a seminary professor, and once gave a workshop for hospital chaplains.  He told me of a priest who had observed that the hours are so long and punishing, the apprentice doctors in residency get the humanity “ironed out of them.” After graduating, some regain their hearts, some don’t.

All doctors get grumpy.  For me one time, it was a mom who kept interrupting. Her child had a headache, and I was explaining that I didn’t think she had a brain tumor, but needed a CT scan to be sure. But every sentence I started, before I could get to the CT part, mom cut me off with “that’s all stupid, I want a CT.” I finally snapped and shouted, “Shut up, quit interrupting, and I’ll tell you what you want to hear!”

Everyone, especially doctors, gets grumpy in “people” professions.  While most patients are nice and polite, some aren’t.  And doctors don’t always start life warm and fuzzy. As we discussed above, medical schools select for academic performers rather than kindly grannies with a twinkle in their eyes.  Then comes the rigors of residency, where long hours and crushing responsibilities turn the nicest guys into ogres.

After residency, the hours and the responsibilities don’t quit.  Fatigue is an occupational hazard, and one continues to have to make potentially life-and-death decisions all day. Doctors dread the patient coming back to the hospital, maybe dying, after making a judgement call that turned out wrong.  Dr. Richard Selzer explained this internal struggle best:

“Yet he may continue to pretend, at least, that there is nothing to fear, that death will not come, so long as people depend on his authority.  Later, after his patients have left, he may closet himself in his darkened office, sweating and afraid.”

So doctors sometimes get snappish, and may seem uncaring about your child’s suffering. Yet worry for patients caused the stress in your doctor in the first place.  So if your kid’s doctor seems grumpy, give him or her a break, a second chance to recover. If he continues to seem uncaring, get a new one.      

Becoming A Doctor

Many kids want to become doctors, and many doctors want their kids to be doctors too. Once I had a great opportunity to show my son how cool it could be.  I spend a week each year in Honduras working in remote mountain villages, and take one of my kids along.  It was the end of the day, we were packing the trucks to head back to town, when I heard shouting from the road, “El doctor, el doctor!”

Two villagers were coming up, carrying a makeshift litter of two tree branches draped with blankets. Inside the blankets was an 8 year-old boy, face twisted in pain. Peeling back the covers, I saw a huge chunk of flesh missing from his right thigh.  Excited voices informed us that he had just been bitten by a pig.

We unpacked the trucks, moved back into the schoolhouse we had been using, and pushed school tables together to lay him on.  One of the other doctors, an anesthesiologist, injected a nerve block in our patient’s hip to numb his leg.  While I was arranging my surgical tools, I thought, “Great, my boy will see his Dad be a hero,”  like an episode of the TV show MASH.

However, as I started working, I noticed my son at the far side of the room, his back to us. When I called him to come see, he said he’d rather not.  Instead of exciting him, the blood, the wound, and the child’s pain made him sick.  So much for Dad The Hero and his son the doctor; my boy was going to go another way.

None of my kids want to be a doctor, though they occasionally like the idea of being a doctor.  Many feel that way: it sounds fun to have the prestige and income, to help others in a meaningful way, to have some excitement.  But my kids know better- it takes a lot more, at least 11 years of school and training, than just liking the idea.

It takes perseverance.  What helped me was that I loved science (unlike my kids). Studying biology and chemistry was just plain fun.  Also, I wanted to care for others using science, and was undaunted by the long hours.  I wanted adventure too, and medicine promised that.

I wanted to be a doctor since sixth grade, but some decide that later.  One resident of mine failed college after his first semester, already not your typical path to an MD!  His dad was a nursing home administrator, and while he was moping about his academic disaster, his dad said, “While you’re doing nothing, come spend time with some of my patients. They’re so lonely.”

The first patient he went to see had cancer, as well as being elderly.   He sat down with the man, they started talking, and hours later he was still there.  They became fast friends for years, until the man’s death.  That visit stimulated this resident to continue his dream of patient care.  He became a paramedic, and after several years with EMS, got serious about college, and went on to medical school.  In 4 weeks he graduates residency to be a full-fledged doctor.

Though we discussed above that becoming a doctor means loving science, it’s really about taking care of people.  Often that ideal is lost in the rigors of the eleven year training, where student live and breathe medicine and science.  Patients become subjects of study, rather than people in need.

But immersion in medicine, becoming a “medical nerd,” is pretty much required.  First, students need all A’s and B’s in four years of college, usually in a science degree.  Then, only one-third of medical school applicants get accepted to go on. The next four years in medical school are even harder- 50-plus hours per week of class, study, and hospital time, instead of the 15 to 18 hours class time in college. After medical school comes residency, where the “resident” doctor works 80-hour weeks apprenticing in a specialty. Residency takes three years for the basic specialties (pediatrics, adult medicine, family practice), more years for OB/GYN, surgery, or subspecialties.

But if you are not dissuaded, and want a life of profound duty and fulfillment, service and excitement, and have a capacity for delayed gratification (I was 29 years old when I finished school and training), go for it!  Just don’t forget about your patients.