human behavior

Rewards and Punishments

Posted in Habits & Manners, Health & Medicine, Religion & Ethics by humanb on April 13, 2010

I’m doing my rotation in Emergency Medicine in medical school at the moment. The Emergency Room is different from working on the wards because the doctors have little time to involve students in their business. The patient comes first and immediately, and there is a steady stream of them. The student can easily be relegated to the shadows as an uninvolved observer. Consequently, past students have found ways (quite easily) to avoid being in the Emergency Room. After all, no one notices.

So the director of the ER has come up with a sheet that lists all the procedures and activities he would like students to do during their rotation: ECGs, urinalysis, blood sugars, IV insertions, CT and X-ray interpretations, etc. “This should keep them in ED”, he thought.

Of course, what the director didn’t recognize is that medical students are Cluster C personalities: fraught with generalized anxiety and fear of failure, eager for affirmation, sensitive to criticism and above all, obsessive-compulsively perfectionistic. So the rotation has now become a quest not for knowledge, but for signatures on that blasted sheet.

I’ve spent most of my time in ER trying to learn and get involved without getting in the way. I’ve done my weekend duty, my evening duty, and more often than not, my full 8-hour shifts. No other student to my knowledge has.

But they’ve got their signatures.

With a single-minded focus, they have made efficient use of their short stays in ER on any given day to get their signatures, while I’ve done many of the tasks but neglected to pull doctors aside to say, “Sorry, before you see the next patient, you need to sign this sheet!” They’ve also spent little to no time with a doctor and her patient, but have managed to pull the doctor aside and say, “I’m going to interpret your patient’s ECG and then I need you to sign that I did it”. I on the other hand, may have spent time with the doctor and the patient but forgot all about that stupid sheet.

At the end of the course, who gets the reward? Not me. The director will look at my sheet and look at theirs and conclude that I was not involved, that I managed like students past to evade spending time in the ED. He’ll conclude that I lack initiative. At worst, he’ll barely pass me.

I like to think that what I’ll have lacked is not initiative: I’ve approached countless doctors and nurses in ED requesting to be involved. What I’ll have lacked is a single-minded focus on my own needs in an environment where my needs are actually the least important. What I’ll have lacked is shamelessness.

Or perhaps I’ve got this wrong and I AM the weakest student. Perhaps it IS my responsibility as a student to make sure that I meet stated expectations. Perhaps I AM supposed to have such a single-minded focus on self, because after I’ve graduated, these same doctors will expect me to be competent. They’ll want to know that I’ve served my own educational interests above all else over 6 years to ensure that I would be a responsible and effective doctor.

I’ve always tried to be of help to ER staff. I chase bed pans for patients when nurses are busy, and doctors and nurses have both been astounded that I would perform a duty so ‘beneath’ my training. Fetching and emptying a bed pan may be a nice (and necessary) thing to do for a patient, but it won’t do diddly squat for my medical training.

So as I look at my half-empty sheet of signatures, anxiety has begun to creep in. I’ll have two weeks to get this sheet filled, and I’m irrationally fretting over the prospect of failing the course because of one sheet of paper. I’m currently on the downward slope of the Yerkes-Dodson Curve of performance anxiety. It’s paralyzing me, not propelling me forward. It’s overwhelming me at the wrong time – while I’m sitting at home on my week off trying to write a paper on Aboriginal health.

I have this anxiety because I know – as most people over 12 do – that good behavior is not always rewarded and bad behavior is not always punished.  People can get away with murder, and to be recognized for one’s accomplishments you often have to shove them in someone’s face. This is not the moral way.

But it is so often, the way of the world.


One Response

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  1. condore said, on April 14, 2010 at 12:04 am

    I would suggest you have to do both. Learn as much as you can for yourself, because when it is all done you will be the doctor; and, compete for the signatures. You have to remember that although you are fair, life isn’t.

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