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Let’s Talk About Hierarchy And Priorities In Medicine

Discussion in 'Hospital' started by The Good Doctor, Jul 25, 2021.

  1. The Good Doctor

    The Good Doctor Golden Member

    Aug 12, 2020
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    Life is full of hierarchies — whether you are the older brother in the family, the supervisor in a company, a chief resident in medicine. There is always a hierarchy. It is a pecking order that keeps our society organized. You know where to look for guidance. Who is the person above your title that can help you with a challenge you are facing?

    Even within surgical specialties, there is a hierarchy. Physicians or patients may think a neurosurgeon is more valuable than a pediatrician, which may reflect why society does not value the reimbursement they make.

    A neurosurgeon can easily make ten times as much as a pediatrician. But why would that difference in value be placed?

    Does the pediatrician — who is astute, the gatekeeper that keeps your kids safe and realizes something is wrong with your child and works it up to diagnose aggressive cancer — not carry the same weight as someone that operates on your brain tumor?


    Is what the pediatrician did for your child or any lesser “value” than a neurosurgeon did for a brain tumor. If you are the parent of the child, I would beg to differ. You would donate your kidney in gratitude for a physician that was able to care, listen, diagnose and take action to do what was needed to save your child.

    It is interesting that even within a surgical specialty, the same principles apply. If you are a urologist, which in itself is a very competitive specialty, it is as if “just” being a general urologist carries a stigma of inferiority by default.

    Maybe you cannot “hang” to be able to do 8-hour grueling cystectomies (removal and reconstruction of the bladder). Or maybe you are just not technically savvy enough to do a two-hour prostatectomy. There is always an unspoken value that is less for those that are general urologists. As if what we do is the default of not being “good enough” and not a conscious decision.

    I will say that although others may have thought this or said it out loud to others, I have never had this thought myself as a general urologist. Being a general urologist and really an outpatient surgical one, is not a choice by default or an unconscious one.

    I consciously decided I want to do surgeries that are less lengthy, easier to recover afterward. Not because I do not have the stamina or skill to do them, but because it does not serve my goals in life, I have chosen for myself. My ego is not driving what I need to do to prove myself to others. My value and worth are within me and not due to an external accomplishment.

    What is important to me is to take care of my patients 110 percent, but then go home and do things that serve me — rushing perhaps, driving 58 minutes, and changing clothes in a parked car to make it to yoga class during residency to keep my sanity. Or rushing home at 5:02 p.m. with all my notes finished, charts closed to go see my kids. After all, I had spent all day working, and the time from getting home at 5:10 p.m. to their bedtime is short.

    I want to be present for my life, my health, my husband, and my kids.

    For me, starting my clinic at 8:30 a.m. instead of 9 a.m., which will not allow me to drive my daughter to school, has no value for the extra money seeing two extra patients will bring.

    The value for me is spending time with my daughter, helping her when she is nervous at drop-off, giving her a big hug, and putting her next to her school friends as they read their morning story. Yes, it is a 13-minute drive to school, but those 13 minutes are priceless.

    Now, when I share stories like these, others always start to feel uncomfortable and angrily react to tell me they love their kids, they like to spend time with them, etc. My opinions and the choices I make do not reflect anything you are doing or not doing. Or maybe it is? Maybe subconsciously, it is making you angry or uncomfortable because there could be some truth to the priorities you have been placing and when you see this is someone else, anger sparks.

    Now, I never said others should do what I do. I never said 8-hour surgeries are not absolutely valuable, but I said what works for me and what I find value in. However, there is still this discomfort from others when I state it.

    If anything I wrote or my priorities make you uncomfortable, then I ask you to think about the why?

    Why did you immediately feel anger?

    Why did you feel resistance inside your body?

    Did your muscles tense, did your jaw clench a little when you read it?

    Maybe it didn’t, and that’s OK too. Both reactions are OK, actually. I do not want you to change them, I just want you to explore why, and you may come up with some amazing answers during your introspection.

    So, challenge your reactions, your emotions that come up.

    Challenge the hierarchy and the unconscious choices we make daily.

    Challenge the value you are putting in things in life.

    It may transform you.


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