Scutmonkey Chronicles

Commentary on healthcare in general, life as a medical student, and issues of concern thereof. Readers warmly encouraged to contribute their "best" and "worst" experiences with the healthcare system (who knows, some budding young doctor might learn something from your pain...?) Submit via comments section, or email me at if you'd like to become a regular contributor. Welcome, and don't forget to double-glove!

Friday, March 03, 2006

Scutwork Revisited

I am still a year away from possessing the title Doctor. However, with nine and one half months of rotations now under my belt, if there is one thing I now feel qualified to comment on, it is Scutwork. I will begin by saying that although the term Scutwork may come across as completely negative, to say that there is nothing of value in Scutwork would be incorrect.

As with most things, Scutwork is, in and of itself, neither good nor bad. It just is, and it just has to be done. And if you are a third year med student, it just has to be done by you.

Ok, so maybe it is painfully obvious that I stood two calls this week and am on the hook again tomorrow (Saturday). Oddly enough, I am not really all that resentful regarding my current work hours. Just resigned. And given the experience I now possess, I can say with some degree of confidence that even though I'm maxed out, this rotation is one of the better ones I have been on.

So I suppose what brought the topic of Scutwork to mind was a random encounter I had this afternoon, in the corridor of the generic med school I attend, with a friend who is in the class behind mine and who just set up her schedule for next year. It went something like this: Friend (wide eyed and painfully eager): Hey, I just signed up to do my XYZ rotation at PQR Hospital. I heard you were there. What can you tell me?

Me (sixty four hours into my eighty hour week, clutching a Diet Coke in one hand and a coffee in the other): Get out now. Or run away and join the French Foreign Legion.

Friend: Really? But that hospital has a great reputation.

Me: Yeah, and well they should--they spend all their money on PR. That swanky pen you're holding is all you'll ever get out of them.

Friend: So you mean, they'll kill me with scutwork? Was it the worst schedule you ever had?

Me: No, they didn't kill me. And no, not the worst schedule.

Friend: What, then?

Me (struggling to put into words the bag full of anger I had about this hospital, that I didn't know I had, until my friend asked me about it): Oh man, just don't go there.

So I got to spend the rest of the afternoon trying to figure out why, two months after I left that place, I had this unexpectedly vehement reaction to being asked about it. This is the conclusion I came to: the massive amount of *@it work I put in during that month was in no way balanced by the minimal amount I learned during that time. I was too dumb to know it then, but I do now.

Third year, is , some ways, a psuedo-economic deal you strike at each rotation site: I will provide X-amount of slave labor, and in return, you will provide Y-quantity of learning.

Sometimes scutwork itself is enlightening, but not always.

Some rotation sites are "honest brokers" in that there is a lot of teaching built into the schedule, and you will get a fair deal just by showing up and working hard, without every being forced to haggle for your enlightenment. (Enlightenment which you are also paying the yearly equivenlent of a luxury sedan to attain.)

At other places, it becomes painfully obvious that med students are nothing more than calculated components of somebody's business plan, and that the plan doesn't include teaching those white coat wearing revenue generators much of anything.

A student who takes a totally negative attitude toward scutwork is headed for trouble and disappointment. It is a simple fact of life that somebody has to copy down lab results, make calls to welfare agencies, and sometimes, lift huge patients on and off stinky bedpans.

I actually don't mind doing these things, most of the time. I've been a patient my fair share of times, and I know that when you are on your back and helpless, the last thing you want to deal with is a resentful, snarling medical staff. When this personal logic fails, I try to remind myself that the huge person who has to be lifted off the bedpan is probably somebody's grandmother. (Although my grandmother is not huge and stinky, if she were, I'd still want somebody taking good care of her, and not be giving her a lot of attitude about it. )

When even that fails, I corner the local resident (in the nicest way possible...yeah right) and subtly remind them that in exchange for the amount of grief I am taking off their hands, I should be getting some amount of teaching in exchange. Most of places and most residents do allow for some degree of negotiation regarding the balance between indentured servitude and learning.

As for my friend, who got an earful that she was not expecting, she had the good/bad/random luck to tap me on the shoulder on a day where all remnants of my (not too diplomatic on the best of days) conversational tact had been fully eroded. So regarding Hospital X, what I had not even admitted to myself just came flying out: they took advantage of me, and of all the other students who rotate through there.

They make cavegirl mad, and cavegirl not forget...


At 06 March, 2006 08:40, Blogger banzai said...

At least with scutwork there is the apparent need for it, as unpleasant as it is.

In the military there is another mindset used to strip away points of view which may result in failure of the mission and the death of troops (in order to build in it's place the mindset necessary for teamwork and other useful factors to replace it). There the "scutwork" mostly has no purpose whatsoever other than punishment for infractions or to occupy time.

(painting the bottoms of rocks on the parade ground, waxing and buffing floors repeatedly, polishing the bottoms of your boots, things like that)

And even negative leadership/management can be learned from. Unfortunately it's much more difficult to learn the way not to do things rather than the way to do them. :(


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