True Tales of Medical School: Grand Rounds
Filed under: Medicine
Once you start the clinical rotations in your third and fourth year of medical school, grand rounds become a way of life. For those of you unfamiliar with the term, “grand rounds” is a weekly event where all the physicians of a particular specialty come together to hear an educational lecture. Medical students are required to attend the grand rounds of whatever specialty they’re on at the time. Some “gunners” also attend the grand rounds of the specialty they intend to go into, particularly if it a highly competitive field and they want to be “seen.” I was never one of those.
OB/Gyn grand rounds were held ins a dark little theater with comfortable seats. To an exhausted medical student, that just meant a nice place to nap. Pediatrics had the best grand rounds. They were short and sweet, just forty-five minutes, and were on useful topics. They were also held at lunch so we didn’t have to stay late or come early — plus food was provided. For a poor medical student, any meal I didn’t have to pay for or buy at the highly suspect hospital cafeteria was a definite bonus. Internal medicine also held their grand rounds at lunchtime, but we had to bring our own lunch. The topics weren’t nearly as interesting to a medical student either. Psychiatry grand rounds were Wednesday afternoon. There was an hour lecture followed by a half-hour discussion of the lecture. Since we got to go home a half-hour early on those days, we were happy. Surgery grand rounds were the worst. They were Saturday mornings at 6 AM. Even on the rare Saturdays you weren’t working, you were still expected to be there for grand rounds. Like psychiatry, the lecture was followed by a discussion of the topic. Frankly, the discussion period was much more interesting than the lecture. The head of the surgery department was set to retire at the end of the year and his replacement had not yet been named. There were two leading candidates in the department and each had their followers and detractors, and the two sides were quite vocal about their feelings. Like clockwork, the discussion after the lecture quickly degenerated into partisan bickering, and as a medical student with zero interest in surgery, I always found this much more educating and entertaining than the lecture itself.
There are two grand rounds in particular that stand out in my memory. The first was a psychiatry grand rounds. An out of state psychiatrist was brought in to speak. He had no clinical practice; instead he worked as a consultant for the FBI — primarily helping them track down sexual serial killers. This was long before Silence of the Lambs, CSI, and Law & Order: SVU, so the subject of serial killers wasn’t as common as it is now. His lecture was fairly interesting and filled with lurid and explicit crime scene photos. He finished his talk, answered a few questions, and then left. The after-lecture discussion started, and nobody talked about the lecture. Instead, they all talked about the lecturer.
“Did you see the way he was getting off showing the crime scene photos?” one staff psychiatrist asked.
“He’s clearly a reverse voyeur,” another intoned.
“He has issues with women,” the department head announced.
This went on for half an hour. I was fascinated, a little dismayed, but mostly amused to see these professionals go to such length to psychologically “dissect” another psychiatrist who had just spoken to them. For the record, there was something a little off about the speaker and I think the other psychiatrists were undoubtedly right in their analysis. I still think it was rude, though.
Then there was the surgery grand rounds where a well-known hand surgeon was brought in from Los Angeles to speak. He was talking about surgical reconstruction of hands that had been severely injured by gunshots. He was an excellent speaker and had some memorable and somewhat sickening before- and after-surgery x-rays. About halfway into the lecture, he made the point that it was difficult to get good follow-up with the injured patients because “they’re ghetto people and theyrre unreliable about making it to their follow-up appointments.”
At this point, Dr. K-, the acting head of our surgical department stood up from his seat, fixed the speaker with his steely gaze, and said, “We don’t appreciate racist talk here. Please refrain from making any more such statements.”
The speaker had that deer-caught-in-the-headlights look for a minute, and then he collected his thoughts and resumed his lecture. It went well until about five minutes later when he made another statement about “those backwards ghetto people.”
“That’s it!” Dr. K- announced as he stood up. “I told you that we do not tolerate racist comments.” He paused, took a breath and then simply said, Let’s go.” At this point, all the other surgical attendings stood and filed out of the room. Dr. K- looked over at the medical students and residents and told us we could stay or we could go at our own discretion. We all left.
Other True Tales of Medical School
January 24th, 2007 at 10:03 am
Wow. This is amazing on so many ways. First, as a non-medical type, I’m fascinated by the rigors of the medical profession. Second, the stance of Dr. K.–what integrity! That is the sort of leadership there’s just not enough of.
Such a great story–I love your comic book dissections, Doc, but more of this, too!
January 24th, 2007 at 11:26 am
I like how each of the lectures conformed to the worldview of the specialty. Psychiatry talked about itself. Pediatrics brought snacks. OB was in a small room…
January 24th, 2007 at 4:55 pm
Dr. K did exactly what I would do. I can not stand racism.
January 25th, 2007 at 4:05 am
What was so racist about the ghetto-comments? Would someone care to clarify?
January 25th, 2007 at 10:27 am
Racist is probably not the correct word, as ‘ghetto people’ come in all races - though when we think ‘ghetto’, I can probably assume safely that most of us think ‘black’. Biased, closed-minded, predjudiced, and stereotyping all come to mind before racist does for me. But it means same basic thing in the end, really.
January 25th, 2007 at 1:52 pm
But was it racist - or prejudiced - because he commented that people from ghetto don’t keep appointments or because he identified them as “ghetto people”? Because from what Scott told us, I thought it was important to get as much done in one meeting as possible, as there might not be another.
Identifying the probability for second meeting to realize seems pretty important to me, and I can’t really understand how else you can tell about it… but of course, I’m neither doctor, American nor native English speaker.
January 25th, 2007 at 4:13 pm
Perhaps its more of the way he phrased it. Instead of saying ‘ghetto people’ something like ‘many of the patients we see with these types of injuries are from a low socieconomic demographic, which makes it difficult to get follow ups as many are unable to pay, and as a result, do not wish to make a follow up appointment’ would have been better. Or even better, if the doctor had just left it at ‘its difficult to get a second appointment’, he could have avoided the risk of insulting somebody altogether.
January 25th, 2007 at 9:12 pm
Yes, AFAIK ghetto is commonly used as a black insult. However even if he is not referring to black people it is very insulting to the persons he is referring to.
January 27th, 2007 at 2:23 am
the first statement, as presented, shows bias, but also reflects what is probably common shorthand for professionals who regularly work in that environment. the second statement, however, where he added the “backwards” was totally out of line. i teach at a community college, by choice, because I got tired of the elitism of the traditional 4 year university attitude. my students are struggling for their education and truly value it in ways that traditional university students never will. and they tend to be poor and many are the first in their families to ever get education beyond high school. As an institution, we have to be very careful about our assumptions with these students. They aren’t backwards or stupid, they simply don’t know some things that those of us who are educated take for granted. I would imagine that this is a similar situation for any other professional working with the lower socio-economic classes as well, regardless of race.
January 28th, 2007 at 12:04 pm
“i teach at a community college, by choice, because I got tired of the elitism of the traditional 4 year university attitude. my students are struggling for their education and truly value it in ways that traditional university students never will.”
Not even the traditional university students who used to be struggling community college students until they graduated from their community colleges and became transfer students at their traditional universities?
December 15th, 2007 at 9:13 pm
I have to say, Dr. K seems a bit overly sensitive. It seems to me that the lecturer was speaking truthfully from experience. The sad fact is that people who live in ghettos (not a derogatory term, but a noun which refers to low-income communities) tend to be less likely to keep medical appointments. They’re also much more likely to need surgery to treat gunshot wounds.
It’s not racist if it’s true, then it’s simply a fact. However, assuming that “ghetto” refers to a specific race DOES sound racist to me.
December 25th, 2007 at 10:07 pm
I agree with Adam. And while it’s somewhat offensive to call a stubbornly ignorant person “backwards”, it’s not exactly inaccurate.
February 16th, 2008 at 8:40 am
This isn’t terribly important but I’m a little confused. You wrote that while in your second year of med school you attended The Nightmare Before Christmas, which was released in 1993. Silence of the Lambs was released in 1991. Assuming the FBI consultant’s grand round took place in your third or fourth year, what year was it then?
November 16th, 2008 at 5:15 pm
I have never heard the term ‘ghetto people’ used with any kind of racial association. I always thought it meant people who lived in a ghetto, i.e. those who belong to a lower socio-economic standing.
The only way I can see it might be racist is if the guest speaker had been showing photographs of victims primarily from one racial background (for example if most of the gunshot victims were white, African-American, hispanic, and so on) and therefore it was implied that he was referring to just one race.
But it does seem that it is important to judge the probability of a return appointment. The fact is that people from certain backgrounds, particularly poorer backgrounds, are less likely to make follow-up appointments - that seems to be all he was trying to express. And it is shorter to say ‘ghetto people’ or ‘people from the ghetto’ than ’socio-economically disadvantaged urban individuals.’
Now ‘backward’ may not be a nice way of putting it, however, ‘backward’ literally just means ‘living as if it was some time in the past.’ I realize it has certain negative connotations in some circles, but nonetheless it is often an accurate term. Certainly it seems accurate, if insensitive, for those who do not obtain medical care (whether by choice or necessity of circumstance).
I can’t judge, since I wasn’t there, but my initial impression (and still my general impression) was ‘Wow, that Dr. K- is really over-sensitive!’
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