What is pride?
There may be many sorts of pride, but I think of pride as a positive emotion which has to do of a transfer of identification from yourself to another or others, to feeling better about yourself because of the virtues you see in others, virtues which may reflect back on you, to make you feel bigger, better or otherwise more praiseworthy than you would have felt alone.
You can feel pride in what you've done on your own, a problem solved, so it is possible to feel silently, inwardly proud, but, for the most part, pride is something you share with others or at least in relationship to others.
Is that too complicated?
Maybe this is because there are so many different sorts of pride: the pride a father feels seeing his kid score the touchdown; the pride you feel when your team mate scores a wining goal, even if you were not on the field; the (phony) pride a fan feels when "his" team wins the Superbowl--as if he had anything to do with it; the pride you feel when you figure out how what was wrong with the car and you change the spark plugs and it starts right up--you want to tell somebody about it; the pride you feel when your regiment runs up the hill and overwhelms the enemy and bullets have whistled by your head and you've taken a risk with others and triumphed.
Growing up, I felt justifiably proud when I trained for a particular swimming meet and beat somebody I wasn't supposed to beat, when I won a wrestling match. I don't think I would have felt pride had I not also known defeat, known that it was not a given that I would win.
The big pride sweepstakes culminating the end of childhood was college acceptance--the kids who got into Harvard, Princeton or Yale could be proud. The rest of us might not feel humiliated if we had to settle for Brown, Cornell or Dartmouth, but we weren't proud.
Through college, at the beginning of adulthood, people started to sort themselves out by what they were studying, the steps they were taking toward the future. Some people declared themselves engineers, others pre meds (candidates for medical school) and they set themselves apart from the guys who were just taking philosophy or English lit courses. Engineering, math, science, those were courses you could be proud of, because they entailed competition, struggle and the potential for victory.
As we trudged off the the library, past the frat boys on their porches, drinking beer, playing loud music, throwing balls, we did not respect them and we gained some respect for ourselves, some pride in our own self discipline, in our capacity for suffering.
In medical school, the first two years, when we were learning anatomy, pathology, histology, there didn't seem to be much to be proud about. We looked at each other and realized we were studying stupid things mostly to keep faculty of microbiology and pharmacology employed. Scoring high or low on some mickey mouse pharm exam didn't enhance or injure your pride.
But when we hit the wards, there was pride. Could you hang in there, holding retractors for an eight hour surgery? Could you stick with that GI bleeder, running up and down the flights to the blood bank and following his numbers on well maintained charts to follow his progress? Could you keep your head when a patient suddenly frothed over in pulmonary edema and remember, step by step what to do to save him?
There was pride in picking up on clues others had missed to figure out what was going wrong.
There was pride in discovering a problem neither the patient nor his other doctors had appreciated.
But medical practice, distinct from surgical practice, has gone in a direction away from pride.
The surgeon is still, clearly, the captain of the ship. If the surgeon is not good enough, it doesn't matter whether the pump team, the operating room nurses, the recovery room staff, the ICU staff are good--the patient crashes.
For physicians however, pride has vanished in a system of "team" and shift work. There is no ownership of the patient or what happens to him.
The tasks are broken down for efficiency and cost control: Just as the assembly line worker puts the wheel on the left front axel and doesn't notice, doesn't care if the windshield is broken or the steering wheel on backwards, the patient who sees the cardiologist might have a melanoma on his back and that is no concern of the heart doctor.
When I arrived at a new clinic some years ago, I discovered there were no gowns or capes for patients in the exam rooms. "But how do you examine the patients without those?" I asked. The nurse looked at me puzzled.
"Why would you need to have them get undressed?"
"To listen to their hearts."
"Doctor Jones just listened through their sweaters."
"Did Dr. Jones find many melanomas? And how can you hear wheezing or a soft heart murmur through a sweater?"
Just a shrug from the nurse.
There were complaints from nurses and staff alike when I insisted shoes and socks be removed so we could examine the feet of every diabetic every visit. It was unsanitary to have bare feet on floors. We would have to find a towel for the floor.
Listening to a heart one day I heard what sounded like atrial fibrillation on a patient and I asked the nurse to get an EKG machine. The endocrine clinic did not have one but we borrowed one from the oncology clinic next door.
Later, one of the younger endocrinologist asked me why I had done the EKG. I told her the patient did not know she had atrial fibrillation and I had to call her primary care doctor and get her seen for that.
My colleague looked aghast, "But if you do the EKG you have to read it. You could miss something," she said. "Then that's on you."
"Yup," I said, "But I know how to read an EKG, and that worked out well for the patient."
"Oh," she said. "I would never want that responsibility."
This woman had passed her board exams in internal medicine. Fully certified.
A dermatologist, a graduate of Duke medical school, who had trained at Harvard in dermatology came to Washington, D.C. to set up a cosmetic dermatology practice with a specialty in laser dermatology. She hired an architect to design a glam office in the West End of DC, down the street from the State Department. She came to me because I had been writing articles about various doctors around Washington for the Washingtonian magazine, people like Tony Fauci who was heading up the effort to identify and then to treat HIV at the National Institutes of Health, and Henry Masur, who actually wrote the first article to identify AIDS for the New England Journal of Medicine and he worked with Fauci at NIH, and Martin Wolf, a tropical disease specialist who worked with the State Department treating the exotic parasitic diseases brought home to Washington by diplomats, who once got called to the emergency room in the middle of the night and diagnosed bubonic plague in a patient.
These were doctors I was proud of.
The dermatologist wanted me to write an article like that about her. She was model thin, had a great blond bob and had the looks of a starlet on the Tonight show.
I asked her if I could refer her a patient I had just seen that morning, who had a lesion on his shoulder I thought might be a melanoma.
"Oh no," she said. "I could biopsy it, of course, but if it came back melanoma, then I'd have to call him with that bad news. That's such a downer, doing stuff like that. No, I'm just not into that."
I never wrote the article about her. Someone else did. She became the dermatologist to the stars, Washington, DC edition.
I can't say I was proud to know her.
There may be many sorts of pride, but I think of pride as a positive emotion which has to do of a transfer of identification from yourself to another or others, to feeling better about yourself because of the virtues you see in others, virtues which may reflect back on you, to make you feel bigger, better or otherwise more praiseworthy than you would have felt alone.
You can feel pride in what you've done on your own, a problem solved, so it is possible to feel silently, inwardly proud, but, for the most part, pride is something you share with others or at least in relationship to others.
Is that too complicated?
Maybe this is because there are so many different sorts of pride: the pride a father feels seeing his kid score the touchdown; the pride you feel when your team mate scores a wining goal, even if you were not on the field; the (phony) pride a fan feels when "his" team wins the Superbowl--as if he had anything to do with it; the pride you feel when you figure out how what was wrong with the car and you change the spark plugs and it starts right up--you want to tell somebody about it; the pride you feel when your regiment runs up the hill and overwhelms the enemy and bullets have whistled by your head and you've taken a risk with others and triumphed.
Growing up, I felt justifiably proud when I trained for a particular swimming meet and beat somebody I wasn't supposed to beat, when I won a wrestling match. I don't think I would have felt pride had I not also known defeat, known that it was not a given that I would win.
The big pride sweepstakes culminating the end of childhood was college acceptance--the kids who got into Harvard, Princeton or Yale could be proud. The rest of us might not feel humiliated if we had to settle for Brown, Cornell or Dartmouth, but we weren't proud.
Through college, at the beginning of adulthood, people started to sort themselves out by what they were studying, the steps they were taking toward the future. Some people declared themselves engineers, others pre meds (candidates for medical school) and they set themselves apart from the guys who were just taking philosophy or English lit courses. Engineering, math, science, those were courses you could be proud of, because they entailed competition, struggle and the potential for victory.
As we trudged off the the library, past the frat boys on their porches, drinking beer, playing loud music, throwing balls, we did not respect them and we gained some respect for ourselves, some pride in our own self discipline, in our capacity for suffering.
In medical school, the first two years, when we were learning anatomy, pathology, histology, there didn't seem to be much to be proud about. We looked at each other and realized we were studying stupid things mostly to keep faculty of microbiology and pharmacology employed. Scoring high or low on some mickey mouse pharm exam didn't enhance or injure your pride.
But when we hit the wards, there was pride. Could you hang in there, holding retractors for an eight hour surgery? Could you stick with that GI bleeder, running up and down the flights to the blood bank and following his numbers on well maintained charts to follow his progress? Could you keep your head when a patient suddenly frothed over in pulmonary edema and remember, step by step what to do to save him?
There was pride in picking up on clues others had missed to figure out what was going wrong.
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| White Pride |
There was pride in discovering a problem neither the patient nor his other doctors had appreciated.
But medical practice, distinct from surgical practice, has gone in a direction away from pride.
The surgeon is still, clearly, the captain of the ship. If the surgeon is not good enough, it doesn't matter whether the pump team, the operating room nurses, the recovery room staff, the ICU staff are good--the patient crashes.
For physicians however, pride has vanished in a system of "team" and shift work. There is no ownership of the patient or what happens to him.
The tasks are broken down for efficiency and cost control: Just as the assembly line worker puts the wheel on the left front axel and doesn't notice, doesn't care if the windshield is broken or the steering wheel on backwards, the patient who sees the cardiologist might have a melanoma on his back and that is no concern of the heart doctor.
When I arrived at a new clinic some years ago, I discovered there were no gowns or capes for patients in the exam rooms. "But how do you examine the patients without those?" I asked. The nurse looked at me puzzled.
"Why would you need to have them get undressed?"
"To listen to their hearts."
"Doctor Jones just listened through their sweaters."
"Did Dr. Jones find many melanomas? And how can you hear wheezing or a soft heart murmur through a sweater?"
Just a shrug from the nurse.
There were complaints from nurses and staff alike when I insisted shoes and socks be removed so we could examine the feet of every diabetic every visit. It was unsanitary to have bare feet on floors. We would have to find a towel for the floor.
Listening to a heart one day I heard what sounded like atrial fibrillation on a patient and I asked the nurse to get an EKG machine. The endocrine clinic did not have one but we borrowed one from the oncology clinic next door.
Later, one of the younger endocrinologist asked me why I had done the EKG. I told her the patient did not know she had atrial fibrillation and I had to call her primary care doctor and get her seen for that.
My colleague looked aghast, "But if you do the EKG you have to read it. You could miss something," she said. "Then that's on you."
"Yup," I said, "But I know how to read an EKG, and that worked out well for the patient."
"Oh," she said. "I would never want that responsibility."
This woman had passed her board exams in internal medicine. Fully certified.
A dermatologist, a graduate of Duke medical school, who had trained at Harvard in dermatology came to Washington, D.C. to set up a cosmetic dermatology practice with a specialty in laser dermatology. She hired an architect to design a glam office in the West End of DC, down the street from the State Department. She came to me because I had been writing articles about various doctors around Washington for the Washingtonian magazine, people like Tony Fauci who was heading up the effort to identify and then to treat HIV at the National Institutes of Health, and Henry Masur, who actually wrote the first article to identify AIDS for the New England Journal of Medicine and he worked with Fauci at NIH, and Martin Wolf, a tropical disease specialist who worked with the State Department treating the exotic parasitic diseases brought home to Washington by diplomats, who once got called to the emergency room in the middle of the night and diagnosed bubonic plague in a patient.
These were doctors I was proud of.
The dermatologist wanted me to write an article like that about her. She was model thin, had a great blond bob and had the looks of a starlet on the Tonight show.
I asked her if I could refer her a patient I had just seen that morning, who had a lesion on his shoulder I thought might be a melanoma.
"Oh no," she said. "I could biopsy it, of course, but if it came back melanoma, then I'd have to call him with that bad news. That's such a downer, doing stuff like that. No, I'm just not into that."
I never wrote the article about her. Someone else did. She became the dermatologist to the stars, Washington, DC edition.
I can't say I was proud to know her.
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