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Any Thoughts On This Article Re: Entitlement In Medicine

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Hmm I get what the author is saying, but idk if students now think they are more deserving and more entitled to their seats.

If anything, I would think current students more than ever, recognize that there is an increasing amount of luck involved in the admissions process and think of themselves as being very fortunate (at least I do).

But at the same time, I do understand where the author is speaking from. What I don't understand is if the "entitlement" he speaks of is actually due to the pampering of medical students, if it's due to the ever-increasing competitiveness in admissions or even due to the generation it self (generation y - "generation me").

Definitely crossed my mind as a what if's, and it's definitely something I hear from members of generation x all the time.

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I definitely agree with the author's viewpoint. Definitely a very well-written and well-presented article. That being said, I do not agree with some of the recommendations set out by the author. I think that his admiration for the humanities has biased his conclusion. I think requiring medical students to study humanities in order to understand their own entitlement is a bit overboard. Rather, medical schools and educators should adopt different attitudes towards teaching, as the author so eloquently described in the article. 

 

Two things about medical school always stood out to me as extremely arrogant: the white coat ceremony and the same-colored backpacks adorning medical students. I understand the white coat ceremony is a celebration; an opportunity to revel in the accomplishment of entering medical school. However, at least from a public viewpoint, the ceremony does not include the much-needed caveat that these students understand practicing medicine typically requires inordinate amounts of responsibility.

 

The white coat ceremony gives many new students the opportunity to brag about entering medical school. I think this is harmful for both students and the public alike. For students, the effect is as described in the article -- learners that feel that they've 'made it' and are above reproach. For students who were denied entrance or are yet to be admitted, a toxic sense of envy can manifest. The public can develop a sense of distrust for students who present themselves as being of a different social class. In essence, no one likes a bragger. Medical students should not feel that they are superior to others.

 

The same-colored backpacks remind me of the jackets "jocks" wore back in high school. Everything about it screams elitism. In some medical school admissions videos, medical students will literally flaunt their backs in front of the camera, almost like a sign that says, "YEAH, once you're in our club, you get to wear these exclusive cool backpacks too! And everyone on campus will respect you because it means you're a medical student!" Medical students should aim to be the most self-effacing students on campus. Sure, it allows one to approach their studies with an open mind. But, more central to this discussion, it also allows students to approach everyone else they meet with an open mind too. That way, when students start treating their own patients, respect and cooperation are things that come naturally. 

 

Being humble is not just an admired character trait because of normative approval, but rather because of the very real consequences that accompany alternatives.

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I'm kind of tired of this repeated crucifixion of modern society, of millennials and of these comparisons to WWI/WWII as if those were supposed to be what we base ourselves off of for conduct and behaviour. You know what? There will be many people who get into med feeling entitled. Those people come from rich families who didn't teach them well. There will also be many people, from rich or poor families, whose parents and relatives had the insight to make them value hard work for the sake of accomplishment instead of praise. There has and there always will be those who feel entitled to everything because they've never lacked for anything.

Comparing modern western society to war-torn societies or groups that were involved in some of the darkest hours of humanity is just inadequate as far as arguments go. We are not living in a state of stasis right now, as if we could die tomorrow. That's a good thing. People can take their safety for granted, but you know, good for them. Living like people do where I was born, afraid of being robbed and kidnapped and killed for nothing more than a couple dollars, those people are not warriors for going through that. They're prisoners. I am willing to bet that most of them would be more than glad to relinquish their position. 

Another thing that I quite dislike is when people tell me or anyone that it's foolish to expect things to change. It's childish to expect the world to owe anyone anything, sure. but fighting so that some "ideals" become realities, that's within the reach of societies anywhere, as long as there's not a big push toward the status quo and all its obsoleteness. It's démodé to be blasé and to pretend that things have to be the way they are. People don't have to starve, or suffer for their colour and sexuality. We've come a long way, and change is unavoidable because thinking idealistically drives us forward.

 

Ultimately, I just feel like however wrote this article is someone young trying to suck up to their older generation mentors. I disagree strongly with it, because I think it paints that bitter picture of "everything is the millennials' fault and all was better back in the day." 

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Two things about medical school always stood out to me as extremely arrogant: the white coat ceremony and the same-colored backpacks adorning medical students. I understand the white coat ceremony is a celebration; an opportunity to revel in the accomplishment of entering medical school. However, at least from a public viewpoint, the ceremony does not include the much-needed caveat that these students understand practicing medicine typically requires inordinate amounts of responsibility.

 

The white coat ceremony gives many new students the opportunity to brag about entering medical school. I think this is harmful for both students and the public alike. For students, the effect is as described in the article -- learners that feel that they've 'made it' and are above reproach. For students who were denied entrance or are yet to be admitted, a toxic sense of envy can manifest. The public can develop a sense of distrust for students who present themselves as being of a different social class. In essence, no one likes a bragger. Medical students should not feel that they are superior to others.

 

To a certain degree I agree with you about the backpacks... It really is unnecessary and serves no sentimental value other than to flaunt the fact that you're a canadian medical student. It's similar to leather jackets engineering students love wearing.

 

However, I completely disagree with your viewpoint about the white coat ceremony. Admitted students should be allowed to formally celebrate their acceptance into the school and future profession with their new peers, future colleagues, and most importantly - their family. Yes, they get the stethoscope and the white coat, but it's also a formal way of introducing the hippocratic oath and some of the expectations of them as students and future practitioners. 

 

If the students who weren't admitted feel envious, that's their own problem. The "toxic" envy is felt by the extremely insecure and bitter students who didn't get in, not caused by the students who did. The admitted students shouldn't be punished and prevented from celebrating their accomplishment. Why should they be made to feel bad about other students not getting in when they had no control over it?

 

In addition, why does the public feel mistrust in medical students and their white coat ceremony? Are medical students publicly wearing their white coats and stethoscopes 24/7 and criticizing anyone and everyone for not being doctors? Are medical students cutting in front of the line of McDonald's and saying, "look at my white coat, I'm a medical student, give me my chicken McNuggets"?

 

Unless all medical students are intentionally bragging about getting into medical school and the general public is forced to watch the white coat ceremony every year, I don't understand how the white coat ceremony is responsible for creating the "sense of distrust" and how students present themselves in a "different class". There are similar ceremonies for those in engineering, the navy, the army, the police academy, and even post-secondary education graduates. Should all those ceremonies be banned because those who aren't in the ceremony are all envious? Should they be banned because the "public" senses distrust? The last time I checked, it wasn't the police academy graduation ceremony that created mistrust in the police with the public but rather the everyday actions and the decision making of members in their profession.

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I agree with HiHopes. This incessant criticism of millenials taking things for granted or having it easy are absurd.

 

 

When I was admitted to medical school in Canada, I was commended by my new professors as one of the country’s brightest students. The first months inculcated and cultivated the idea that I was exceptional and set apart from other students who did not make it to medical school. Sometimes the praise was explicit, sometimes not; few probably noticed. Yet there was a subtle message: I was special and deserved all my success because of it.

 

You are special if you get into med school. The same goes for dental students getting into dent school, optometry students getting into optometry school, nursing students getting into nursing school, PhD students finding something they want to write their PhD in. People should be congratulated for getting into med school or any other school that they have worked hard to gain admission, but I have yet to see the kind of self-aggrandizement that this author speaks of when I started med school or even when I researched what I needed to get into med school. There are many brilliant candidates. There is hardly anything that separates someone who was admitted vs. someone who was waitlisted vs. someone who was rejected post-interview. There is a considerable amount of luck involved in the admissions process. The kind of early mindset the author shows is not a fault of society, but a fault of the author for placing so much self-importance to his realised goal because he has been working towards that goal for most of his post-secondary life.

 

 

I have to admit that initially such praise was quite pleasant. Who does not love to be praised? Yet as I contemplated my “greatness” I readily recalled peers who never entered medical school, but were surely just as, if not more, capable than I. We all can remember these students; the approbation helps me forget them

 

In his book Excellent Sheep, William Deresiewicz shares a colleague’s reflection on the “old days” at Yale.

In… September 1957… I remember the Dean of Yale College telling us that the pool of applicants from which we had been drawn was so large and so good that Yale could have recruited a class every bit as qualified as ours… He went on to say that it was the duty of each of us over the next four years to prove that Yale had made the right choice by picking us …. [1]

He continues to highlight how that mindset changed just over a decade later and students were told they were “the most wonderful set of human beings who had ever entered Yale, and how wonderful it was for Yale that they had decided to attend.” [1]

 

I remember one of the very first things that Dr. Joseph Finkler, who was assistant dean at UBC Medicine in 2011, told us during the interviews was that everyone who was present were outstanding candidates and would make fine doctors regardless of whether or not they were accepted, and that there were many capable candidates who were not interviewed because for logistical reasons it was impossible. Neither our cohort nor any other cohort I know of was ever told that we were the best year out of all the years who had studied medicine. I'm not sure what the author of the article is trying to show with that quote other than changing the focus of exceptionalism from "getting into Yale" to "being the best class ever to have gone to Yale." I have never seen or heard of this latter exceptionalism in med school in current times.

 

 

In Canada today, we fit the latter cohort. Our egos are stroked and we lap it up. This exacerbates the pervasive culture of entitlement. Compared to previous generations, we think far more highly of ourselves. [2] We believe that we should get what we want and expect to be protected. [3] This is bolstered by assurances that failing is unlikely (because the school will do everything to prevent you from dropping out) and that second chances are seemingly inexhaustible. Even the white coat ceremony can cultivate our entitlement. [4] Yet we are so very blind to this. I recall a residency interview when candidates were asked about how the entitlement culture affects medical learners today; nobody had any idea what to say. As a result, I picked up a book on the generation that lived through the Great Depression and World War II. I was chastened. Despite their tremendous sacrifices and accomplishments, they “made no demands of homage” and expected little to be done for them. [5] Not my generation.

 

This paragraph reeks of ridiculous ageism. Protections were fought for so that subsequent generations would have a better quality of life. That's not something people should be shamed for. White coat ceremonies occur in many other fields in some way or another and is not limited to medicine. Canada is a country made up of immigrants, and I assure you that many people have harrowing experiences just as terrifying as living through the Great Depression and World War II. To limit society's wants, needs, and protections based on prior generations is a stifling of progress. Millenials have their own set of hardships, including unprecedented levels of poverty, far higher levels of debt, and far lower pay for the level of education.

 

 

Entitlement is apparent in daily banter regarding personal gain. Lifestyle factors dominate conversations. Of course, we are still taught how to appear “professional,” but this amounts to superficial performance, a mere façade of altruistic character. Furthermore, we believe we deserve prestige and high pay, and hence, performance for these ends dominates our pursuits over the poorly remunerated altruism. Entitlement is changing the profession, and the educational system is fostering it.

 

Being able to enjoy a life outside of medicine isn't entitlement. It's a compromise. Residents were overworked, staff were overworked, women physicians were few and far between. Medicine isn't the good old boys club anymore. Those things have changed because we have realised that burnout is real and causes errors, job dissatisfaction, and mental health problems.

 

Physicians deserve high pay for the amount of work they do, the amount of training they have undergone, and the amount of responsibility they undertake. That kind of entitlement is not a negative kind. It preserves our ability to push back against government policies that erode healthcare and our positions as healthcare providers.

 

I find it ironic that the author quotes C.S. Lewis's stance on chronological snobbery when he is doing the exact same thing himself.

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No doubt we have heard it before: The incessant narcissm and egoism of millenials and generation y is too widespread and causing us to take everything we have for granted. We don't "work hard enough". We "have it easy". We just don't know "what true hardship" really is.

 

My contention with the author is that, as others have posted, he seems to strongly appeal to the aforementioned belief and older generation. I also find it it ironic that he quotes C.S. Lewis, as he himself appears to partake in this "chronological snobbery". I believe he goes overboard in asking medical admissions to implement lectures on humanities and philosophy, when a closer examination and more revealing self-reflection can be just as achieved through experience and community involvement. Possibly, his bias towards the humanities and philosophy could be a factor towards such radical suggestions to a curriculum that is already heavy as it is.

 

Yes, he does mention that a lot of his concerns are generalizations ("many educators and learned do not fit this broad picture"), but I would appreciate if he could have placed greater emphasis on the "learners" being a generalization rather than the "mentors". Such focus only further reveals his bias and favour to an older, "wiser" generation. Hardship is extremely personal and subjective; not every med student I'm sure feels entitled and I think he needs to stress that even more.

 

I do not entirely disagree with the author. however. To his credit, many of his statements may serve as potential warnings to certain groups in the medical student community, and encourage change to those groups. His application of the humanities and philosophies provokes thought on the non-scientific aspects that affect how physicians present themselves within the broader community. All in all though, I just think he takes it too far.

 

Moving on. On the other hand, I do find that his comments regarding the backpacks and white coat ceremony to have some validity. First off, the backpacks I believe do encourage a sense of community, but does impart a sense of separatism from the community. The white coat ceremony offers a chance for future physicians to connect with their peers, celebrate their achievements with friends/family, and reinforce the hippocratic oath, but again may promote elitism. Personally, I do not have an issue with any of these, except for when individuals seemingly flaunt their new backpacks and white coat ceremony pictures over social media repeatedly. One time is alright, but entire photo albums and comments on aspirations for the future?

 

Even though I'm not a current or upcoming med student, I can see how individuals may feel bitter or envious of their peers who are finally taking their next steps in life. I can also see how, as the author posits, a sense of entitlement may be fostered among med students. However, I disagree with a proposition above that only the most anxious or neurotic individuals are susceptible to such negativity->every individual is vulnerable, especially for something that takes years and years of hard work.

 

Out of respect for my peers, if I ever do enter medicine, I would like to only use the backpack during my time in school; otherwise, my current backpack will do just fine. I would even prefer to use my current backpack. Sure, it's none of my business how others feel, and I doubt that their feelings would reach me, but why not take that step to avoid the aforementioned negativity? 

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I can't comment on the medical education, learning environment, and clinical experience in Alberta generally, let alone in pediatrics.

 

I'll just say this:  Neither my ego nor anything else has been stroked since at least 2007.  My preceptors, peers, nurses, and allied health have had consistently high expectations of me, and have not been shy about letting me know when I have not met them.

 

If Dr. Liang feels he is being coddled too much, I can introduce him to a couple of surgical charge nurses who will quickly disabuse him of that feeling.

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I have no idea what this insane shitstorm is with the backpacks.  Almost NOBODY knows what they are.  I had no idea they even EXISTED until I started using this forum when I applied to medical school.  It really bugs me.  I like my backpack because then I can identify other med students/residents and talk to them.  Because I think that's fun.  Literally nobody other than another med student or physician has EVER approached me on the basis of my backpack.  Well maybe one.  In six years.

 

Nobody should be a snotty asshole about being a doctor.  I am well aware that there are people in the world who work more hours doing shittier jobs for less money.

 

That being said, I have sacrificed a lot for this career.  I work a difficult job that requires a lot of technical skill and exposes me to shitty hours, violence, and secondary trauma.  I have a crapload of debt that I'll be paying off for years to come.  So yeah, I think I deserve some amount of respect for what I do.

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I have no idea what this insane shitstorm is with the backpacks.  Almost NOBODY knows what they are.  I had no idea they even EXISTED until I started using this forum when I applied to medical school.  It really bugs me.  I like my backpack because then I can identify other med students/residents and talk to them.  Because I think that's fun.  Literally nobody other than another med student or physician has EVER approached me on the basis of my backpack.  Well maybe one.  In six years.

 

Nobody should be a snotty asshole about being a doctor.  I am well aware that there are people in the world who work more hours doing shittier jobs for less money.

 

That being said, I have sacrificed a lot for this career.  I work a difficult job that requires a lot of technical skill and exposes me to shitty hours, violence, and secondary trauma.  I have a crapload of debt that I'll be paying off for years to come.  So yeah, I think I deserve some amount of respect for what I do.

 

 

 

Summarized my feelings exactly. Never knew about the backpacks until I got into med and now that I am in med its a nice convo starter when travelling places and seeing fellow meds. 

 

Ppl need to chill....

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The author is 100 percent right.

 

Professional school should not baby sit students. They should grill students and do their best to fail students (in the written and clinical components and in both med school and residency), especially anxious students. :) 

 

I hope as well the government, provincial and federal one, take the necessary steps to cut health care costs by reducing the salary of physicians. They are very overpaid. Their salaries should reduced to 100-150 k for general practitioner and 150-200 k for specialists.

 

We need these cuts to fund the treasury and to reduce provincial and federal debt, so that future generation can have a good life.

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The author is 100 percent right.

 

Professional school should not baby sit students. They should grill students and do their best to fail students (in the written and clinical components and in both med school and residency), especially anxious students. :)

 

I hope as well the government, provincial and federal one, take the necessary steps to cut health care costs by reducing the salary of physicians. They are very overpaid. Their salaries should reduced to 100-150 k for general practitioner and 150-200 k for specialists.

 

We need these cuts to fund the treasury and to reduce provincial and federal debt, so that future generation can have a good life.

??

 

I'm pretty sure you wouldn't get most people doing surgeries at all hours of the day and doctors in general working well over 40hrs for a cap at that salary.

 

Good luck.

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Physicians, at least in Ontario, are not salaried in the first place.  Do you have any idea what you're talking about, or do you just like to rile people up?

 

hopefully the later - what is the point of a school trying to fail students? Considering the 100K per year to train them it would be at the very least more logical to to the screening early on. 

 

besides you can always argue a group should cost less for the benefit of society. It is after all always true. It would be nice if say the police cost less so taxes go down. However the police have something to say about that. So do doctors ha :) 

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Please. Physicians have had overblown senses of entitlement and inflated egos for long before the current generation arrived on the scene. Likewise, while there are heroes to read about during the Great Depression and WW2, there were plenty of entitled, petty, controlling, and whiny people too. Romanticizing the past is no better than being believing the present is special. I wish the author would take his own advice and actually study the humanities, not just play armchair sociology using obtuse language and esoteric quotes.

 

I'll agree that generic, blanket compliments are not helpful. Neither were the generic, blanket criticisms that medical schools having been trying to eliminate. The common thread is generic, blanket feedback that doesn't provide any direction on how to improve, not that the feedback is generally positive or negative.

 

Lastly, I can't help but chuckle that one of the author's criticisms is that learners want to change their learning environment to better suit their preferences... and his major suggestion is to change the learning environment to suit his preferences. Medical education has a lot of room for improvement and won't change without pressure from all angles, including students - there's nothing wrong with students trying to make their learning worthwhile.

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http://blog.ualberta.ca/2017/04/entitlement-and-me-problems-in-canadian.html?ct=t%28The_Quad_August_18_20168_4_2016%29&m=1

 

Not sure if I agree with this article but would love to hear thoughts/discussion on this. 

 

Yeah i do think in some ways we are entitled, but at the same time i think its inevitable and we should just accept our entitlement and enjoy it. The reality is that medical students in Canada at least are talented and people who have opportunities elsewhere. I think we just have to understand and accept that as well.

 

I feel like medical students are actually overburdened by all the advice we are given and all the expectations we are given and this includes the advice the author is giving us in this article. 

 

Not only are we expected to be kind and empathetic to patients, we are also expected to be always on time, always eager with a smile on our face, never tired and to work fast, accurate and be well read and intelligent. I think too much is demanded out of us at times. On top of that, we are told by some that we are too entitled, which adds to our stress. I don't think people in other fields have such demands. I think we should stop giving ourselves these high expectations. 

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Physicians, at least in Ontario, are not salaried in the first place.  Do you have any idea what you're talking about, or do you just like to rile people up?

 

I'm not sure if they're salaried or not, but one thing is known for sure, they're overpaid. Personal attacks speaks to your stupidity and ignorance.

 

hopefully the later - what is the point of a school trying to fail students? Considering the 100K per year to train them it would be at the very least more logical to to the screening early on. 

 

besides you can always argue a group should cost less for the benefit of society. It is after all always true. It would be nice if say the police cost less so taxes go down. However the police have something to say about that. So do doctors ha :)

 

Nope you have nothing to say but abide by the rules. The governments are not obliged to listen to you.

 

You need to fail people who proved to be the wrong choice. :) 

 

The author is 100 percent right.

 

Professional school should not baby sit students. They should grill students and do their best to fail students (in the written and clinical components and in both med school and residency), especially anxious students. :)

 

I hope as well the government, provincial and federal one, take the necessary steps to cut health care costs by reducing the salary of physicians. They are very overpaid. Their salaries should reduced to 100-150 k for general practitioner and 150-200 k for specialists.

 

We need these cuts to fund the treasury and to reduce provincial and federal debt, so that future generation can have a good life.

 

Public awareness is good. :lol: 

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I find that I don't agree with most of the points made in this article, and from an essay-writing point of view, there's a few problems with the arguments that I've only just saw upon a second reading. There are many accusatory claims made with weak or absent evidence, such as where lifestyle factors "dominating" conversation is somehow used as evidence that attempts to appear professional are "mere facades of altruism", without establishing any link between the two. Moreover, there is an entire paragraph about growth vs. fixed mindsets, and the detriments of the fixed mindset (which I get the impression that he thinks most people in medical school has), that seems to come without any connection or context; while the research on growth vs. fixed mindsets certainly may be true, it's debatable whether the growth mindset praised here is as absent - or the fixed mindset as prevalent - as implied. In fact, as a significant portion of medical students in Canada took more than one application cycle to obtain admission, it would imply that many of us weren't fixed in our abilities, and that we have been constantly working and mold ourselves to get to where we are. In fact, one of the most important qualities of being a good physician is arguably the ability to relate to your patients, which is undoubtedly something cultivated through work and reflection, and cannot be born with or carved in stone. 

 

Also, the so-called "culture of entitlement" is a reflection of the good times that we live in, that people - regardless of position - feel empowered to speak out for change. It's this so-called entitlement that has allowed people and programs to change for the better. The women in the days of suffrage were said to be entitled, among other things, but at least 50% of current medical school students wouldn't be here without those pioneers. And why shouldn't students be encouraged to speak out against bad learning conditions? Given the prevalence of burnout in the profession, they should try to do what they can to prevent it. As it is, a significant portion of students are scared to speak out - especially against preceptors - for fear of repercussions on their academics or career, without having articles like this shaming them for advocating for their own well-being. While the point about having to work with characters that may be like your nasty preceptors, being co-workers with such characters and being in a student-preceptor situation of power imbalance is very different and places additional stress upon the student. Moreover, even if the student survives the "nasty preceptors", it could also cultivate a negative mindset within the student that is neither helpful to them or the patients they will treat. And... I'm not sure if anyone really slacks off from the reassurances that they won't fail out. Fear of making the wrong call when approaching clerkship provides more than enough motivation to stay on your toes, as well as the whole process to obtain a residency spot. 

 

Lastly, steering this back to the backpack discussion above (wow, we like discussing backpacks), I just wanted to add myself to the camp of those who never knew what a med backpack was until I came across it as a verification question to join this forum. I did my undergrad at a university with a med school, so I had seen clusters of them around, but was never curious enough to find out what they were (and the words on the backpacks are far too small to read without stalking creepily close behind someone with the backpack, lol). I'll admit, I was a bit envious after I found out, but that just became another motivation to get there, and it actually became a great way to spot people that I can talk to for advice on med school and beyond. And while on the topic of personal anecdotes, I've personally been very humbled in my road so far by the people I met that, in getting to know them, would make wonderful physicians, but due to financial reasons or simply not testing well under pressure (even though they could talk at lengths from the incredible amount of knowledge they've retained from their studies), have been delayed or prevented from doing so. 

 

Perhaps my views on this will change once I spend a few years in the system, but for now, I can't say that I agree with the author.

 

/long post over. A bit late to the discussion, and didn't really want to post at first, but read it again while clearing tabs and some things were really bugging me.

 

Edit: of course, I obviously don't think everyone in medicine are humble and personable; there are always people that feel entitled to everything, that they can do no wrong, and apparently there are clerks who ask to leave as soon as their workload hours are up regardless of what they're in the middle of doing (which could still just be an inability to read cues rather than entitlement), but it's debatable whether they are the majority and/or reflective of the current generation at large. 

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