JARGONIST FEBRUARY 13, 2013
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How it's used: “The carpenters love to get in, use their tools, and get out, but they should pay more attention to the patient. Remember the patient?”
Who uses it: Doctors playing a game of one-upmanship / med students over drinks / people who used to write for “Scrubs.”
Hospitals, as anyone who has ever watched network television knows, are as cliquey as high school cafeterias. The swaggering surgeons are the cool kids, often known as “blades” or “scalpel jocks.” To them, the internists are “fleas,” as in, the last things to leave a dying dog. Vascular surgeons are “plumbers” (all those arteries), and psychiatrists are, of course, “shrinks.” Patients also get nicknames, and sometimes they’re vile: Dementia-ridden seniors wasting doctors’ time are known in 1978’s every-resident-reads-it cult novel The House of God as “gomers”—“get out of my emergency room.”
When orthopedic surgeons call themselves “carpenters,” it’s self-deprecation. Nine in ten are men, and part of their job isto treat your skeleton like a piece of furniture, using saws, retractors, drills, pliers, and awls, as well as significant physical strength, to mend unhealthy bones. But when other doctors use the term, it can connote condescension with a dash of concern—a slightly more high-minded version of the crack, “An orthopedist is as strong as an ox, and half as smart.”
The embedded critique has always been that orthopedists fail to appreciate that repairing a human leg is vastly more complex heuristically, emotionally, and medically than repairing a table leg—even if mechanically the procedures are not dissimilar. But a recent study suggests that the “carpenters” epithet also has a darker dimension to it. Researchers found that the majority of Canadian orthopedists didn’t recognize the frequent link between women who visit with broken bones and domestic violence; a significant chunk even thought abuse was usually the woman’s fault. Said the orthopedist who led the study: “We shouldn’t think of ourselves as carpenters who fix broken bones, but doctors who heal the whole self.”
2 comments
Interesting...but it isn't the tradesman slang that encourages (some) surgeons to lose sight of the whole patient, it's the nature of the work itself. When 80% of your time--and 100% of your compensated time--is consumed by solving thorny technical problems involving hand tools inside the bodies of the deeply unconscious, their faces and every other part of their bodies except the unnatural crimson gash within which you toil shielded from your view, it takes a special effort NOT to lose sight of your patients as whole people. Also, as I mentioned, surgeons get paid by the operation, not the pre- or postoperative consultation, so every minute a surgeon spends getting to know you in all your glorious human complexity, hearing about your roller hockey league or your secret fears about being unable to satisfy your wife sexually, is time that she has given to you free of charge and, given the unshrinkable time hole that is the OR, is yet another minute when your surgeon fails to be present to watch her children grow up.
- AaronW
February 13, 2013 at 7:49am
And by the way, while there is likely more on- and near-the-job schtupping at a teaching hospital than there is in many other work environments--really not all that surprising when you consider that such institutions throw together hundreds of attractive people in their late twenties, indoctrinate them in a frank and unembarrassed approach to the human body and to sex, require them to stay on-site overnight several times a week and provide them with beds in private rooms scattered in out-of-the-way locations throughout the building--and yet a hospital is NOT like high school. The surgeons are not the cool kids. They can't be, because you never see them; they're always operating. And anyway, the social ecology precludes the formation of cliques. The thing I remember most vividly about my internal medicine residency is how much of the time I spent by myself. Even when you're in a work-room full of other people, you're often quite alone, each person locked in a solitary struggle to blacken in all the boxes on his own to-do list.
- AaronW
February 13, 2013 at 8:21am