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The Hospital Orientation

The nun who gives us a big welcome to Our Lady Of An Undisclosed Location Hospital. The intermittent reminders that The Hospital Was Founded By Nuns, You Know. The lingering fear from my days in Ireland, when all of my friends had Nun Horror Stories and parents would scare disobedient children by telling them they better behave or the nuns will come for them. The distant memory of my father telling me that hospitals run by nuns are a thousand times more cut-throat and ruthless than hospitals run by supposedly efficient businessmen.

The Hospital Mission Statement. The descriptions of the long procedure, the countless doctor-hours of work, the innumerable committees, that went into drafting this mission statement. The firm assertion that this mission statement is a divinely inspired pipeline to the culture of this particular hospital, meditating upon which will tell us the sort of institution we have been hired by. The total indistinguishability from any other hospital or clinic mission statement I have ever heard, all of which go something like “We strive to provide comprehensive care to patients in a culture of excellence” and could have been devised by the average college student in three minutes.

The big Vietnamese guy from Internal Medicine sitting next to me with a nametag reading “Becca Silverman”. The halting attempt to be humorous – “That’s funny, you don’t look like a Becca”. The deadpan assertion “Becca is an ancient and traditional Vietnamese name.” The awkward, uncertain silence.

The discussion of the hospital’s Ethical Guidelines. The assurance that, although not all of us are Catholic, the hospital guidelines are rooted in Catholicism but not limited to them and we will all be able to appreciate their wisdom in a nice ecumenical way. The segue into the first of these guidelines, which is COMMUNION WITH THE CATHOLIC CHURCH.

The introduction to various executives and officers, a disproportionate number of whom used to work in the auto industry but left for the hospital industry when times got bad. The inspirational quotes from Henry Ford, who, if these executives and officers are to be believed, is some sort of credible expert in the art of hospital-running. The growing worry that someone is going to tell me my patients just need an oil change.

The educational movie about someone who drives drunk and then gets in an accident and dies. The explanation that the moral of the movie was “Don’t make bad decisions”. The feeling that this is probably one of those problems that could benefit from being taskified. The only good part of the movie, which was the totally unnecessary plot twist where the drunk driver turns out to (secretly!) be the son of the doctor who was supposed to treat him, leading the actor playing the doctor to shout “NOOOOOOOOOOOOOOOOO!” in a very Anakin-ish way for about five seconds straight.

The presentation on work-life balance at the end of a long ten-hour day. The feeling that every time a company makes employees stay overtime to attend a mandatory seminar on work-life balance, an angel does a facepalm. The request for audience suggestions on how to fit a sixty to seventy hour work week in with sleep, study, errands, and family. The comment from Becca: “That thing with the hourglass Hermione used in the Harry Potter movie?”

The inspirational speech about how we should let Jesus guide us in our medical practice. The suppressed comment that as far as I know, Jesus only encountered one psychiatric case, which he diagnosed as a demon and treated by casting it into a herd of pigs who then fell off a cliff. The suspicion that this is no longer considered Best Practice. The doubt over whether Medicare would even reimburse him for the pigs.

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32 Responses to The Hospital Orientation

  1. Randy M says:

    I’m picturing your patients lying on an assembly line operated on by Nuns in habits.
    Get some rest–in the morning there will be verbs, and perhaps (grammatical) objects.

  2. Benjamin Finkel says:

    Goodness. Good luck and don’t go crazy yourself. Sounds like the hell they say they want to save you from.

    • Scott Alexander says:

      Possibly not quite that bad?

      • Deiseach says:

        I want to hear more of your horror stories about nuns (I have none myself despite being educated by them all through primary and secondary school; my brothers who went to the Christian Brothers, on the other hand…)


  3. Creutzer says:

    Wow. I’m pretty surprised that an assortment of noun phrases can actually be good writing, because this is!

  4. JP says:

    Good luck, and nuns aren’t that bad.

  5. Rain says:

    Welcome to Michigan. We take our crazy seriously up here.

    • Scott Alexander says:

      I didn’t know you lived in Michigan! (unless you told me, in which case I forgot) Whereabouts are you? I’m planning a meetup next month if I can get the scheduling to work out.

  6. Salem says:

    Jesus also engaged in unlicensed psychiatric practise in Luke 4:33-36, and spoke out against medical guilds in Mark 9:38-41. No wonder you rent-seekers are badmouthing him!

    • Scott Alexander says:

      I stand corrected.

      “Whoever gives you a cup of water to drink in My name, because you belong to Christ, assuredly, I say to you, he will by no means lose his reward.”

      Do they have any idea how much harm an unlicensed practitioner giving out cups of water willy-nilly could do? There could be *anything* in that water! I say no one should be able to give cups of water to the sick unless they have at least five years’ training and a Water Distribution License from an AMA-approved program!

  7. Deiseach says:

    Well, the Gadarene maniac went from living in a cemetery and being periodically chained up by his neighbours to being clothed and in his right mind, which is as much as you can expect from modern psychiatric treatment.

    And seguing from that, what’s good for depression? I’m drinking a lot again and I think that is not the best way to handle it. Any free advice? I can reimburse you by saying a decade of the rosary, which may help with your new job at Our Lady of Perpetual Overtime πŸ™‚

    • Geirr says:

      Google ketamine depression. Shrooms or acid also seem to do some depressed people a lot of good. More seriously, buy and follow Feeling Good: The New Mood Therapy and Moodgym, run by ANU, both have reasonable evidence of effectiveness. Exercise helps too. But really, google ketamine depression.

      • Deiseach says:

        Stuff like mushrooms or acid are right out for various reasons (part of which is me being a chicken) πŸ™‚

        Self-help books and tapes do me no good because I am so enraged by the poor prose style, the chirpy anecdotes they use as teaching points (Joe used to live in a paper bag until he applied these five simple rules. Now he earns six million a year!) and the general Americanness of them (sorry to all in America) that whatever good they may contain just does not percolate through my “Dear God in Heaven, if I had handed the likes of this in when I was eight for my English homework, Sr. Dominic would have given me the bata” seething.

        Ketamine – the only thing I know about that is ‘horse tranquiliser’ so I do need to have a look at it. And I have noted that I drink more, and more heavily, when I’m depressed which is obviously not good, but since all my father’s side of the family is bloody well on “pills for their nerves” I don’t want to go to my GP and ask for a prescription. Though liver failure is not a more appealing option, so I should probably bite the bullet and ask what can be done.

        • Daskeyboard says:

          Get 100$ worth of bitcoin, go on the silk road, buy some psilocybin or ketamine. It’s not scary. It’s extremely pleasant. Have someone watch over you though.

          If my depression was a serious problem and not a minor one, I would not use lame excuses not to try powerful remedies.

          Granted there are other ways to treat depression, so maybe consider it a last-ish resort.

        • Deiseach says:

          Thank you for your sympathy towards my “lame excuses”, Daskeyboard.

          It’s like the advice about “Exercise if you’re depressed! The endorphins will make you feel better!”

          If I could muster the enthusiasm and energy to walk out the front door in the first place, I wouldn’t be depressed. It’s like telling someone with two broken legs “Now, what you need is a brisk walk to make you feel better!”

          But I suppose that’s only a lame excuse as well, in every sense of the word.

        • randallsquared says:

          This conversation may be suffering from Internet Tone Failure. Sometimes it’s difficult to figure out whether a comment is snark or genuine heplfulness phrased oddly. πŸ™‚

        • Mary says:

          Yes, it’s amazing how lacking in empathy the professional purveyors in good cheer are. . . if we could get up and go, we wouldn’t need advice.

          Hmmm. . . .

          For those who want an idea, I offered my story, “Isabelle and The Siren”, published in Sword And Sorceress XVI. The heroine is depressed. Other people with a history of depression have told me that it conveys what they feel very well.

    • Sarah says:

      I’m not Scott and not a shrink but I have read the literature on this — in the long run there’s a lot of evidence that drinking makes it worse. Damages your HPA axis, causes a heightened “stress response,” messes up sleep. Most of the existing studies are about alcoholics, but it appears that to a lesser extent regular moderate drinkers also develop sleep problems and neuroendocrine disruption.

    • Scott Alexander says:

      Have you seen a psychiatrist? That really is the first step.

      As a bonus, if you tell me what part of Ireland you’re in it’s possible I’ll know some of the psychiatrists there and can give you recommendations.

      Feel free to contact me privately about this at Also, the other people on this comment thread are recommending illegal and highly experimental (albeit fascinating) drugs usually used only on very treatment-resistant cases. If you haven’t even been to a psychiatrist yet (and even if you have) I’d suggest exploring your other options before you resorted to those.

      • Douglas Knight says:

        The book “Feeling Good: the New Mood Therapy” is neither illegal nor highly experimental. It is as better established than anything in social psychology.

      • Deiseach says:

        Thanks for the offer of help, Scott. Part of my problem is I am so resistant to going to the doctor because I am so bloody suspicious of, and not trusting towards, medical establishment in Ireland (absolutely did not help when my physical health went bad in the past five years, and I met four different consultants for various things, only one of whom treated me as a human being and not a hysterical ignorant stupid nuisance).

        I’m in Waterford, so the nearest to me would be either Waterford City or Cork City.

        Also, no worries about the drugs. I hate with a passion taking even prescription drugs, so I am in no way tempted to indulge in unprescribed things I have no idea of their strength, purity or effects on top of me generally having idiosyncratic reactions to medication anyway πŸ™‚

        • Deiseach says:

          That’s the one bit of advice or request I’d make of you, starting out on a medical career:

          Try and treat your patients like people, not as a file on your desk that you only saw five minutes ago.

    • cool rich guy says:

      Read Feeling Good by David Burns. It’s CBT, non-cheesy, very compatible with LessWrong-ism, plus I think it’s clinically proven to work. I cannot recommend it highly enough.

      Also regarding the drug ideas, what the fuck, guys?

  8. Vertebrat says:

    Peritoneal dialysis is basically the same as an oil change, right?

  9. Alex says:

    This sounds considerably worse than the past year of your life, I hope it gets better.

  10. michael vassar says:

    I suppose that typical college students might be able devise indistinguishable mission statements in minutes, though I doubt it’s really typical college students that can do that. Sounds more like typical Ivy students. Anyway, writing such statements was always totally beyond me, which is probably a big part of why the normal world was totally not for me. I wish there was some targeted hiring pipeline whereby I could hire specifically graduating high-school seniors with good test scores who were unable to write bullshit.

    • Sarah says:

      Persuade a young college grad from a good school to spend a year or two working in the admissions office. Have him/her send you the applications that have excellent test scores and essays that show lack of ability to BS.

    • JRM says:

      I think that’s misguided. I think the ability to write fluffy nonsense deliberately is paradigm-enabling to provide optimal outcomes for clients internal and external. No, wait…

      What you might want is people who are unwilling to write these things, and resist them with vigor when seen. But being able to emulate bullshit as a game is a useful skill; I have no doubt SA could achieve an outstanding achievement in the field of excellence in satirical mission statement writing, and I don’t think SA or younger SA-equivalents ought to be disqualified for this skillset.

      • Deiseach says:

        Being able to emulate this kind of management-speak is a survival technique; too often the diktat comes down from head office that they want a new mission statement (I think the newest buzz phrase is ‘vision casting’?) and if you send back an honest assessment (‘we don’t have time for this crap, if you let us hire an extra staff member we’d increase efficiency and productivity instead of writing these nonsense reports’) then you may find yourself seeking alternative employment where your synergy is a better fit with the active partnership relationship for thriving with a provider of inspiring, innovative services and solutions.

    • I am unable to write bullshit :), I would have gotten good test scores if i would have cared to take a test :|, but i am one the wrong side of the Atlantic :(.

  11. Shmi Nux says:

    “Communion with the Catholic Church” can be understood, according to Wikipedia, as “where some elements of Christian faith are held in common”. If you twist it as your best interpretation of WWJD (the hypothetical CEV Jesus, not the church-interpreted one), then you are almost in communion.

  12. amuchmoreexotic says:

    Perhaps one day hospitals will be run by godless secular humanists who see patients as nothing but so many kilograms of meat and bone.

    One glorious day.