That's the age old question. Every time a medstudent does scut work or stays long hours, this question runs through the back of his/her mind. The first time I heard this quesiton was from one of the workers in the locker room who was hesitant to give me extra pairs of scrubs when we both knew full well that there is a 2 pair maximum. "What's in it for me?" she asked as I attempted to sweet talk my way into getting extra scrubs. I told her that I would smell a little better and my team would like me more and everyone would be happier... "Yeah but what's in it for me?" Nothing really, you'd just make my day and save me an extra trip across campus to pick up clean scrubs. In the end, she did give me those extra pairs of scrubs which was much appreciated.
As I get close to finishing third year, this question comes up a lot. Should I stick around extra on post-call mornings to help the residents with their work knowing that I probably won't see them again and they will not contribute to my evaluation. Should I actually research how to treat oligohydramnios like the attending asked me to if I'm not going into ob/gyn (yes because it came up twice on the shelf exam). What about that patient who asks me for more pain medicine? It's easy to ignore her and why would I want to pester the overworked resident with such a trivial concern. If I walk the extra mile, what's in it for me?
For better or worse (usually better), residents are the primary role models for medical students. The easiest way to get along is to go along. Use the same language as residents, try to do procedures the same way, manage patients/cases the same way, and get good evaluations because everyone is in agreement. One day late on a weekday afternoon I was asked to write a post-op eval on a patient who had an hysterectomy for PID. "Don't press on my belly!" she barked. About 20 seconds later she kicked me out of her room and I left unaffected as she just made less work for me. The nurses told me that she had "fired" a bunch of them repeatedly and that I didn't need to feel bad. This patient was an all around jerk, and didn't care if everyone had her best interest in mind. And then the chief resident who operated on her came in to see her. He told her that we couldn't help her if she didn't let us help her. He patiently asked her about her kids, made small talk about pop culture, and then asked her what her favorite breakfast food was. The next morning he brought her some grits with blueberries from the cafeteria. That same afternoon after a long morning in the OR, we walked to the hospital starbucks for a well deserved coffee break. Knowing that residents get free food, naturally I wait for the chief to buy my soda only to find that he disappeared. As I was reluctantly getting ready to buy the two drinks, he returned from the ATM, bought the beverages, and tipped the barista 5$. Here's a resident who is underpaid, works ridiculous hours, and is constantly tired, but he took the extra time to go to the ATM and tip this barista. She wasn't attractive, she was elderly, and the bottom line is there was nothing in it for him.
To some extent this question will always guide our actions. But maybe if we try to look out for the best interest of patients and coworkers, things will work out for the best even if there's no immediate reward. In fact it's downright dangerous to decide to cut corners just because there's no incentive to doing a good job. When picking a profession, medstudents always consider hours, pay, prestige, patient populations, and the type of work involved, but perhaps the most important factor is how happy other attending physicians seem as they go about their day. For whatever reason dermatologists and urologists come off as the happiest SOBs ever, but it's too difficult to make a broad sterotype about a field. Medicine is a field built on delayed monetary gratification. Until I rake in the big bucks, a simple thank you may be the best reward I get.
