The Other Kind of Pimping

If you wander through the hallways of a hospital, you may overhear seemingly inappropriate statements from physicians:

"Man, all Dr. XYZ does is pimp all day long."
"Yeah, I got pimped hard the other day."
"I just stood there and got pimped."
"Did you hear how much I got pimped at conference?"

Don't worry, your doctors are not working in the sex industry.  The term "pimp" is part of everyday language in medical education and no one even thinks twice about its alternative definitions.

I'm not sure if anyone really knows where the term came from. Some people will tell you that it stands for Put In My Place but apparently the practice has been referenced as far back as 1628.  In 1989, Dr. Frederick Brancadi published an article in the Journal of American Medical Association (JAMA) entitled "The Art of Pimping." He defined pimping as "whenever an attending poses a series of very difficult questions to an intern or student."  More specifically pimping involves asking seemingly unanswerable questions for the purpose of maintaining the distinct seniority ladder.

www.roflrazzi.com

Medical education is kind of like the military but without the push-ups, guns, and MREs.  It is deeply rooted in hierarchy and respecting the order of things.  Medical students are the bottom of the totem pole, followed by interns, residents, chief residents, fellows, attendings, department chiefs, chairs and so on.
 
Brancadi sarcastically elaborated on his definition:

On the surface, the aim of pimping appears to be Socratic instruction. The deeper motivation, however, is political. Proper pimping inculcates the intern with a profound and abiding respect for his attending physician while ridding the intern of needless self-esteem.  Furthermore, after being pimped, he is drained of the desire to ask new questions - questions that his attending may be unable to answer.  In the heat of the pimp, the young intern is hammered and wrought into the framework of the ward team. Pimping welds the hierarchy of academics in place, so the edifice of medicine may be erected securely, generation upon generation.

Dr. Brancadi's commentary on pimping is legendary and has sparked numerous follow-up pieces from other physicians.  Even though he wrote his article over two decades ago, all of the general principles still hold true.   It runs so rampant that there are actually entire books devoted to surviving pimp questions:

www.amazon.com

In my opinion, the worst pimpers are surgeons. I think this is because they have you physically trapped with them for hours at a time.  You stand in one place and you can barely move for fear of  contaminating something.   You have to pee, your stomach is growling, and the only thing you have for entertainment is to stare at the surgeon's hands.  You hold the retractors until you think your own muscles may just fall off.  Just at the moment you feel like you may not survive, the surgeon looks up at you and says:

Surgeon:  "Med student...(something unintelligible)....?"


Dying Med Student:  "I'm sorry, Sir. I couldn't hear what you just said."

Surgeon:  Dramatic sigh. "I said, what is this artery?!"

Confused Med Student: "Oh, umm, well I honestly can't see inside the surgical field but I'm guessing it's the external carotid?"

Surgeon:  "You're guessing or you're telling me?"

Uncomfortable Med Student: "Well, I'm guessing because I can't see the artery from where I'm standing."

Surgeon: "Oh. Well, it's the .........(something unintelligible)...artery.  It's only seen in less than 1% of the population."

Surrendering Med Student: "Oh ok, sorry.  I'll have to look that up."


This video sums up the surgery experience pretty nicely:


There's a big distinction between teaching and pimping.  One involves important information, applicability, and good intentions.  The other involves obscurity, randomness, and alternative motivations.  This, among a gazillion other reasons, is why I love emergency medicine. There is very little pimping in emergency medicine because emergency physicians have virtually no attention span or patience. The only thing that matters is what is relevant. 

Therefore, I can honestly say that I don't care who invented that piece of OR equipment, who is singing the terrible song on the stereo, or why some organs are paired and others are not. 

It doesn't change my management of aortic insufficiency if I can't remember never used eponyms such as Landolfi's Sign (alternating constriction and dilation of the pupil), Muller's sign (pulsations of the uvula), or Becker's Sign (pulsation of the retinal vessels).  More importantly, I'd hope the ridiculously loud heart murmur would have tipped me off a little earlier.

When I grow up, I will be an attending emergency medicine physician and I will not pimp you.  

Please don't take that the wrong way.