Tuesday, February 8, 2011

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 1628In 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.


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:

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.


  1. This is the reason doctors intimidate me so bad!

    Me and another nursing student were looking in our patents charts this morning, the doctor came around and asked for a certain room numbers chart. We didn't have it so we kept looking, before we know it the doctor is yelling at us to put up all the charts, that the night RN's left laying around all over the nurses station very chaotic like. Yeah, now I am terrified of doctors! haha I have always been intimidated, I am just more than glad that my patient had a different doctor and I didn't have to deal with grumpy doctor!

    I actually had a rather bad day overall, i ended up in tears. I didn't do anything wrong but I hate med/surg so bad that I was on the verge of crying. I wonder if I am even meant for this some days. When we did ER I loved it! I am ready for something better to come my way!

  2. I love those videos. WAtching the "Ortho vs Anesthesia" or the "Put some cream on my hemorrhoid" are great entertainment at 0200. Also, CT surgery...the worst! The general surgeons aren't horrible. There were some great attendings that try to teach everyone involved in rounds while the others stare at themselves in the mirror thinking about how awesome they are. lame.

  3. My husband has also sworn to not pimp if he ever had a medical student or resident in his presence. He's in Occupational Medicine, so I told him not to worry, there aren't enough dorks to go around for him to supervise a budding dork. OccMed would be a hardcore pimper's dream specialty - there's so much random nonsense and little tidbits.

  4. Funny story about internship: a friend walked around with a tiny notepad in his pocket (imagine being and intern AND in the Army...). When someone outside his chain of command started to pimp him, he would flip open the notepad, look through a list of names he had written, and say, "Nope, sorry. You aren't on the list of people who can give me s#!*. I am not answering your questions." He didn't make very many friends that way, but it sure did make me laugh.

  5. Too funny! I only knew about one kind of pimping until this second.


Note: Only a member of this blog may post a comment.