The merits and pitfalls of lines

It’s no secret that Duke students love waiting in line. 

I’m not the first to make this observation, but the more I walk around campus, the more lines — literal and metaphorical — I see. Sure, some of this is intrinsic to dense spaces, as there are bound to be queues for dining halls or buses or other services that many people want at the same time and can’t have all at once. But there is something special about Duke and lines. 

Maybe part of it has to do with that psychology experiment in which they made kids stare at a marshmallow for 15 minutes with the promise they’d get a second one if they could resist the temptation to eat it. Waiting requires cultivating one’s appreciation for delayed gratification, an attitude that students have certainly had to embrace in their pre-Duke years to be admitted. Perhaps we subject ourselves to the pain of waiting in line out of the belief that an experience must be earned to be fully enjoyed. 

I mean, who else but Duke students would draw up a nearly 50-page manual about how to wait in a line? (Disclaimer: by no means am I mocking this — in middle school, when I thought some of my relatives were exploiting loopholes in board game rules at holiday gatherings, I drafted an addendum to the rulebook and circulated it among family so that people would be advised that their tricks wouldn’t work next year. It is no wonder why I’m always in high demand to attend exclusive gatherings.)

Sometimes, it’s not even clear why people are waiting in a line. There are days when I stroll down the Bryan Center Plaza, see a bunch of people filing up to a table, and figure why not? I’ll get in line because it’s probably something pretty good, like Monuts. Even a clicky pen is passable. If you and 10 friends started a fake line that led to nothing, some people would still probably join and stand there for a while before realizing that they’d been duped. To some extent, your desire to jump into a line stems from the assumption that the person ahead of you knows something that you don’t. Why else would they be there? This supposition, however, can be troublesome.

I was waiting for the self-checkout at Target the other day and saw a station that seemed to be open but that no one was using. Most people just trusted the person ahead of them, assuming that the area was out of order or off limits. Eventually someone ventured to go ahead and start scanning items, questioning the wisdom of the line. The station worked just fine. Evidently some past bystander — acting either out of ignorance or using since-outdated information — had neglected that particular checkout area, causing a ripple effect where everyone else tacitly assumed they couldn’t use it. Of course, it’s worthwhile to mention that most of the time, people are right and bucking the line won’t get you ahead. But sometimes, a healthy dose of skepticism goes a long way

In medicine, I’ve noticed quite a bit of metaphorical line-following, as trainees usually do things because that’s the way they’ve seen other people do them. Again, in general, this is good. Medical students shouldn’t be giving out new antibiotic regimens for diseases in which there’s already an effective, well-established treatment. In the same vein, nobody wants to be operated on by the surgery resident who has a new trick up their sleeve that they’ve been waiting to try out.

But sometimes it’s good to pause and ask ourselves why we do what we do. It’s one thing to look at medical practices from centuries past and shake our collective heads at treating ailments with some blend of leeches and cocaine before modern-day knowledge of microbiology and pharmacology came along. It’s another, though, to examine more recent practices and realize that some very outdated ideas were held as medical gospel not too long ago.

One famous example of this is Dr. William Halsted’s radical mastectomy, first popularized in the 1890s. The technique — performed on patients with breast cancer — not only removed breast tissue but also eviscerated nearby lymph nodes and muscles to extensively remove the cancer. Radical mastectomies were frequently used to treat breast cancer for the better part of the next century until people started to question whether the extent of the operation was really beneficial. And at the end of the day, though much of the decision-making depends on the extent of the cancer, studies showed that radical mastectomy offered no additional benefit compared to less disfiguring surgeries in many patient groups. They are rarely performed today.

Other examples — big and small — abound in medicine. There’s even a campaign called Choosing Wisely that points out perfunctory tests or practices that offer little benefit. Medical training is about blending a rapidly increasing amount of knowledge with the relatively fresh outlook of someone who hasn’t done the same thing for years on end. Veteran clinicians have indispensable wisdom accrued over years of patient care, but it’s always worth re-examining long-held practices to ask if there’s a better alternative. 

Lines are ubiquitous and unavoidable, literal and metaphorical. Next time you find yourself in an ambiguous line, it might be worth thinking about whether the person in front of you really knows something you don’t — or figure out what you’re waiting on in the first place. 

Nathan Luzum is a third-year medical student and a member of the DSPC Board of Directors. His column typically runs on alternate Wednesdays. 


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