So I posted a different topic yesterday and let’s just say it went a little sideways. Did some reading, called some attendings, feel like this is a worthwhile discussion.
Where my bias comes from is a product of my generation and training so let my lay my framework and see if we can reach some mutual understanding. Grew up in the eighties, it was a different time. Words back then didn’t carry the same social stigma now that they did then not to say the people hearing it weren’t hurt by it. Also, as a guy, ribbing each other was constant and could get cruel and mean but most everybody got along. Bullies were usually physically intimidating or small guys with larger than themself personalities. Trained in a community hospital and now work in a University hospital and community hospital.
In training we had three abusive attendings and one I didn’t get along with. One, let’s call him Dr R would get off the handle and berate some of my seniors. I never saw the wraith but after commiserating with a colleague we could see how bad it could be for some people. My response when I had interns was to prepare them for his pimping and step in and take the fall if they didn’t have the answer. He once yelled at an intern who was 6+ ft and when the intern stood up he walked away. The other was a Dr J, he was just a cantankerous little doc and he once berated an attending from behind thinking it was an intern and was mortified when they turned around. Still remember what she said, you shouldn’t apologize to me because I’m an attending, you just shouldn’t talk to anybody that way. There was a Dr C who wasn’t ever verbally abusive but you wouldn’t get the same teaching if he didn’t think you werent interested. Amazing teacher though if you got his teachings. The only one I didn’t get along with, not to say people got along with me, was a Dr M who started yelling at me when I shielded my interns. Well, we got into it, told her that the only people with a right to yell at me are my parents, that ended with a meeting with the associate program director and a truce. We never really got along after that but remained professional. Program director never put up with it and let’s just say they won they lost the battle but won the war.
Now at work, there are some people who are, who carry a reputation for being real tough/mean. Most trainees who finish that rotation actually love them and remain in correspondence in their professional careers. Most others are generally nice and well-liked. Definitely there are surgeons around and senior fellows who carry unbecoming dispositions but by and large it seems things are ok. Here’s where my gap in understanding this comes. We have been having memos going around about abuse and microaggressions and so it must be an either large group of residents or a very vocal minority who don’t feel how I do. I’m about ten years out of training.
As for me, my teaching style is best described, from my reviews, as not hands-on enough to gives great autonomy. I do morning rounds but don’t bedside round on all cases. I give short related talks to the case at hand. I give afternoon teaching sessions on Bayes theorem and the mathematical nature of diagnosis, biomed stats talks, ethics talks, billing, and whatever clinical stuff they are in to. I never make them feel small at the bedside, I don’t round in front of other teams, and I lay out very concrete expectations. I don’t generally give feedback at the end of the week but pepper it along as we go. I don’t sandwich. I take a more coach athlete approach. I’m a very happy person but have been told by friends I may be mean sometimes. I like Dr Cox from scrubs but no better than to be him.
So surveys from 1990 and more recently show basically the same thing. Residents feel abused, about 20%, consistently, and 80% of graduating residents feel they have been abused at least once. Work hours remain long but are down from the past. Doctors continue to commit suicide at much higher rates then the public. I won’t even begin to speak about sexism since I’m not a woman but I’ve seen it and heard about it and it remains a problem.
So thanks for getting this far, that being said:
To what extent is the abuse a systemic problem? To what extent is it a problem of individuals?
At what point does the feelings of the abused an internal problem and not an external problem? This is not a generalization and I understand it’s a very nuanced problems.
What factors such as sleep deprivation, large quantity of material to learn, emotional stress of practicing medicine/surgery play into augmenting the feelings of being abused?
What is the true role of medical education?
What does my generation not understand? Not speaking for all of us.
Is physician burn out a system problem or a personal problem? Since it isn’t a binary problem, where on the spectrum are we?
What do we do about it?
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