poured out before bed
Medical school is an awful lot of things. It’s opportunity. It’s exciting. It’s fulfilling. But it’s also frightening. And tiring. It’s time and family and outside interest consuming. And it’s sometimes rather mean — the hierarchical training structure of medicine lends itself well to swollen egos and abuses of power.
Now in my final year of medical school (ya-hooey!), I have personally witnessed only a handful of situations involving residents or attendings flexing their mental (and physical) muscles for the younger generation in ways inappropriate. I, myself, have had extended, unpleasant interactions with only one abusive individual. My experience is much (much) tamer than that of my mentors, and theirs still tamer than the would-be healers who came before them. Yet, bullying remains a weak and mismatched thread running through the fabric of medicine. Weekly do I hear of other trainees’ uncomfortable (some of them downright national-newsworthy) experiences with demonstrative, demeaning, harassing senior members of the medical team. Unfortunately, some of the most brilliant minds in medicine are also the nastiest. And it is these people who, oftentimes by stepping on subordinates and colleagues alike, have made their way to positions of power in the medical complex.
After I had this concept slapped into me last week, I did what any bewildered seeker of higher education would do – I queried Google about bullying in medicine. Among the mish-mashery Google dumped on my screen were two articles – one quite hot off the press, the other having cooled for over a decade – which I felt compelled to share.
The more senior article is a personal views piece from across the pond in the British Medical Journal. In it, a surgical trainee recounts the abuse – and it’s awful, painful effects – suffered at the hands of a professional disembowel-er. It’s called Bullying in Medicine, having appeared in the December 1, 2001 edition of the BMJ. I can’t help but wonder where the author is now.
The junior article, a piece from the New York Times Doctor and Patient health series, underscores research done on and efforts to squash bullying in medicine here in the US, at UCLA’s David Geffen School of Medicine. It’s entitled The Bullying Culture of Medical School, and came out just this month. You might also peruse the original research article it highlights, Eradicating Medical Student Mistreatment: A Longitudinal Study of One Institution’s Efforts, published in the current issue of Academic Medicine.
Medicine is an amazing profession. But, like all other trades, it and those who practice it are subject to flaw – perhaps more so than many other professions because of the fierce competition to become and the overwhelming expectations for physicians. Here’s hoping victims of hierarchical abuse know they are not alone – and not in any way “weak” for feeling bothered by said abuse. Here’s hoping they find the wherewithal and the infrastructure that allows them to report. Here’s hoping medical institutions create and enforce standards of collegial and interpersonal excellence at all levels of medical training. And here’s hoping that, rather than emulating those bad actors who teach us, we can rise above them, providing the next generation of doctors good, strong mentors and role models even as we offer our patients good, strong care.