Back in the murky mists of the 1990s, I did my surgery rotation. When I first got to medical school, for some reason I thought I wanted to be a surgeon. I do not know where on earth I got that idea, which at this point in my life seems roughly as sensible as thinking I might take the podium after the Olympic decathlon. By the time I actually got to learn the rudiments of real-life surgery, I had abandoned the idea of doing it professionally. Indeed, since I was unmistakably terrible at surgery, it was for the best that I had given up the dream well before the rotation started.
[Aside: Seriously, I was terrible at surgery. I once broke the needle when suturing a patient shut. The next day I was suturing another patient shut when the resident said “Be careful with your technique. Yesterday one of the students broke a needle trying to close the patient.” To which I replied, “Um… that was me.” And then proceeded the break the needle again. It was maybe not my very best moment. (I got better at suturing eventually.)]
Anyhow, I remember reading the first chapter of the text that we were supposed to read during the rotation. I don’t really remember much of the content, but one bit stands out in my memory. It was, in a nutshell, a little section about how to deal with being yelled at during one’s surgery rotation. So common was the phenomenon of being yelled at by surgeons that the authors felt compelled to include a little guide to the experience in the textbook. (I recall no such sections in the texts for any other rotation.) Suffice it to say that I found that… telling.
To be fair, I found my surgery rotation to be pretty benign on balance. Though my only experience of overt homophobia came from a surgeon, almost all of them were easy enough to get along with. I recall that the residents during my OB/GYN rotation were pricklier on the whole, and there was always at least one attending physician per rotation with a reputation for being awful. (The internal medicine attending at my school with the nastiest rep had earned the charming nickname “The Screaming Teratoma,” which never fails to make me chuckle nostalgically when I remember her.) It was a matter of course that on a semi-regular basis you could be made to look stupid if you rubbed the wrong resident or attending the wrong way. You were expected to put up with it. (I did not put up with the homophobic comment, but fat lot of good came from my complaining.)
All of this is my rather lengthy introduction to this piece about bullying culture in medical education:
For 30 years, medical educators have known that becoming a doctor requires more than an endless array of standardized exams, long hours on the wards and years spent in training. For many medical students, verbal and physical harassment and intimidation are part of the exhausting process, too.
It was a pediatrician, a pioneer in work with abused children, who first noted the problem. And early studies found that abuse of medical students was most pronounced in the third year of medical school, when students began working one on one or in small teams with senior physicians and residents in the hospital. The first surveys found that as many as 85 percent of students felt they had been abused during their third year. They described mistreatment that ranged from being yelled at and told they were “worthless” or “the stupidest medical student,” to being threatened with bad grades or a ruined career and even getting hit, pushed or made the target of a thrown medical tool.
Of course it was a pediatrician who first noted the problem. Pediatricians are awesome.
The term for being made to feel stupid is “pimp,” which stands for put in my place. The team rounds on the patients, and at some random point the attending singles you out and asks you how many of Ranson’s criteria the patient has, or to define Fitz-Hugh-Curtis syndrome. (I selected those two examples because I could never remember the former, but totally nailed the latter this one deeply awesome time.) It’s often done if you make the mistake of looking like you weren’t paying attention. (When I’ve seen it done during teaching conferences at Children’s, it tends to be relatively good-natured and mainly when someone is foolish enough to glance at their iPhone.) While I heard stories of thrown clipboards or pens, I never actually saw it.
Obviously this kind of malignant behavior is mean-spirited and pointless. I was particularly troubled to read how pervasive actual physical menace apparently is, and it’s vaguely horrifying to consider that our finest institutes of medical education cannot either stamp it out or create an environment wherein students feel confident enough the report it and expect an appropriate response. And it was also discouraging but not entirely surprising to read that the efforts at the medical school at UCLA to mitigate the problem were not particularly successful.
To be honest, I’ve given far more thought to the brutal grind of the long hours worked during residency than to the casual and accepted psychological bullying (or worse, it seems) that pervades medical education. (Members of other professions and vocations should chime in with their own experiences if it’s not just medical schools that have this problem.) One very positive change I’ve seen as a medical provider is that nurses are far more likely to stand up to aggressive and inappropriate doctors, so it’s not like the culture within the medical realm is totally impervious to change if it’s demanded strongly enough. But seeing how easily I just accepted it, along with my classmates, makes me think it’s tacitly accepted by the majority of doctors as just something to live with until you’re done, and nothing will change before that attitude does.