Today was exit interview day for me and a group of my classmates. This is a fabulous opportunity that our school gives us to sit down with the assistant Dean and discuss the pearls and pitfalls of medical training at our particular institution. And to get free pizza lunch (always a win).
I think it is great that they debrief the grads in such a way. I think it is a more effective way of finding out what is going right or wrong and have a discussion about how to change things. Plus, it is a great chance to give credit where credit is due to some of our amazing clinical preceptors that don’t otherwise get much attention.
My medical school is awesome. We may be one of the smallest in Canada, but we get top notch clinical training and we have so much independence so early on that we feel well prepared to start clerkship. It was great to discuss how great the good things are.
But, like any medical school (at least, I am assuming), there are some sub cultures that are less than appealing. Those hogged a good later chunk of our conversations.
The main issue at hand in our discussion of the bad stuff was the culture of bullying in medicine, not just at our school, but during our electives and selectives away as well. I know this is an ongoing issue in Medicine. As the Dean said, it has been something people have been dealing with for at least 30 years (since she started school here). On the bright side, she agreed with us that things are a hundred times better than they once were, but that there is still obvious room for improvement everywhere.
Bullying in the workplace is something many professions deal with. In Medicine, I feel it can be taken to the extreme. I feel blessed that I work in a society and at a time in which much of it is prevented, at least compared to back in the “old boys’ club” days. But, I think where Medicine is such a hierarchy, sometimes people take advantage.
The majority of faculty is amazing, kind or at least tolerable people who want to teach (or at least don’t hinder learning). They use constructive criticism. And yes, there is a culture where pimping is acceptable. I may not like it, but it is part of things. And sometimes a touch of humiliation goes a long way to teaching someone a lesson or making you remember something.
But, there is a far cry between pimping and constructive criticism and the odd episode of embarrassment to getting a strip torn off you in front of patients and peers. It is one thing to be put under pressure to perform, but another to have something thrown at you because you aren’t quick enough at suturing in the OR. And its not just physicians either… I have been bullied by other medical professionals who feel they have the upper hand over we inferior clerks.
You have probably seen it on TV… Think Christina Yang on Grey’s banning her interns from the OR and making them run her personal errands.
These things very, very rarely happen. But, they still do. And in almost any other profession would be considered unacceptable. And in this profession, they are considered unacceptable. Yet, people who teach us still sometimes get away with them.
The funny part is that sometimes, we just think it is normal. Yes, so-and-so throws things now and again, but he is a great surgeon. Or, he definitely objectifies women, but if you act like you don’t care, he won’t bother you too much. It becomes part of our day-to-day. We don’t like it, but we really don’t do anything about it. Because it generally isn’t a big issue or we are scared or often it just doesn’t come up because it is just so “normal.”
This brought us to a discussion about disciplinary action and our reporting system. As Clerks, we are at the bottom of the food chain. We are scared to report anything for fear that it may somehow negatively impact our evaluation, our reputation or our future employment. Living in a small place can make word get around fast. Nobody wants to be “that person.” As a result, often events don’t get formally reported. Or, if they do, they are more often by hearsay and cannot be used as documented evidence. Plus, the small town culture makes situations in which everyone knows who does these things and you “just avoid them.” Because that is all you can do. Because everyone knows and nothing can be done.
It seems backwards. We talked about better ways of making evaluations anonymous, but even then, there is still fear that the person would find out. Plus, formal action requires formal letters. Scary stuff. And sometimes, we don’t even know the aggressor’s name or can’t have a formal evaluation because they aren’t a physician, but a nurse or RT who works on the floor.
Then, many of the culprits are older (stereotypically) and are tenured. Which, thanks to the university makes them fairly untouchable. Apparently, people can lose their housestaff privileges for reported bullying if it is appropriately documented and is serious enough (losing housestaff would then require the physician to do all of his/her own work, including the portion normally managed by clerks and residents… This would be a big imposition, especially for someone who is used to having housestaff). Especially if it jeopardizes accreditation. It has happened elsewhere, we were told. They, however, cannot be fired or anything like that unless there was legal action, which would be a really extreme case.
We also talked about the fact that we all see this as wrong. We talked about primary prevention. That perhaps, unfortunately, we may not change the people who see this as a “right of passage” or who see nothing wrong with their behavior. But, that we cannot bully our students. That we can make sure the “right of passage” is reasonable and does not include reducing people to tears or doing things that generally constitute some sort of assault. We considered that if we were to have a reporting system in place, we can weed out, or at least try to weed out people who will cause trouble before they are tenured and more difficult to reprimand.
We agreed that some of the pimping and correction and even, yes, a touch of humiliation is a part of medicine, just like the sleep deprivation and the famed “peds sick.” But, that does not mean that you can be a bully about it.
Bullying in medicine is a culture. A food chain attitude. A superiority complex. That does not excuse it or make it better.
Clearly, there has been a culture shift. Or at least a start of one, especially at our school. And I think that the culture shift is for the better. I am not “soft.” But, I am not going to eat people alive. We have learned to center care around patients, we have learned that doctor does not always learn best, but when are we going to learn to fully practice what we preach? That bullying is not okay in schools, therefore, it is not okay in hospitals? I think we are getting there. Accreditation is there. Programs can lose accreditation if they have too many issues with workplace bullying. And I think overall, there is little bullying. One or two bullies and a few people with some missing social skills. Perhaps another couple who are ridiculously traditional. I think the outliers just need to find their way to the place where you can be traditional, but have some sort of tact. And by appropriate evaluation and safe reporting, as well as collegial support, we can get there. We are almost there.
It was a great discussion. It is always good to know that things are changing and that we are improving as individuals and as a school. I think it was also fascinating to discuss the culture in medicine and how there is a big movement to move away from the bullying and such. It is interesting to see how in some ways, we are going to be part of the change that happens in the culture of medicine by having a voice in such matters.
It sounds cheesy, but we agreed we wanted to be the change we want to see. Because sometimes, the people who are most affected are the people with the least voice. And as we “grow up” in the world of medicine, we can try to protect those in our position now or at least try to help, not by coddling, but with tough love and constructive correction WITHOUT degrading the people in question.