The chain of command is entrenched on the hospital wards, creating an obstacle to speaking up:
This new division of labor established hierarchies. On the top were the senior physicians who made rounds on the wards once or twice daily. Next were the overworked residents, who essentially lived in the hospital while training. Last were the medical students, who spent the most time with patients but were most assuredly at the bottom of the heap.Although some senior physicians welcomed feedback from their juniors, others disdained it, either overtly or through intimidation. And students were all too easily intimidated. In a 1993 article in The New England Journal of Medicine, a Harvard medical student reported that although her resident routinely made derisive remarks about her patients on rounds, the rest of the team laughed nervously rather than confront her.
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I was cursed, and blessed to have a sociopathic intern on my first med school rotation. Managing his attempts to get me to lie for him and cover for him was extremely streesful, but from that, I learned the value of integrity, how to buck the heirarchy and win, and to face my own fears of intimidation, and punishment by the system.
In short, the value of moral courage. It was a good lesson, as it doesn’t come naturally and had to be learned the hard way. Since then, physicians have been gathered from their independent practices into “systems of care” run by MBA ethics rather than Hippocratic ethics, and in recent years, the lessons then learned have stood me in good stead. In facing threats of professional/business retaliation for standing up to hypocricy and lies, I have called often on the conversation that I had with another intern about whether to go along to get along, or stand up to the sociopath. She reminded me that, despite all the threats “You know that you won’t starve, no matter what happens.”
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