A tough disposition is required to endure physician training

The Theresa Brown furor has got me thinking.  To be honest, I don’t think the doctor’s apparent offense was really that bad.  I remember giving and taking worse.

When I was at medical school and in specialist training, there were senior doctors and nurses of legendary temper and bad disposition.  Tiptoeing around them, and working to their satisfaction, however unreasonable, was an accepted part of the job.  But the work got done, and something tells me it may have been done better than in the more docile and politically correct environments I have experienced thereafter.

Let’s explore this further.

Being a good doctor or a good nurse is a very difficult job.  Mistakes are inevitable.  Personalities are going to clash.  Bullies will exist, as will passive aggressive victims.  Among these will be both caregivers and patients.  This is an inescapable part of providing healthcare, however unfortunate.  Patients, being ill and under pressure, can hardly be expected always to be of sunny and meek disposition.  But the new openness of social media and communication technology have brought this into the open domain, causing what can be thought of as a quiet revolution in healthcare.

So are we tough enough to cope with this environment?

I see doctors and nurses as being frontline troops in a war against illness.  And wars are tough.  I know – I was in one too.  Without training to be tough, troops are not going to do a proper job without taking high casualties.  That’s why boot camp is the tough place it is.  It’s not personal.  It’s to build character and strength under pressure, so that the job can be done when it counts.  We had a motto in the army “Train hard, fight easy.”  Train hard we did.  I became very tough, and that toughness has remained as a resource to fall back on long after my war has ended.

So much that is wrong with modern healthcare all over the world is going to be difficult to change, and conflict is inevitable.  Removal of bullies from the system will have to involve victims standing up to those bullies.  Good doctors and nurses will have to pick out bad doctors and nurses and raise the standards.  This is not “doctor bashing” or “whistle blowing” – it is a critical aspect of policing our profession ourselves, our own peer review process.  If we don’t do it for ourselves, others will.

I am not for a moment supporting bullying or doctor bashing.  Medical practice is already tough enough, and no one needs it.  But a high standard of discipline is expected in medical environments, and when indiscretions occur, and there is due cause for conflict, an open and transparent process has to be implemented. This is bound to be difficult.

Perhaps this process needs to start at medical school, where would-be doctors learn the communication and conflict resolution skills to minimize issues in real practice. And to take the military analogy further, those who want to do medicine need to know that the fight against sickness will have its casualties.

So being a doctor is like being a Marine – if you know you’re not tough enough, don’t even think of applying.

Martin Young is an otolaryngologist and founder and CEO of ConsentCare.

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  • http://drsamgirgis.com Dr Sam Girgis

    Very well said. I agree completely. Medical school and residency were difficult, but they made me a stronger physician and and a better person overall. During my MICU rotations, we took overnight call every third night which usually turned out to be a 30 hour shift. I believe the recent change in resident work hours will take away opportunities to strengthen their mental and physical abilities. Being a physician is tough, and we should be selecting the toughest among us to take on these responsibilities.

    Dr Sam Girgis
    http://drsamgirgis.com

  • Kristin

    I’m not sure I’m following. This is how I’m reading this piece:

    1. Health care providers who have “legendary tempers” and/or “bad dispositions” contribute to success in patient care, as compared to the “docile and politically correct” providers.

    2. People in health care, both providers and patients, can and will be jerks, so it’s good to have practice in dealing with jerks.

    3. Toughness is good.

    4. But removing bullies is important to medicine.

    5. An “open and transparent process” is a good way to do that.

    6. And medical students should learn skills to minimize conflict.

    I can certainly see the merits in points 1-3 and points 4-6 on their own, but they seem weirdly spliced together. Do we need to learn to tiptoe around jerks for our own good in order to be effective providers of medicine when both our patients and our colleagues will be jerks, or do we need to learn to not be jerks in the first place and to refuse to tolerate rampant jerk-ness? Is it good to have people who treat their subordinates like crap, or not?

  • http://www.breastsurgerysa.com tex

    Well said. Just being smart and tough are not enough either. Medical [and nursing] students should be taught basic communications & negotiating skills, along with the usual extra ethics. You think work hour restrictions are bad? Wait til tomorrows docs text pts while standing in the same room……

  • soloFP

    I found that the best learning was with calm and collective teachers instead of the docs who would scream every swear word in the book until something was done their way. I saw surgeries where intstrument trays were thrown against the wall and nurses’ hands were shaking so much that accidental needle sticks would happen during the surgery. Having a drill sergeant personality is not necessarily meaning the doc is good. Often the screaming and arrogance was to mask lack of real intelligence. The docs who can hold it together during a code or surgery have better outcomes and are less likely to get sued. In the real world, there are a handful of subspecialists in my area who have god complexes and get sued a minimum of once a year. Their tempers and arrogance are so bad that patients ask me to send them 30-45 minutes away for a subspecialist, as the reputations of some of the local subspecialists proceed the referral.

  • medstudent

    Im tired of the profession making excuses for its bad behavior and bad personalities:

    “they are the top of their field, so they can be a jerk. Or they can treat you like crap because it will make you stronger” = No they are actually a jerk and it doesnt matter if they are the janitor or the CEO of the hospital it shouldn’t be allowed. And most of these jerks are the ones who went into medicine, then figured out being a doctor still wont make people like them. And now they are bitter about it.

    “Everyone in medicine needs a little bit of an ego, We are dealing with life and death here”…. No, everyone needs confidence in their abilities to help the patient at hand. Ego is all about recognition and all about a me attitude. Not needed at all.

    “100 hour work weeks and 30 hour shifts don’t just make you a better doctor, they make you a better person” … Now I can maybe (and thats a stretch) agree they help to make a better doctor. But they definitely dont make you a better father/mother, spouse, friend or person overall. They do probably take years off your life though.

  • http://onsurg.com/about Chris Porter MD

    Recalling my own training. The only value in learning to work with jerks is gaining the tools to work with future jerks.

    My strategy then was to shut up and seethe. Now my strategy is to calmly, immediately, tell the jerk that their behavior creates tension in the room and disrupts our goal of good patient care. Try it – everyone loves it, except the jerk!