Get rid of the trolls in medicine

Scientist J. Robert Oppenheimer once said, “There are children playing in the streets who could solve some of my top problems in physics, because they have modes of sensory perception that I lost long ago.”

Like physics, medicine has its share of problems, namely cost control.

Like children, we must open our perception to the problem of cost control to consider other possibilities that better account for the issue than the theories at hand.

Consider trolls.

No, these are not the fun-loving, furry creatures children adore but rather spurious personalities who live for the chance to instigate conflict and discord. Known for their activity on the Internet, it’s time to consider their presence in medicine at every level and the damages they continue to wreck upon unsuspecting individuals.

Medical student trolls. Forums like Student Doctor Network serve as a resource to those at varying levels in their medical training. In applying for medical schools and residency programs, some post their scores and extracurriculars and then ask their peers for an honest evaluation of their competitiveness. Even with scores in the 99th percentile and first-author publications, students seeking simple reassurance may face nothing short of mockery and ridicule by other users. Medicine is a profession known for its camaraderie; deviance from this norm is what trolls seek to emulate.

Resident trolls. Much of the third year of medical education comes down to evaluations completed by resident doctors overseeing their students. While these evaluations serve as opportunities for open communication, students may face the bitter surprise of being labeled as incompetent, disinterested, or unprofessional altogether without prior warning. Though interview season starts in November immediately after Halloween has ended, accredited residency programs still face trolls in disguise. Otherwise, they would never select immature unable to mentor others simply because they tested well.

Faculty trolls. Medical schools offer faculty advisors for students to assist with maximizing their chances of matching into their intended specialty. As anxieties run high, students turn to their mentors for help only to find their e-mails and voicemails unreturned sometimes for months on end. The inability to provide timely responses comprises a serious professional deficiency, one that would never be tolerated in students, and with faculty tasked with the duty of modeling professional behavior, we logically conclude trolls are involved here as well.

Systemic trolls. In the final year of their medical education, students use ERAS, the Electronic Residency Application Service, in landing interviews for residency programs. This application cycle, ERAS went offline the very first day thanks to technical issues. It would truly be a tragedy if the highly regulated system that we have established to produce esteemed physicians would still suffer such troubles given the advancements of modern technology. Trolls stand to be leading diagnosis in the differential of this dysfunctionality.

Certainly some entertain the possibility of a broken education system that underscores modern medicine, but it may be time to look for explanations elsewhere. The theory of trolls provides us with one alternative, so let’s commit to exposing these individuals and cleansing the system of their malicious ways.

Petr Rholls is a medical student.

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