How medical training is like dogfighting


Since being fired from my program as a result of my cancer diagnosis, I am on a mission to help medical students and doctors. After starting the website, Improve Medical Culture, I have found that much of the general population has little sympathy for doctors. Some find us completely unrelatable. Because of this, I wrote the following comparison between dogfighting and medical training. I aim to show the public that their negative perception of doctors and the negative qualities possessed by doctors can both be changed.

Why would we want to help doctors? It is true that doctors can be out of touch with reality, emotionless, and arrogant. However, in all likelihood, when they entered medical school their hearts were filled with love for mankind, and their actions were fueled by a desire to heal. Why would you want to help fighting dogs? They are so mean and violent! Just like the doctor, the dog was also once different. It was once a playful puppy that also loved mankind! What happened to these dogs and doctors? Training.

A first-year medical student is like a puppy: naïve, eager to learn, and cute (in an endearing way). They are playful and curious. However, eventually, they are taught to fight for survival. They slowly lose their loving nature and learn to be predators. I admit some of these behaviors help the dog survive, just as a medical student does have to be extremely tough to make it in medical school.  I am not suggesting we turn the dog into a vegetarian, just like I am not suggesting we make medical school a walk in the park. What I am suggesting is that we do not allow the puppy into the hands of dogfighters. Dogfighters beat their dogs to increase their aggressiveness. Let us also not let medical students into the hands of abusive training programs. Doesn’t it make sense that medical students who are harassed and belittled turn out to be hostile physicians?

Dogfighters use heavy chains to keep the dogs in their place. Keep in their place: This is almost identical to a term we have in medical training called PIMPing which means “Put In My Place.” This occurs when a superior asks an “inferior” rapid-fire medical questions, usually with the intent to humiliate them in front of their peers and other superiors. It is a public display of control. Many of the training methods in dogfighting involve torturing and killing other animals in front of the dogs. Likewise, I have witnessed many friends break down in tears during a pimp session.

Fighting dogs are afraid of their masters just as medical students are afraid of their attendings. When I was a third-year medical student, there was an attending on my team who would call me at home, almost every night at 2 a.m. to pimp me. I was terrified of him. Maybe you are thinking “Gosh, I would have reported him!” If you are indeed thinking that, you are probably: a) not in medicine; b) just starting medical school; or, c) you had humane medical training, (if the latter then I would like for you to contact me as I am looking for model programs).

Those who train fighting dogs add weights to their dog’s chains slowly over time. This is why I did not report my attending. You see, the chains of abuse get subtly worse over time so that we don’t notice. It is the epitome of the boiling frog anecdote. I have seen fourth-year students calmly accept abuses that would prompt a first year to call the police. Before medical school, I was working in a hospital and witnessed an attending lie to a patient about her diagnosis. I was shocked!  I told him that I believed it was wrong and reported him. What resulted from that? I did not get a letter of recommendation from him, and he continued lying to patients. During my fourth year of medical school, I heard attendings lie to patients countless times, but by then the weight had been added. I was now too busy being shocked by the next-level criminal behavior of the attendings to worry about a little thing like them lying.

Dogfighters force the dogs to live in small cages and in filthy conditions. While governing bodies for medical students have rules about our living quarters such as size and access to restrooms, I do not believe many institutions read them. I rarely slept in a call room that lived up to those rules. The rooms medical students have to sleep in are dark, dirty, and moldy. They might not even have running water. Sometimes, the beds were filled so I had to sleep on the floor (if I was lucky enough to get time to sleep, that is). Sleep deprivation is rampant in this field. To build endurance, fighting dogs are forced to run on treadmills for hours.  Medical students are told that hours of continuous work builds endurance. Doctors and medical students are expected to work shifts of 28 consecutive hours or longer.

If you don’t want a nation filled with violent fighting dogs, shut down dogfighting rings and give them proper training. If you don’t want a nation filled with unapproachable doctors, shut down abusive training programs and replace them with humane ones. It is difficult to know where dogfighting occurs because the only ones who want the information to get out are the dogs and they cannot speak. This is exactly the problem in medical training. Whistleblowers in medical training are not only shunned by their own programs but prevented from practicing medicine elsewhere. It is because of this that the public must educate itself. Time published an article recently stating that 27 percent of medical students are depressed. Compare that with the 7 percent of the general population. You can imagine how terrible the fighting dogs must feel in comparison to family-owned dogs. Sadly, as dogfighting sometimes ends in death so does medical training. Doctors have the highest suicide rate of any profession. Perhaps that is their way of silently trying to tell us that something needs to change.

Anger begets more anger, so show kindness. Cruelty has been in the medical profession since its beginning. If we start adding in some kindness now, we might see a change in our lifetime. Let’s help the healers so that they can help heal us.

Stephanie Waggel is a psychiatrist and can be reached at Improve Medical Culture.

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