“Those emergency room residents are f**king retarded!” This was the comment that rang through the workroom. I had only been on this hospital service for three days, and I was having a discussion about a patient with my attending when the on-call resident had burst into the workroom and sat down next to me. He was fuming.
“Why the f*** would they think I need to be consulted for this? Only a f**king retard would think that.”
In a few months I will become one of those “f**king retarded ED docs,” and his outburst immediately made me feel defensive. The resident who uttered this phrase knew that I was going into emergency medicine, but he didn’t seem to care that I, or the attending, heard it. The phrasing and vulgarity of the resident’s statement caught my attention more than most affronts, but only because his language was crass — not because the idea of insulting another hospital colleague was new to me.
I remember on my first day of medical school orientation our dean had a very specific request for us: “Don’t be mean.” At the time I didn’t understand why this needed to be verbalized. As a fourth-year medical student, I am a well-worn traveler of the wards. My short white coat is not really that white anymore, and not neatly pressed like those of new students. What it lacks in whiteness it makes up for in other characteristics — blood, grit, pen stains, experience, tears, and exhaustion. But there is something else woven into the threads of my white coat that I didn’t anticipate: the stench of “shit-talk.”
One of the few realities of being a medical student is that most often no one cares that I am there. My stay on each service is short, and I will be soon replaced with another anonymous, nervous, short white coat in a few weeks time. Because I am invisible, things said around me are unfiltered. Having worked on almost every ward in this hospital, and some wards in other hospitals, I can tell you that no unit is without “shit-talk.”
“How did she even become a doctor?“
“Ugh, I hate that nurse.”
“Dr. Smith is an idiot, why would he order that test?” We have all heard things like this.
“He is the worst doctor I have ever worked with.” That one was from me.
But why is this so rampant? Medicine can be tough. Patients can be tough. Our colleagues can be tough. But criticizing others — now that’s easy. It is even easier to disparage people we don’t know personally, especially when they are not there: we see it in the news, on social media, in our own lives, and for myself, most prominently in the hospital. It’s easy to curse at the anonymous name on our computer screen, or to rant about someone who you feel has wronged you, mostly because there are no noticeable repercussions from the action. We recognize that “shit-talking” is not appropriate, but yet we don’t change our behavior or even acknowledge that it is wrong unless we are caught doing it.
Now in my fourth year of medical school, I hold nothing but wonder for my classmates. Their traits give me confidence in the profession — their continued sacrifice, accomplishments and empathy are all in the best interest of patients. I am confident that most medical students and professionals are humanistic people acting for the greater good of their patients. So, with more training, what happens? Why would I think that another provider is not working as hard as they can and doing what they believe to be best for their patient? What changes? When do we become so mean?
Because we know it’s inappropriate to disparage our colleagues, we need to put a stop to this culture. While there may be no noticeable harm to us, “shit-talk” creates an environment that makes disrespect the norm. Most importantly, in no way does this help patient care, which is our ultimate role in the hospital. Toxic hospital culture is bad for physician health, and can lead to worse patient outcomes. Environments are structured around their goal. The hospital is a place to heal and help, so the environment we work in should reflect that.
The best medical providers demonstrate humility by knowing when to ask for help, admitting when they are wrong, and striving to better themselves. Replacing this culture of disrespect and “shit-talk” with one of humility and collegiality must be our goal. It won’t be an overnight event, but it can start with any one person in the hospital.
Make an effort to stop “shit-talk” amongst your team members. When a provider does something, you don’t understand or don’t agree with, treat them as a colleague rather than an anonymous person or offender. Call them. Hear their point of view. Ask questions. Teach. Learn. This will improve both the culture of the hospital and patient care.
First and foremost, don’t be mean.
Aaron Lacy is a medical student.
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