Why we’ll never eradicate malignancy in medical training

For a bunch of folks striving to stomp out malignant processes in our patients, we sure tolerate a fair amount of destructive behavior among training programs.

I’ll be the first to say I’m not the most delicate flower in the garden. Before pursuing medicine, I was a college athlete. I’m no stranger to long hours, harsh coaches, or repeated failures.

Medical students get their first bitter taste of malignant behavior during clerkships. Sometimes the hateful snaps are directed at them; other times, they witness an attending demean a resident.

Residency is where trainees learn to tolerate the hatefulness. It’s not every day, maybe not even every month. But it’s there. When stress is high, when eyes are heavy, when stomachs are empty, or when someone makes an error. I’d like to think most of the time, teachers approach learners in an affable way. But sometimes they slip. Sometimes it’s a snarky comment. Sometimes they say something downright abusive. It’s not everyone; there are only a handful of rotten eggs.

Fellowship provides a unique opportunity to be even closer to an abusive “mentor.” More isolated. More one-on-one. Less dilute. Inherently, smaller programs mean more time spent with your boss. Sometimes, it can feel like there’s no escape from the dark cloud of hate.

As trainees advance through medical school, residency, and fellowship, the stakes become increasingly higher to tolerate such nasty behavior. Why would a trainee stand up for themself, at the risk of sounding contentious, when they can finally see the light at the end of the tunnel?

“Just get through it.” “In a few months, you’ll finally be on your own.” “It’s not worth it. Just keep your head down.”

And if you stand up for yourself, asking to be treated with respect, the perpetrator holds all of the power. They can fire you at the drop of a hat. All those years of studying, rounding, taking call … it could end in sad defeat before reaching the finish line.

You may not realize you’re with a bad egg initially. It starts with a curt response. It devolves into an off the cuff comment, a request to quit asking questions about their technique, or a false accusation about your performance. The realization ends with a sickening one-way shout fest, where they demean your every action, every intent, and every thought.

They think the world revolves around their heady empire, and they show contempt and disrespect to everyone in their sphere of influence. They are an authority, not a leader. Leaders inspire, love, and educate.

And even if you know you’ve landed yourself with a bad egg, their words still sting. Those hateful messages repeat back in your head like a broken record as you lay awake at night. The nastiness takes months or years to forget … if it’s ever truly forgotten.

Do they recognize you once looked up to them? Do they know how much you celebrated when you matched at their program? Do they realize how much you yearn for their teaching and leadership?

Do they remember what it’s like to be in your shoes?

They don’t. They’ve forgotten. Or, the bad eggs just don’t care.

But bad eggs won’t change.

And I’ve come to accept this. I’ll be submissive. I won’t ask questions. I’ll ignore the repulsive behavior and complete lack of leadership. I’ll allow my personality to be squelched beneath the boot of what feels like parental authority.

Had I not found my voice, solidified my beliefs, and become a vehement feminist, perhaps I wouldn’t see them this way. Maybe I’m too cynical. Maybe their actions, words, and opinions are acceptable.

Or maybe no one says anything because the stakes are just too high. Maybe they have all the power. Maybe they hold the pen that puts the final checkmark on my resumé. Maybe it’s a broken system for trainees.

Let’s end the hate, the microaggressions, the sexism, and the power differentials. Somehow and someway, there needs to be a system for trainees to report these behaviors – without risking their careers. We’re in desperate need of a checks and balances system.

The author is an anonymous physician.

Image credit: Shutterstock.com

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