I played college football at a Division III school. That means there were no scholarships or cheerleaders, and high levels of academic work were requisite to playing on the team.
But the rigors of the team — sprints and pulling heavy objects up a dusty hill and doing two practices a day in the heat of late summer — were intense and real. Our coach was certainly not always polite, and part of the reason he was able to extract such hard work from us was that we were scared of him. There was a lot of shouting, quite a bit of belittlement, and frequent exertion past the point of exhaustion.
But I, like most of my fellow players, look back on that time with the fondest of feelings. It was a time when I knew I was getting the most out of myself, getting out of my own way, and contributing to something bigger than myself.
In a similar way, I look back on my medical training — as taxing and exhausting as it was — with fondness and respect. So I was interested to read an article in the New York Times characterizing much of medical training as bullying and harassing.
A recent New York Times article, by Dr. Mikkael A. Sekeres, M.D., looked at whether the US medical training system, especially for doctors, is marked by bullying, belittlement, and harassment. He cites a study that surveyed 1,387 American medical students in their final year of school finding that 42 percent reported having experienced harassment and 84 percent experienced belittlement during medical school. And he shares his experiences in medical school and residency, with doctors pulling rank, obsessing about his perceived faults, expecting inhuman work hours, and unattainable ideals of precision. In other words: he had normal training for a doctor.
Dr. Sekeres’s experience didn’t surprise me, of course, and indeed makes me remember many of my own teachers and experiences — things that these days might be called bullying or even harassment.
The recent tendency in medicine has been to soften the system a bit. The hours' cap has dramatically changed the face of residency and not always for the better. Along with more reasonable work hours, I’ve observed a lower level of felt personal responsibility — the resident's hours are up for the week, so he is signing out, whether or not that’s what’s best for the patient.
For that reason and others, I have to admit that when I read Dr. Sekeres’s article, my response wasn’t primarily agreement — it was concern. My concern is that as doctors, we have a duty to care for our patients at the highest levels of rigor. And the medical training — the long hours, the unreasonable standards, and the exacting mentors — supports that in many ways.
But the more I thought about it, there more I realized that while rigor is crucial, there is a difference between rigor and bullying. I even see it in my own medical teaching. While other surgeons were known for loud operating rooms — music and shouting and even throwing things — my OR was always quiet and calm. Similarly, my relationship with the medical students was always calm, precise, friendly, and even relaxed — we collaborated from a love of learning and a love of work done well. And they worked very hard. So even my own experience contradicts this idea that rigor goes hand-in-hand with bullying.
Especially in the medical landscape in which we find ourselves today, healthcare collaboration is deeply important, possibly the most important thing that can happen on any given case. The truth is that the time of the Lone Wolf Doctor is over, and so if the bully-them-until-they-shine approach was ever effective, it’s certainly not effective in an age when collaboration and coordination calls for teamwork, respect, and collegiality, all of which can be taught and modeled just like surgical techniques.
My takeaway? We benefit from rigor but we don’t benefit from our teachers pulling rank, creating an un-collaborative environment, or not valuing every member of the medical team. We don’t benefit from teaching new doctors that they are alone in their work, must solve every problem on their own, and can disrespect their colleagues when it suits them.
Yes, demanding high standards of care and work ethic alongside high standards of professionalism and collegiality is a very high bar. But our patients' lives require it, and I believe that each of us is up to the task.
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