THE WAY I SEE IT

It's med school, not boot camp

Tormenting students and residents is no way to teach the art of medicine.

By Andrew M. Seddon, MD
Family Physician/Billings, MT

About 20 years ago, I was a junior medical student on my first clinical rotation in a large university hospital. Because of my unfamiliarity with the building's layout, I had taken longer to accomplish a task than the surgical resident felt was appropriate. Refusing to accept my excuse, he backed me up against a wall.

"Don't you ever get lost in this hospital again!" he screamed, his face inches from mine. "Do you hear me?"

The attendings were no better. When a detail of anatomy eluded me during my first surgery, one of them sneered, "What have you been doing for the last two years, driving a cab?" If I'd had any desire to be a surgeon, that first day on rotation would have snuffed it out. I wasn't the only one being bullied. I remember my partner on that surgical rotation crying in the call room.

Residents and attendings alike seemed to consider it their privilege, their right, perhaps even their duty to trample the feelings and self-confidence of students. It was a form of misguided machismo, a rite of passage like fraternity hazing that all would-be physicians had to endure. Many of us considered quitting medicine, and some did. Some even contemplated suicide, and one actually did.

But most of us endured, earning bruises and scars in the process. I finished my surgical rotation filled with distaste and anger for the system of medical education. But what could a mere student do? We were powerless to change the system. Our only goal was to survive it.

The bullying did strengthen my determination to become a physician. I wasn't about to let these tyrants have the last word. Graduating from medical school was my private victory over them.

Thankfully, my community-based residency was totally different, a paradise compared to the near-hell of medical school. There I learned medicine from many caring and considerate physicians who provided a much more civilized and compassionate environment.

Unfortunately, bullying is still common in medical schools. What does that say about our profession? That we care nothing for the emotions and personalities of those who will be the next generation of physicians? That we want only the most dominant, and most arrogant? Do we rate toughness over compassion, self-assertiveness over humility, arrogance over knowledge?

To be sure, every physician must develop some emotional insulation, a layer of thick skin to protect us from the pain and hurt we encounter everyday in our practice. For that reason, a measure of clinical detachment is essential; we couldn't survive without it. But we must not insulate ourselves from all hurts. We must have sympathy for those who entrust us with their health and their lives.

The practice of medicine is a mixture of knowledge, skill, and heart. All three are required before a physician should be entrusted with the lives of patients. But while knowledge can be learned, and skills can be practiced, the heart must be nurtured. That won't happen if our medical training is conducted by abusers, because bullying and caring are irreconcilable. Perhaps that's why recent reports show that some patients are more satisfied with nurse practitioners than with physicians; and that some view "alternative" practitioners more positively than us.

In a recent office visit with a feisty elderly patient, I told her that I'd need to consult with a certain specialist about her condition. "I met him once," she replied, frowning. "I told him to get out of my room and not come back until he got a bedside manner." Then she smiled and said, "He was much better the next time I saw him."

We can't expect most patients to change the way we practice, as this lady did. It's up to those of us in the medical community and those in positions of authority at medical schools and residency programs to eliminate bullying. If that works, it will help restore patients' trust in and respect for our profession.

 

Andrew Seddon. The Way I See It: It's med school, not boot camp. Medical Economics 2003;1:76.