It Sucks to be You

My post on my first day of third year seems to have struck a nerve and a few of you have asked some variation of the question, “What can we do to end the abuses which are so much a part of medical training?”

The short answer is, “nothing.”

As long as there is a steady stream of people willing to sell their mothers to get into medical school it will always be a seller’s market and there will be no incentive to change anything. On top of that, too many people look at medicine as a religious calling which means that, like any Pharisee, they will defend their beloved orthodoxy against attack from reformers.

Not to mention the operation of human nature which ordains that many who have been made to suffer feel it is their duty to inflict pain on others. This explains the sanctimonious old-school attending who defends the abuse of medical students because he had it much worse in his day.

So on an institutional level change is going to come very slowly. The increasing numbers of non-traditional medical students who are less willing to put up with the usual chickenshit is an encouraging development. A twenty-something medical student who has gone straight through from high school to college to medical school without seeing how the rest of the world works is a lot more inclined to accept the status quo as normal than somebody who has worked outside of medicine. Additionally, a resident or attending who knows nothing other than the life of academic medicine is inclined to believe that nobody else works as hard as he does and this makes him more than a little self-righteous.

In reality, other people work hard, often for much less money and prestige than doctors. As a Marine, for example, I endured hardships that would make the Chief of Surgery’s blood run cold. But you don’t see me running around abusing people because I humped a 120-pound pack up and down the mountains during arctic warfare training or spent week after week sweating in a central-American jungle.

About the only thing we (you) can do is to stand up for yourself. There is no rule in medical school that forces us to be pussies. Let’s say you don’t know the answer to a pimp question, instead of getting flustered and embarrassed as we usually do, why not try saying, “I don’t know.” And then just look at the guy like he’s some kind of idiot for pressing you on something which you have just told him you don’t know.

“I said I don’t know, Bob. What part of that don’t you understand?”

If enough people take a stand against abuse by not tolerating it the whole sorry house of cards built by the insecure to protect their fragile egos will come down. The worst thing that can happen, as long as you are reasonably respectful, is that you might get a bad evaluation here or there. The days are long gone when your attendings had the kind of absolute power over you that they once had. There is nobody at your hospital who can stand in front of a review board and explain how he has the right to mistreat his subordinates.

Still, you need to go through medical school with good humor. Most of your attendings and residents are decent people and their knowledge and accompishments should command respect. They have a duty to instruct you and this involves criticism. You need to be able to take legitimate criticism even if it is sometimes delivered with a little well-deserved sarcasm.

I can, however, tell the difference between criticism and plain old bad manners.