Medicine needs to swallow a bitter pill for a healthier future

Abstract

Many doctors will recall as a student or trainee hanging nervously off the end of a Deaver – a large retractor used in pre-keyhole gall bladder surgery – while simultaneously trying to answer the surgeon’s barked questions about the anatomy in the cavity. The problem is you can’t actually see into the cavity without loosening your grip. A looser grip means less vision for the surgeon and usually a torrent of abuse for the trainee. Such moments of “teaching by humiliation” during medical training underscore the nature of medical culture: a totem pole that places surgeons very much at the top. Indeed, doctors have long enjoyed both enormous autonomy and deference to their apparent god-like power to stave off death. Within this mythology, medicine has built a hierarchical and autocratic workplace culture in which incivility, and even frank bullying, towards subordinates is commonplace. Medical students gradually acculturate to this during their training, often at the cost of their empathy and compassion. A recent meta-analysis of 51 studies on harassment and discrimination in medical training showed 59.4% of medical trainees had experienced at least one form of these. “Teaching by humiliation” – regarded by some as a kind of necessary hardening experience – was experienced by 74% of students and witnessed by 84%. Many still felt the sting decades later. Such power-oriented, stratified workplaces are good for no one. And, in medicine, many of the worst consequences fall on patients.