Doctors keep screaming and throwing scalpels. What can I do?

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Dear Dr. Wible,

Thank you for the work that you do. I have been following your push for humane medical education for several months now. I finally decided to contact you after reading your article about how “burnout” is actually abuse. I am a med student entering my third year. I have been consistently hearing horror stories from other students about the treatment we will receive on our clinical rotations—doctors belittling us, calling us names, screaming and yelling everyday, throwing scalpels in the operating room, not giving bathroom or lunch/dinner breaks, manhandling patients under anesthesia, and many other things that students are too scared to even describe. When I have brought these concerns up, I have been told by peers and even administration that the best way to handle this behavior is to “keep my mouth shut and my head down.” The school is very aware of the problem. We’ve asked the administration to establish a formal student mistreatment policy (we currently do not have one) but I sincerely doubt that any changes will come as they claim that they don’t have less abusive clinicians to teach us. 

I came to medical school specifically to work with underserved populations and to further social justice in health. I am very concerned about being broken by this abusive system in my third year. I am already exhausted, experiencing depression and anxiety, having panic attacks and insomnia. I am torn between my intrinsic desire to fight against abuse and what everyone is telling me—to stay quiet to survive. I know that it will kill a part of me to “just take it,” but I don’t know how I can get through this training any other way. I honestly don’t know what writing you will accomplish, but you seem to be one of the few people willing to acknowledge the rampant and ingrained culture of abuse in medical school.

Thanks again,

Matt

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Dear Matt,

Silence will not save us. The health care cycle of abuse is perpetuated by those who do nothing to stop it. Victim blaming and shaming with labels such as “burnout” actually perpetuate the mistreatment by deflecting attention from institutional abuse and making individuals feel defective. You are having the normal reaction anyone would have to an inhumane health care system. Here’s what I recommend (in no particular order):

1) Keep a daily journal. List all incidents of abuse and mistreatment of students and patients. Writing has been the best therapy for me. Helps you process and get the pain out of your system.

2) Publish your experiences in training. You can do this (even anonymously) through popular blogs such as mine or KevinMD. Submit an op-ed to local, regional, even national newspapers (under a psuedonym if you must). I called my med school and residency out on their cruel vivisection experiments in the local newspaper—and still graduated! (Some of my superiors even thanked me for being courageous).

3) Start a petition with your classmates to present to your dean demanding that your human rights be respected during training. There’s power in numbers. They can’t scapegoat the entire class. I petitioned for my rights successfully in med school. Read how I did it here.

4) Advocate for humane treatment of attendings. They are injured and need help too. So many docs have Stockholm syndrome, and see themselves as strong and capable, while seeing med students as whiny lazy kids who need to grow thicker skin. They need to be cared for and educated so that they see themselves as survivors of abuse—and empowered to break the cycle of abuse. 

5) Remember that you are not defective. Don’t take threats and abusive comments personally. Most of what they say has nothing to do with you. Theses folks need therapy.

6) Invest in your health so you can help others. Get routine counseling and massage. Sleep and eat well. Do what you can to stay resourced and strong so you can think clearly. 

7) Report unsafe and inhumane working conditions to OSHA and other oversight agencies that are involved in accreditation of our medical institutions.  

8) Give positive reinforcement when abusive instructors actually behave. Your feedback may help them to be better teachers. These folks are seriously wounded. As weird as it seems, they need your help.

9) Start a Balint group, peer counseling, or other support system among your classmates. Maintain cohesion. Intimidation and public humiliation work best when students are divided and conquered. Stick up for your peers. Speak out as a group if a student or patient is mistreated. Here’s how one med school class got rid of their bullying professor.

10) Most importantly—do something. 

Hope that helps!

🙂 Pamela

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Pamela Wible, M.D., is the founder of the Ideal Medical Care Movement. Dr. Wible is the author of Physician Suicide Letters—Answered. Need a letter answered? Contact Dr. Wible.

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12 comments on “Doctors keep screaming and throwing scalpels. What can I do?
  1. Dr. John J. Shigo says:

    Burnout is common with practicing physicians. We must report and speak out about this abuse!

  2. Pamela Wible MD says:

    Matt replies: “If things don’t move forward with the mistreatment policy I will consider starting a petition, but everyone is so beat down around me I doubt anyone will sign it. Anytime I talked to fellow students about abuse people are either like ‘This is a problem but I want to graduate.’ Or they pretend it doesn’t exist.”

    My response: “If everyone had that attitude then we would still have slavery, women wouldn’t have the right to vote, and we would all be in the dark ages.If you are all true healers you are being called from your soul to do something to stop this abuse that will not end unless the victims stand
    together for what is right. (Think MLK – bus boycott, lunch counters, Rosa Parks).

    • Super Lung says:

      The petition doesn’t have to be strictly reserved for medical students (think out of the box); nor, does it have to be just a petition. There is a website (https://www.surveymonkey.com/), that allows for it’s users to create surveys that can be complete anonymously and generate statistics – for free. Matt can use this website and poll his peers, and that of those in medical school state/nation wide. This way, participants remain anonymous and the data reported can be used to support the need for reform. Numbers don’t lie/speak for themselves.

  3. A. Walsh says:

    Student Mistreatment policies are mandated by LCME. The possibility of accreditation sanctions always seems to be the squeaky wheel that gets the grease (no accreditation = no students = no money -> a no-brainer!). Encourage your fellow 4th years to complain loudly and in detail on the anonymous Graduate Questionnaire they will soon be given, and if you are really brave, consider contacting the LCME directly about the non-existence of policy and the gross mistreatment incidents at your school – you WILL get results.

  4. suzanne says:

    I find this very difficult to believe. Since starting medical school in 1999, and working at several hospitals in several states, and have never witnessed the “abuse” described above. Sure, there is an occasional doctor who behaves in some of the ways stated above. But I think this notion that this kind of abuse is widespread is false. It paves the way for other forms of abuse. In my experience, abuse from “empowered” nurses is rampant.

    My life has been made miserable by nurses who report me to administration for “disruptive” behavior. I do not do anything that could be considered “disruptive”. I am not the warm, fuzzy type, and when it comes to patient care I just want to get things done efficiently. For example, I have been complained about for not saying “good morning” and engaging in idle chit chat with nursing staff before asking them a question. (None of my male colleagues are expected to do this). After several nurses invented complaints just because they decided they didn’t like me, I was labeled as “difficult” at one institution and was targeted for sham peer review by management. All this time, I never had any problem with my physician colleagues or my immediate supervisors. (Unless you would call not defending me a problem)

    And what about the abuse by patients? Now that i have found a job where I’m not being abused by nurses, the worst part of my job is the patients. As government interference in medicine has rapidly increased the entitlement mentality, patients are becoming impossible to deal with. They are inappropriately demanding, and have completely unrealistic expectations. They refuse to take any personal responsibility for their own health. They see doctors as potential sources of instant wealth, as they scrutinize every action, hoping to find something the doctor did wrong so they can sue. They are demanding bullies who don’t care whether you eat, sleep, pee or have any free time. You are to be at their beck and call, jumping up to meet their every demand instantaneously.

    The decision to go to medical school was the worst decision of my life. It did irreparable damage to me financially, as I have student loan debt that is a huge struggle to pay. I have little hope that I will be able to pay it off before “normal” retirement age (I was stupid enough to go to medical school later in life). I can’t afford to pay my loans and also save for retirement, which means I will be getting poorer as I get older. The future is bleak, indeed, as retirement probably won’t even be an option for me. I am realizing that I am going to be stuck in a field I hate until I physically cannot work any more.

  5. ” manhandling patients under anesthesia” my story I was targeted and abused by a doctor I trusted. I have total recorded audio proof.

    It’s just the icing on my cake of medical blacklisting and abuse in central New York state. I was forced to do things against my will and was abused. I have a ton of documentation and audio proof.

    A large part of the problem that I see in New York state, is the Medical community “polices” itself.

    “Drs. In NY state can do anything they want.” Nys Attorneys Generals office Health Dept.

    The are over 8000 complaints by patients a year and less than 300 are ever acted on…

    Drs can not police themselves… they for some reason are too busy bulling each other… to the point of death. I for one am unable to understand this. I read Physicians Suicide Letters a very moving perspective. I long have felt there were issues in that area.
    I lost my old primary doc to a “sudden death” after his son a medical student at cornell took his own life… so sad sooooooo sad.
    Dr J was good.

    I think the change started when people only looked to how they could make the most money. I think most docs I have come across in the last 20 years fit this bill in my community. They were not the people who were natural care givers, they are “care takers”. They give crap care for big bucks. My community has long been known for substandard care,

    I think another big Pandora box is prescription medications that have the acceptable side effects of unpredictable and uncontrollable… how many doc take “accepted” medications, not many of them are happy seem depressed . hostile etc.

    The best dr i have had, Dr Barber, to this point in my nightmare of care… I think was bullied by his bosses. I had a guy who was a dr in my community for at least 20 years. This dr had never fired a patient… we had talked about this at my first visit. He could never even imagine it. The CEO of NOCHSI, abandoned my total care and I was abused and blacklisted. My dr had been taken over by a Medical Monopoly.
    I hope someone looks out for this guy and me. I feel very sorry for doc Barber, he has to suffer for what has happened in our community.

    Pam you are the only reason I have anyone in NYS to call a dr. I am scared for them too. They had the human in them to take me,this wrongly labeled pill seeker and abused person labeled disruptive…etc
    Please keep your support up for them too. I can only imagine they will be punished too. They will be profiled too.

    Hey is anyone wants to help me I will openly share any of my documented journey in hell. I am still suffering – but will work to make it better for us all.

    When drs hate and punish each other – patients never stand a chance.
    Drs are patients too…
    i care for us all
    i am dr mom

    we can all work together for the greater good of the planet…

    thanks pam on the other coast, YOU CARE!

  6. Patricia J Ritchie says:

    Your words are so wise! I wish there were people like you around when I made an attempt at medical school in 1985.

  7. Heather says:

    I have witnessed this inhumane treatment of residents and fellows almost daily in my 20+ years in healthcare. I am not the sensitive type. The treatment of these individuals by their superiors breaks my heart. My son is planning on going to medical school and I’m afraid for him.

  8. Anonymous hell says:

    Matt

    Follow Dr Wible’s advice and honestly take care of yourself. What you are experiencing is real and I saw /experienced it first hand. Please remember abusers have been abused in the past which doesn’t justify it but helps you understand. If you are yelled at or belittled I also used a Buddhist technique of compassion and reflected back to them an imaginary mirror what was being said to me. As a minority woman with a passion for patients from all walks of life, Muslims, non-English speaking patients, uneducated, uninsured I saw more inequality and hatred in health care than I will ever want to recollect. I write poems about it and that helped me heal. However, remember compassion is so needed in health care but start with compassion for yourself, be kind to yourself first , protect yourself, stay away from toxic people as much as you can but when with them imagine a mirror and whatever they say to you they are really saying to themselves. I was a strong but quiet voice with no one to stand up for me when I experienced unremitting abuse from a surgical attending/supervisor. I didn’t know how to deal with it then so I made so many mistakes but hope this helps. Call it out first by documenting on email. I always say email document first because my learned experience with bullies is that they are sneaky and experts at denial, if you go to them first usually they will get defensive and just blame you. So take it to higher ups by emailing so you also have a written document before they get a chance to manipulate the situation and just call you sensitive which most do. you can say something like this, I appreciate your opinion but from now on I would prefer you speak to me without such and such words or yelling. What is sad in medicine there are lots of bullies it is well known and studied yet ignored and even hidden. Skillpath and many websites on u tube teach how to deal with bullies whether in residency or later as a worker take the time out of your busy schedule and hectic learning because in the end it will save you from lots of agonies. I made many mistakes years ago and suffered in silence, thought I was too busy learning about medications, ventilators etc and that this was going to be just an isolated time experience in my life to learn there are many bullies in health care so learn how to deal with it, it is a real phenomenon and in now way a fiction of your imagination. Hopefully, someday that bullying mentality will no longer be accepted in any workplace, especially in hospitals. I find gentle, kind, compassionate health care workers are so busy caring they don’t take the time to learn to deal with the bullying and are actually more at risk from suffering from depression and self-blame. Hope this helps in any way, keep empowering yourself and looking for answers. Best of luck.

  9. Mohammad Ibrar says:

    I am shocked to hear that students and patients under anesthesia are abused and manhandled. For a doctor being such a groomed and educated person this behaviour is not acceptable at all. It is against medical ethics. I am a surgeon and also being attached for almost four years in a teaching post, never seen such a behaviour by any teaching staf. Frankly speaking affectionate towards students and extremely respectful for a human body even under anesthesia. We even respect a dead body not to talk of anesthetized one. If there is any where in the world any such unethical behaviour,it should be exposed publicly and boldly, at least for the sack of audit and improvement. And if medical ethics are not strong enough to deal and address these isues,they should be reviewed and changed accordingly. After all we are dealing human being whether students or patients. Respect is the prime step them comes learning.

  10. Sr. Dr. Bella MD says:

    These kind of abuse is seems to be ongoing process in every place, not only for the students who goes for clinical rotation, but also for intern doctors. Actually we are going for guided teaching in the hospital for clinical rotation and internship.
    I have been too witnessed the same incidents while i was. when i think of those incidents really i feel may those who reacts were in great stress of continuous duties, or otherwise they also would have got the same treatment while they did their clinical rotation.
    Whatever it may be doctors has to realize the psychological damage which they do for the students will create remarkable scar in the mind and stress some time to make the students to regret taking this blessed profession.
    I always feel profession of physician is God given gift to heal and rectify the life of human kind”
    In this condition if we damage the mind and heart of other professionals like us its really a inhuman attitude, which is not applicable to our holy profession.
    The organizations which are running the hospitals and medical collages has to be notified to check out their rotation with their chiefs to monitor the students performance and their undertakings.

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