Sunday, January 5, 2020


Was talking to a more senior person in my department recently.  This person was going off about how the younger generation of anesthesia trainees is a bunch of snowflakes who don't really know what genuinely toxic cultures are like and how good they have it now.  How in their day, senior faculty were much more abusive of trainees.  Gave a couple of examples.

They were pretty bad!  Sadly nothing out of the realm of what I and my colleagues experienced as in training as well.

One thing stood out to me.  They were talking about this time where they had a really difficult case in the OR with a bad patient outcome.  They were in the process of tying up loose ends from that case when the board runner called them up and sent them to do another really difficult, exhausting case overnight, because they were the call resident.  It was "awful" because the board runner didn't acknowledge the difficult thing this person had just gone through, ask how they were doing after the bad outcome, or give them even a small break in between cases.

Honestly?  That has happened to me so many times I have lost count.  SO MANY, including recently when a neonate I took care of had a bad outcome because of a lethal surgical problem.  This sort of event is so commonplace that I consider it part of the job.

There is no way to respond when senior faculty talk like this. Many things have improved in medical training over the past twenty years, but I've still had my knuckles rapped with surgical instruments by angry surgeons, been dressed down in public over things that weren't my fault, and been abused in countless other ways.  The problem is that many people are unable to see trauma when it is experienced by another person.  If another person reports a traumatic event that happened to them, they are called weak and whiny.  Then the exact same thing happens to them the following week, and it is the worst thing in the world -- they have been abused!  I've seen this play out so many times. 

It makes me sad to hear senior leadership call trainees whiny snowflakes, because I know they are not.  I don't particularly understand why people who have experienced trauma use that experience to justify a) perpetuating it themselves, or b) turning a blind eye to the trauma experienced by those who come after them, but... in medicine at least, it is a thing.  Why is it so hard to see it, or at least listen with open ears and hearts, when other people experience trauma?  It baffles me.  There is nothing left to say.


dolce vita said...

My program director has some choice words about that attitude...and pointed out that it's proven that verbal and physical abuse in the home setting/school/normal office has adverse effects, so why wouldn't verbal and physical abuse in medicine be the same way.

And on your last post. I'm sorry. That's really hard, and it's so frustrating in academia when we have poured our souls into our work and made so many sacrifices. And to anyone who says you've had an easy life...WTF. That's a horrible thing to say to anyone, and I'm kind of appalled that people in medicine would even think that-if anything, my last year on the wards have taught me so much about how we really don't know anything about anyone other than ourselves.

Good luck, I know the interview season is full of ups and downs, but as a MD/PhD trainee, I am so grateful you're documenting it all.

OMDG said...

I’ve never had a program director who did not have this viewpoint. You are lucky.

Sophia said...

I know that the older generation of physicians walked barefoot uphill in the snow to get to the hospital to work 600 hour weeks but there's a lot of evidence that the current crop of trainees is responsible for larger numbers of sicker patients in the hospital and on call. There's no good way to respond to these comments except file them away and realize that this person does not get it and won't ever stand up and use their power to protect you from abuse. It's a fucked up system and we can make it (a little bit) better by refusing to become abusive assholes ourselves.

teresa said...

Makes me think of a meme I saw a few days ago that said something to the effect that if you think younger generations should tolerate abusive/adverse environments because you did and you turned out fine- you didn't.
That attitude also sums up every program director I had. And I agree- there's no constructive way to respond.

Solitary Diner (Also Known as The Frugalish Physician) said...

I love Sophia's last line. I think speaking out against the toxic culture and doing our best to not cultivate it is (frustratingly) the best that most of us can do. I also make an effort to talk about it with trainees and to point out all of the things about the culture that aren't okay. Sometimes just having someone acknowledge that the way you're being treated is wrong (which no one did while I was going through training) can be supportive. (Although not as supportive as getting rid of all the toxic fuckers.)