Where Is The Camaraderie?

I’m irked.

While minding my own business perusing the net, I happened across a post on Twitter complimenting RNs and all the hard work they do. Nice post….I thought. It’s not that I didn’t agree with the sentiment, I completely supported it. I don’t believe RNs get enough recognition or appreciation for the hard work they do and the crap added on top of their regular duties. I was just about to hit the “Like” button when I read further. Then I became disheartened. The post implied that interns behave like “know it alls” who don’t respect nurses. Didn’t really understand how this comment generalizing interns was relevant to the post when the topic was about nurses. Then it hit me–it was a dig. An almost unconscious slight on the OPs part. Against physicians-in-training by a….wait for it….physician. Despite the fact that the majority of interns do not, in fact, behave in this manner. Everyone should respect everyone, that goes without saying. Yet, the OP had no issue showing none to those amongst her ranks. So I responded and let my thoughts be known. Though I received no reaction from the OP, I did from another respondent who did not have the same perception of the post as I then proceeded to comment that she had met interns who were “pretentious pricks” and “assholes”. Nice. Imagine if she had said that about nurses on Twitter. She knows she would lose her job. But speaking about physicians in such a way, it’s acceptable and no repercussions are expected. And she’s right. Her response when I took issue with her characterization? “If an intern got offended by that comment, good  luck in the real-world.” As if it is somehow her duty to prepare fully grown, intelligent adults, receiving a post-graduate education, about the real world. By being derogatory. It has become second nature and the accepted norm to berate, demean and disrespect physicians in the medical community. And there are no better(or worse) offenders than the physicians themselves.

I became a physician advocate the day I read about an emergency physician (EP) who attempted suicide…and failed. This, after he lost a young patient to unforeseen circumstances. The family sued. It was to be expected though the situation was beyond his control; as it is what grieving families do. What was more concerning to me was the fact that his employer at the hospital, with whom he had worked for years, terminated him. Didn’t want his suicide attempt to reflect badly on the hospital, God forbid. His colleagues turned their backs because they were embarrassed. I joined a Facebook group to become an ear to other EPs who might be contemplating the same. To support my colleagues unconditionally and with confidentiality. From there it spread to other colleagues in various specialties. Through this same FB group I made it clear that if anyone needed help, I would find them professional help. Didn’t know how I would accomplish this, but I know how to network and I know how to get things done. And proceeded to do just that.

I am enamored with the art of medicine. Completely and continuously fascinated. I view medicine as a spectrum from primary(IM/FM/Peds) to the most highly specialized care(ie: Pediatric Neurosurgery). By extension, I am besotted with my colleagues. It is exciting to be amongst such distinguished peers. We are connected, not only by our training, but in the fact that we cannot function as silos in practice. At least, not effectively and certainly not well as a team. We need each other’s skills for this wheel we call medicine to roll along smoothly. At the center of the wheel are the primary care docs; every other specialty is a spoke. Patients will eventually return to this center, if they are to be managed appropriately and completely. Without this center, the wheel collapses. Knowing this, why can’t we enjoy our camaraderie? Where is it?

As a physician advocate, I am contacted by residents and medical students as well. Physicians-in-training too afraid to speak up about their treatment by pathologic program directors who are allowed to abuse their positions unchecked. Non-physician practitioners with no medical licenses permitted to be referred to as “Doctor” while a resident, who is actually a medical doctor and has a license, is referred to by his/her first name? This is how future physician leaders are trained? That their title is not worth the respect it deserves; therefore, they are not to be respected? That there will be repercussions if they complain that they are paying thousands of dollars to be trained by physicians, only to have their education relegated to those not trained in medicine? And ACGME does nothing? The people entrusted with their education are the very ones compromising it. Just so they can play nice and not offend anyone except the residents, whose opinions simply don’t matter. What kind of fuckery is this? How can academic physicians in leadership condone this s**t? Where is the advocacy?

With this being said, it again begs the question: Where is the camaraderie in medicine? It exists in the military, fraternities and sororities, sports….but not in medicine. Some of us may briefly experience it in residency if we are fortunate enough to be in a supportive program(as I was) and not a toxic one. But once we enter the workforce, the abuse by our own colleagues is rampant. Physicians, who were driven, motivated and ambitious students seeking to become one of the six percent accepted to medical school, engage in crowdthink. They lose their ability to think independently and follow the crowd. A rumor begins about a doc, they believe it. Nurse complains about a doc, no one asks the doc’s side. He is assumed to be guilty as charged. Doc tries to advocate for a patient and fulfill his oath, he gets labeled “disruptive” by a medical director or CEO who has sold his soul to the Devil. And if that is not enough, they attempt to ruin his career just for jollies. Not because they have to, but because they can. And his colleagues, with whom he once shared an amiable relationship, become active participants in crowdthink as well and look the other way. He no longer exists for them. Why are we comfortable believing the worst of each other? Why do we not give each other the benefit of the doubt? WHY ARE WE NOT ADVOCATES FOR EACH OTHER?

I will tell you why. Fear. Fear of losing one’s job if one speaks out. Fear of what other colleagues will think if you deviate from the status quo. Fear of being the outlier, not part of the “in crowd”. There is nothing more debilitating than fear. Makes one impotent, flaccid and ineffectual. And that fear is also why we don’t have camaraderie. I submit that the vitriol that follows this lack of comradeship is from the guilt or shame of our reprehensible behavior towards each other–manifested as disdain. Yes, there is a tremendous amount of toxicity in medicine. However, we do not have to perpetuate the negative behavior. We each have a choice. How we treat each other is completely within our power. We all learned simple edicts as children. Be good to each other. Be honest. Always do the right thing. RESPECT each other. This divisiveness amongst us…it is not necessary and is completely voluntary. Get some testicular fortitude or chesticles and change it. Become the change you want to see in others. It is within your power.

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