The Hidden Curriculum in Medicine: We need to apologize to residents, but we also need to apologize to ourselves

Last month, Divya Chhabra wrote an article for Huffpost calling out the mistreatment of medical residents during Covid-19 and beyond. 

I read the whole piece nodding my head and thinking (sometimes out loud), “Yep, yup, mhm.” 

The problems Chhabra is pointing out aren’t new. The more people I talk to, the more I see how we strip away our mental wellbeing to become doctors. As my fellow physician life coach and friend, Kara Pepper, MD (@karapeppermd), put it, “Our entire personalities have been hijacked by the medical system.” 

All doctors, especially women, are affected by a hidden curriculum that teaches us the conditions that physicians are supposed to swallow. The latent messaging starts as early as pre-med and only intensifies throughout our medical training. 

Chhabra nails the issues with residency. I, too, remember being “motivated” to work overtime and felt pressured to hide any signs of mental and emotional stress, all while my personal boundaries got tested and ignored. 

I remember as a resident, during a night shift, I got sick with dizziness, vomiting and diarrhea. The chief resident at the time, let’s call him Dr. A, made it abundantly clear that going home would cost me. According to Dr. A, a responsible physician should never leave her shift. 

After several hours of trying to keep it together and continuing to do new admits, I finally went down to the ED and covertly asked for some IV fluids under my white coat. I begged the staff not to call my chief or the attending resident, but one of the ED attendings called me out and encouraged me to take care of myself. So I made the call to Dr. A telling him I was too ill to keep going. I then had to begrudgingly accepted Dr. A’s oh-so-generous offer to cover the rest of my shift (less than 6 hours) in exchange for owing him two of his full shifts in return.

What Chhabra’s article fails to acknowledge is that it doesn’t get much better after training. She poses funding and higher residency compensation as the foundational solution to the problem. Here’s the thing: Attendings get paid better and more. But six figure salaries don’t justify the toxic environment that we continue to tolerate years into being established in our careers – and they certainly don’t change healthcare culture. 

Fast forward a year later from my previous story, when I received a call from a frantic resident colleague on OB call, asking me to come in to deliver the baby of a patient who was requesting me. I would have been on my way if it wasn’t for a minor detail: I had birthed my own daughter just 5 days earlier. What blows my mind, and epitomizes the insidious nature of physician work culture, is that I actually thought about going in! My family had to pull me back and remind me to focus on myself and my newborn. 

Funding is a problem, but it won’t fix healthcare culture. We’re stuck in a loop where we are desensitized to our needs as residents, and then reproduce that same pattern as working physicians. 

We need to be intentional about unlearning everything we know and redefine what makes a “good” doctor. Until we start prioritizing physician well-being, rather than throwing dollars into bank accounts, we can’t reasonably expect that doctors will act more human. 

How can we be kind to our colleagues and residents when we aren’t even kind to ourselves? 

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Errin Weisman DO

Errin Weisman, DO is the self-proclaimed wellness guru on Authentic Medicine. She is a life coach, podcaster and fierce advocate for wellness in medicine. She faced professional burnout early in her career and speaks openly about her story in order to help others, particularly female physicians and working moms, know they are not alone. Dr. Weisman wholeheartedly believes to be a healer, you must first fill your own cup. She lives and practices life coaching and medicine in rural Southwestern Indiana, loves her roles as farmer’s wife, athlete and mother of three.You can find out more about Dr. Weisman on her podcast Doctor Me First, her website truthrxs.com or hang out with her on social media @truthrxs. Her podcast is “Doctor Me First”. 

  8 comments for “The Hidden Curriculum in Medicine: We need to apologize to residents, but we also need to apologize to ourselves

  1. Nicole Alu-Parks
    June 21, 2020 at 10:51 am

    I will never forget in residency when one fellow resident was so sick he passed right out onto the floor of the nicu. We were all whining that he should suck it up and if he wasn’t in the er or hospitalized he better be there the next day. We did that to each other and have a low tolerance for anyone not putting themselves second to the work we do. Sometimes we say and think , “It’s what we signed up for” but is it really? We signed up for taking care of human beings without seeing ourselves in the same way. We have some kind of superhuman persona Or martyrdom to live up to in the public’s eye. But we are just people struggling to do the right thing, including taking care of ourselves and our families. The decision to do the right thing and walk away from the work is a difficult one indeed.

  2. Joe Smegma, DO
    June 17, 2020 at 6:20 pm

    I was told early on in medical training that “all the good stuff happens at night”. I was also told that you always, always do your call. If not, you are a p$$&e. I was taught that you step up and volunteer to help patients and fellow students, interns, residents or fellows. One of my dear friends reminded me in residency that you “show up to work, unless you are dead”. You don’t go home sick with a cold and crap on fellow residents. Myself and another co-chief resident had many instances where we had to be enforcers of “the code” I became. “Dr A”. If you missed your shift we will find you a shift or ten to replace. We had an intern miss most of the year with pregnancy issues and pre-term labor. Not her fault, we all pulled extra call for the year. The system didn’t change. Still hurts a little to talk about it. I didn’t realize the long term implications of this institutionalized behavior until 20 years later. Working for a large hospital system which expected family docs to do full practice , including hospital, office and nursing home rounds, followed by blinding paperwork and documentation. The days were long and stressful. As the years roll by you slowly burn out. The system , however, tells you to carry on. Toughen up. Stay the course. Don’t quit. Don’t let your patients or your colleagues down. Under the stress, we all eventually fail in different ways. You may become depressed. Divorced. You may become numb and incompetent. You may develop cancer or abuse substances. You may kill yourself. You may have a heart attack. That was me. I had 2, one in 2005, and the second in 2008. Both were stress induced. Clean coronaries on cardiac cath. I am otherwise very healthy. Stress is a killer. I was lucky. I quit the system. Now, self employed and happy. The message is protect yourself. The system, hospital or professional obligations will not. They will only consume you. Sorry for the darkness, it needs to be talked about. Peace, brothers and sisters.

  3. Russell Kamer
    June 15, 2020 at 6:07 pm

    My wife, an RN turned NP and business owner, always tells me that “You doctors let yourselves be taken advantage of.” Whether it is by our nature or training, we haven’t learned to say NO.

    That being said, I feel sorry for a resident who wants hazard pay for taking care of infectious people. She had a once in a lifetime opportunity to serve humanity in the worst health crisis of our lives. She should be proud of participating. She might want to reconsider her choice of profession if she thinks she deserves hazard pay. Not only is it unseemly to want extra pay for performing our basic job, it is an error to assume that hospital staff have a higher incidence of covid. An article just published in JAMA showed “Being involved in clinical care, having worked during the lockdown phase, being involved in care for patients with COVID-19, and exposure to COVID-19–positive coworkers were not statistically significantly associated with seroprevalence (Figure 2A). In contrast, having a household contact with suspected or confirmed COVID-19 was associated with antibody positivity”

    So, the real heroes are the families of COVIDs.

  4. sudha manjari prasad
    June 14, 2020 at 7:38 pm

    We highjack our well being while being asked to look after our patients’ well being. That’s like blinding yourself in one eye and explaining stereovision….Well written, Thank you!

  5. Benjamin Van Raalte
    June 14, 2020 at 1:46 pm

    It doesn’t end just there,How many times have I been demanded to come in and sew up a 1 cm laceration. There is absolutely nothing I can do better. It can be revised later too. And I can tell you this after it’s done the family says you have to accept my insurance payment. But the insurance payment may be $100. It’s the same payment as if a nurse practitioner spent 10 minutes with no overhead. I have to drive in, get everything ready and end up spending 2 hours away from family. I have huge overhead. Nor is this either in frequent nor am I hardly ever on call especially for requests like this. People feel they are entitled to a plastic surgeon. Nor are they loyal and become patients for life either. Quite often it’s the nurse practitioner who suggested they call or ask for a plastic surgeon because the nurse practitioner doesn’t feel comfortable. We are told to accept this is part of our obligation, and at the same time nurse practitioners are competing against us doing the things that do pay you the bills like injecting Botox and fillers. I’m supposed to spend half the evenings away from my family for renumeration that is less than the surgical techs get for getting called in in any complaining about this is unprofessional or greedy by other physicians. But my family is supposed to suffer, and I’m supposed to give up an entire lifetime from any free time. No one cares and no one will care. if you’re going to do reforms you have to do everything in medicine not just one or two aspects.

    • Gary Pearce
      June 14, 2020 at 3:49 pm

      Agree completely with you. Thank God I was grandfathered out of ER call after 20 years. I cannot tell you how many times someone from the ER ( the doc or PA or NP) stated “I’m not comfortable around the eye so can you come take a look” and because of EMTALA, we are enslaved. I no longer answer ER calls…and I am in a rural area without any other ophthalmologists……so sometimes patients are airlifted for thousands of dollars to a level one center an hour away. Too bad. I did my time and I am no longer a slave. I would suggest that anyone needing this level of subspecialty care be transferred to a teaching hospital- the doctors there are paid to do ER call. I was fee for service and it is kind of hard for a private doctor to collect money in an ER. Most any scar can be corrected with a secondary procedure. The tragedies are the overlooked intraocular foreign bodies- those patients may end up unfixable. When we finally get a union, we can fight this crap, along with MOC and EMTALA and the requirement that we provide charity care when on call while on hospital premises. Socialized medicine will also get rid of these inequities. I will be retiring soon …….and I am a little scared about the medical care I will receive when I get old enough to need it!

  6. David Adcock MD
    June 14, 2020 at 10:03 am

    I remember reading a book, written by a Harvard medical school graduate, during my first year of medical school. The author described a culture of unrelenting stress put upon the students, stress that was unnecessary and counter productive to learning and “performing “. But, the administrators directing the educational program, acknowledging what was going on, felt completely justified by offering free counseling to all who needed help. My surgery residency was often very stressful, with long hours and not enough time off. For the most part our faculty did not demand of us anything they did not also demand of themselves; this made us a part of the team, and while stressful, was very motivating. My surgery residency was very much in the older apprenticeship model that has fallen out of favor. While today’s physicians in training may be better schooled in maintaining their own health and well-being, I don’t find them nearly as capable, or committed, to the wellness of their patients.

  7. Pat
    June 14, 2020 at 9:20 am

    “…especially women”??

    … now where did I pack that Helen Reddy 45 rpm?

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