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? 

Join 3,622 other subscribers