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.
Fear. The weapon used to control MDs is readily perceived and handled by everyone else for their own objectives and even simply as a learned observed behavior.
Which is why I opted to speak out after my own ordeal, because that fear truly is a terrible weapon.
I was afraid, hell I was full on terrified, when it was directed at me
My FMLA was retroactively changed to involuntary medical leave — 11 years at Washington University in St Louis as an MD/PhD and resident was about perish in fire and darkness.
It challenged my core identity, how I perceived myself.
https://www.ksdk.com/article/news/local/doctors-fear-controversial-program-made-to-help-them/63-ac167fca-a312-4464-a315-de5ba712698f
Why did only one other person question the process? (my clinical mentor, Dr Jim Fehr)
Why was whoever sent me recordings and emails surrounding the faculty meetings too afraid to object to the brutal and criminal intent expressed at those meetings?
How was it that an employer could retroactively rescind FMLA for paternity leave, refuse to grant FMLA for a sheer exhaustion of compensating for a medical condition, and then refuse to allow acknowledge evaluations by my own longstanding physicians?
Hell, I thought I was a real person – 12 Bravo Army Combat Engineer, VA rate sleep disability, completed undergrad and a WashU MD/PhD all while parenting my daughter who was FYI older than the Program Directors’s daughter.
I would guess the answers are connected. . . not being seen as a real human deserving of respect and the ability to blatantly and almost reflexively defy federal statutes.
In fact my attorney was even scarred of Barnes Jewish, “They will destroy you behind closed doors at every turn, and you will never even hear about it.”
Thus, the news piece. . . after all leaving the fear, the weapon, discarded doesn’t take away it’s lethality.
Two people contacted me after the news piece.
Both doctors had been convinced there was no route forward and were near abandoning hope in the future, hated their jobs, distant from their families, were terrified of being unable to practice medicine, and even more terrified of resenting their patients.
We talked.
They both realized that I was OK, which meant they had even more options than they realized.
They had hope- the news piece was therefore a success. Both physicians were looking for the slightest evidence, just a splinter of light, suggesting that the omnipotent bureaucracy was not in fact omnipotent.
(Blithely raining terror, yes, but omnipotent, no.)
My God, Gary…
I wrote this piece and have to admit…I do not socialize with physicians either. I have one friend who is a physician. I don’t trust docs if they are in my personal circle. But I want to. Although my physician advocacy began with my desire to support an EM doc who attempted suicide, I had noticed things in my EM colleagues well before then. When EHRs and metrics became a priority, I saw the stress on their faces. And felt compassion. Some docs gained weight, some lost. When they tried to take small breaks and eat they were constantly interrupted(as was I) for unimportant issues that could have waited. But the perception is that we don’t mind. That we are accessible 100% of the time. Constant pressure to discharge or admit patients and nurses asking what we were doing with the patient when the patient was theirs as well. No ownership. I personally felt as if I was on an island and on my own. I could not exhibit any signs of frustration or there would be complaints. We were not given the benefit of being human. So I decided I wanted to be more interactive with my colleagues. Learn about them. Their life. Humanize them. When one humanizes one begins to care. Then we can have empathy…for each other. Can I comment on the utter irony of the lack of humanity by those who should exemplify it?
I still don’t hang out with physicians, but I feel more of a connection with them as my colleagues. Thanks to organizations like PPP and my EM forums. I don’t want to be what I hated. I don’t want to be disconnected. We are all in this together. It feels good to be a unit. It feels good to have…well…camaraderie.
Yes we are the cruelest bunch of altruists, quite a puzzle. I agree some of our biases against our own come just from being part of this doctor bashing culture, but I also think we absorbed some in training in our tertiary centers, where those docs think they’re superior to community docs.
And then we all went through the abuse directed to those in training.
Sadly, even my wife’s Radiology group is too busy competing for RVUs to stand together against the hospital and administration. She has about maybe half-dozen out of a group of 30 who she would actually trust.
Like many others here, we avoid docs outside of work.
Pat and Lance, glad I’m not alone. I’m in good company.
Thanks for the support.
In the old days physicians used to go to evening dinners sponsored by their county medical society, hospital, or some sleazy drug company. It was often an excuse to smoke and drink but it fostered esprit de corps—pediatricians would schmooze with neurosurgeons, pathologists with radiologists, etc., and everyone got to know each other and decompress together. Now most of us spend as much time with out families as possible, justifiably, but few I know get together for any group meetings. Perhaps there is a happy medium?
I applaud your good, heartfelt piece, which made me sad for what is gone. Fear is the significant result, but not the deepest level of the problem. Physicians are merely a pass-through for the real origin: society does not truly value good care, nor do does it trust physicians. Every code entered, every request for “reimbursement” for work already faithfully done, every medical malpractice premium paid, every mandated CME, ever MOC requirement, every audit, every Press-Gainey threat, every mandated EMR, every arbitrary state restriction on opioid prescribing, and every dictatorial state medical board is a testament to the huge, permanent mistrust that society has for physicians. Doctors sense, incorporate, and reflect the baseline ill will and anger that society holds for the members of this profession.
I taught first year med students for over a decade, and was typically ranked as the #1 preceptor in classes of over 125 students. I was really proud of those results. I liked teaching them, did it for free, and took real joy from the shared experience. Then one day while being forced to add idiotic, irrelevant chart details in order to resubmit, I realized what this really is, a thoroughly corrupt industry – with the exception of DPC !!! – and one that I could never again in good conscience encourage another to pursue. Yesterday I got another request to serve as a preceptor, and it went right into the trash.
I stand with Rick and Lance. I avoid other physicians in public whenever possible, and NEVER discuss what I do outside of work. Doing so only invites more visibility, more threat, and more fear. SLKM
And this is why my best friends are plumbers, contractors, IT guys.
I just cannot stand attitudes.
Life is hard enough.
My days are hard enough.
The profession is hard enough.
When not working, I want to be with normals.
Me too, Rick.
Nobody would ever guess I’m a doctor when I’m not working.
One thing I learned quickly in medical school, which was confirmed in residency and again in practice, is that in Medicine, NOBODY has your back. Even someone you think is your friend will equivocate when asked to back you up.
Coming from NYC*EMS, this was completely unexpected for me – I was used to your partners and coworkers sticking up for you and everyone standing together. No matter the accusation, you’d have no problem finding several eyewitnesses to swear it never happened. We risked our lives for our patients, and we’d certainly go a little extra distance to take care of each other.
We’d all do a lot better if we looked out for each other. Heck, getting into that habit might even be a first step in forming a union.