Students, Physicians, Bullying and Stress
The difficulties facing medical students and physicians are diverse and
persistent. There is no escape from basic human tendencies. The competitive,
critical disputatious nature of humans is amplified in medical institutions,
despite a superficial appeal to collegiality. Physicians often face moral
dilemmas and must cope with the least pleasant aspects of the human experience,
often with little or no support from colleagues. As most medical care becomes
concentrated in large, impersonal institutions, a sense of alienation prevails.
A pamphlet from the Canadian Medical Association for physicians talks about
the “impact of stress on physician health and well being.” Canadian physicians
are generally unhappy about the increasing demands on their time and energy
while resources and rewards are shrinking. In Canada, physicians work in a
government under-funded system that survives on budget cuts and rationing
services.
The CMA pamphlet begins with a fuzzy statement that could win a prize in the
annals of obfuscation: “Stress is part of everyone’s life. A certain level of
stress contributes to optimal performance. However, when it is not managed
properly, stress can become overwhelming, leading to physical, mental and
spiritual difficulties.”I acknowledge that some readers would be more
receptive to this kind of talk than I am. However, I would want them to
ask what is really going on here? Physicians get tired, discouraged, frustrated
and become angry like all other humans.
Physicians tend to be more tolerant and giving than most other humans, but
each person has limited understanding and limited resources. When demand exceeds
supply, physicians, like other people, get discouraged, tired and angry. They
may feel and act badly in a variety of ways. If we really want to understand the
plight of physicians, the first step would be to pledge never to use the word
“stress” just as we have pledged never to use the word “psychological” or the
word “spiritual.”These are nonsense words that obscure what is really
going on.
Dr. Pamela L. Wible wrote about physicians' bullying
medical students and each other. Increasing concerns about physician burnout and
suicide have surfaced in the US. Medical students suffer bullying and some end
their lives. Wiebe stated: "The truth is, doctors are suffering. Surrounded by
sickness and death, we watch families wail, shriek, cry while we stand
silently—sacred witness to their sorrow—until we're called to the next room for
a heart attack, a gunshot wound, a stillborn. Week by week. Year by year. And
when do we grieve? Never. Doctors are not allowed to grieve. Today a physician
tells me she's been cited for unprofessional conduct. Why? She was seen crying.
Her boss told her, "Unless you are dying, crying is unprofessional behavior and
not to be tolerated." Doctors are not allowed to cry. So, what do we do with our
sadness? We injure ourselves—and each other. When I speak to victims of
physician bullying, I explain, "Your instructors are suffering from unprocessed
grief—probably victims of bullying themselves. Medicine is an apprenticeship
profession. Trained by wounded doctors, they're now wounding you. Your bright
eyes, your enthusiasm, your idealism remind them of their loss. Rather than feel
their own grief, they lash out at you." Pamela L. Wible.
Physician Bullying: 'Not Allowed to Cry'. Medscape. Feb 20, 2015.)
There are few physicians who would not respond well to expressions of
gratitude, respect and tender loving care. Each one needs more time off and an
assistant or two to do all the extra chores demanded of them. Physicians spend
much of their time caring for others but seldom receive care themselves.
The increasing tendency for hospital and government administrators is to
treat physicians with disrespect and to blame them for the high cost of medical
care. Physicians confront injury, disease, cruelty, ignorance and anger most
days and often miss opportunities to celebrate the joyful, creative aspects of
life. A basic imbalance for any human is receiving less than he or she is
giving. Physicians become overtired, do not eat well or regularly and often fail
to enjoy friendly and affectionate leisure time with family and friends…. our
description can go on and on. The more we observe specific details of physicians
lives (never using the term “stress”) the more we understand how these humans
suffer, make mistakes, become dysfunctional and ill or, if they are smart, take
a long vacation or quit medicine before they collapse from frustration,
disillusionment and fatigue.
