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‘Great surgeons’ who bully med students are often bad doctors

SurgeryBy Alan Lyndon

If you think that bullying ends after the teen years and that places like medical school and hospitals are immune to such behavior — think again.

The stereotypical surgeonbully seen on television shows like Grey’s Anatomy are not the norm, but they certainly do have an impact on their colleagues, students and patients.  The bullying culture is not new to medicine.  Over half of all med students have reported some form of mistreatment, according to a 13 year study out of UCLA, and over 85% of third year students were subjected to bullying.

Now comes an inside look from Ilana Yurkiewicz, a third-year student at Harvard Medical School, who wrote a compelling piece in Aeon about her experiences in the hospital.

“We’ve known for years that entering the ranks of medicine means developing a thick skin to criticism and being made to feel small,” says Yurkiewicz. “What is disturbing is the increasing recognition that bullies are not only bad people to be around – they’re bad doctors, too.”

The main breakdown in the system is communication, according to Yurkiewicz.  Coordinated patient care is best when all of the providers work together and efficiently communicate with one another.

In fact, according to Yurkiewicz, a report by the Joint Commission over a 10‑year period showed that “communication failure was the number-one cause for medication errors, delays in treatment, and surgeries at the wrong site. It was also the second leading cause of operative mishaps, postoperative events, and fatal falls.”

Recently, a 15 year old girl made headlines when she posted a video complaining about the system of multiple providers coming in and out of her room to wake her and examine her and pepper her with questions.  While that may be frustrating as a tired patient — and understandably annoying when the docs are less than pleasant — that imperfect system allows for potentially better coordinated care.

But as Yurkiewicz points out in her essay, those bullying docs “are a substantial, troubling minority, and they can set the mood for the rest.” Here is one example of the surgeonbully:

He comes to the operating room late, greets no one, and berates the nurse for not setting up the stepstools the way he likes. He tells the resident she doesn’t know the anatomy and sighs when she adjusts her grip on a surgical tool. He slaps the hand of the medical student when she reaches for the retractor to pull back skin for a clearer view. The operating room is tense for hours. ‘I need a different clamp,’ he says at one point, ‘this one is too dull.’ ‘I’m on it,’ says the scrub nurse. ‘You’re not,’ he retorts, ‘or else it would already be in my hand.’

After the UCLA report was released, there was a slight decline in the bullying of med students.  But the New York Times reported that students still “described being yelled at, pushed and threatened. One student recounted being slapped on the hand by a more senior doctor who said, “’If teaching doesn’t help you learn, then pain will.'”

“Brutality doesn’t make better doctors; it just makes crankier doctors,” said Yurkiewicz. “Bad cultures lead to bad outcomes.” Doctors should know — and patients deserve — better.

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