In a recently published JAMA meta-analysis, medical students were found to have a higher prevalence of suicidal ideation and depressive symptoms than the general population. From the mental exhaustion that begins in medical school to the physical fatigue that peaks with residency, it is not shocking that medical trainees are suffering. Current discussions have ignored one of the biggest hindrances for the mental, physical, and emotional health of physicians-in-training: the hierarchical structure of medical training that enables and often encourages bullying of trainees. And, with a new wave of trainees about to begin their careers in medicine, it would serve us all well to remember that we need to curb this bullying — not enable it further.
Every single attending was, in fact, a medical trainee in a previous life — a simple fact that appears to get lost in translation once physicians complete medical training. Because, eight years into my training, I can count on my fingers the number of attendings who have shown an interest in my well-being. Trainees do not necessarily need to be buddies with their attendings, but they do need to feel valued for their work and they do need to feel like their work is growing their skills as a physician. Realizing that physicians-in-training are often simply cheap labor for hospitals is bad enough without the archaic attitudes that perpetuate a system that needs an overhaul now.
Sadly, bullying within medicine is nothing new. A 1990 JAMA study found that by their senior year, over 80 percent of medical students had been bullied. And, a recent national survey of residents and fellows found that 48 percent of those surveyed had been subjected to bullying. But still, nearly forty years since the publication of Samuel Shem’s House of God, trainees are often still seen as little more than gomers running around the hospital at the beck and call of their supervisors.
In our business of life and death, we are all terrible to each other. Interdisciplinary collegiality is hard enough to strive for, but what hope do we have of remedying that situation if even within the same discipline we abuse one another? I am fortunate enough to be in a field where some of my attendings have offered to write notes or see consults on my behalf on particularly busy days — gasp — but these acts of professional courtesy and human kindness need to become the standard, not the exception. Because our future doctors of America do not stand a chance at halting their spiral into despair unless we all acknowledge that a little kindness and a little consideration for each other can make all the difference.