Does Med School Have To Be Torture?
Kendra Campbell -- I just finished my first week of my third-year surgery rotation. I have no better words to describe it other than pure hell. I was unfortunately assigned to night call for my first week. For four nights I endured 16 to 18 hour shifts with no sleep, no food, only small sips of water, and no time to sit down. In addition to the grueling hours, I was subjected to the fierceness of our residents.
On my very first night call, the residents began rounding on the patients at around 6:30 a.m. I hadn’t slept or eaten in almost 24 hours. I was empty in both body and spirit. When the resident asked me about the ins and outs of one of my patients, I had to admit that I simply didn’t know. Not only had I not realized that I was supposed to be monitoring them, but I couldn’t even figure out how to answer his questions because I didn’t know how to use the electronic medical records system (we had received no training). He knew it was my first night of surgery night call. I admitted to him that I had not been trained on using the system, and that I was completely new to the hospital. But it made no difference to him. He laid into me so hard, that I felt like I was being physically ripped apart. I held back my tears and quietly told him that it wouldn’t happen again.
I’ve only experienced one other clinical rotation before surgery, and it was entirely different. In my psych rotation, I knew what the expectations were, and I was able to surpass them all. The hours were reasonable, and the residents and attendings were kind and understandable.
My first week of surgery has been the polar opposite. I’m starting to understand what sleep deprivation can do to my body and mind. I’ve realized that I simply lose the ability to think without sleep, food, or water for 24 hours. Every part of me begins to break down, and my defenses are lost. Welcome to medicine?
From what I can ascertain from my first week, med school rotations (and especially surgery) are very much like boot camp. You’re expected to challenge yourself physically and mentally in every way. You’re looked down upon if you complain. Failure is not acceptable.
A year ago, our very own Medscape editor, Christine Wiebe wrote an article on med student hazing, and I was very much interested in reading it at the time. However, now that I have walked a mile in the shoes of a lowly med student being yelled at by a so-called “teacher,” I understand all too well the devastating consequences of med student abuse.
At the end of only my first week of surgery, I feel like a shell of a person. I don’t have the energy to give 100% to my patients. I’ve lost all hope, and the first night I seriously considered running out of the hospital. I felt all my compassion exiting my body like the sweat rolling down my temples. I simply didn’t care.
I understand that medicine is a challenging field. I realize that the “weaklings” might not succeed. I understand that doctors are responsible for making life and death decisions, and hence should be held to the highest standard. But I can’t say that I agree with torture as a means of “weeding out” the weak ones. And I now realize why I’ve met so many less than compassionate physicians. I guess I just want to believe that there’s a better way.
Cheer up, Kendra :) Surgery's not everyone's cup of tea - don't beat yourself up about it or lose faith in medical school. Every speciality attracts its own type, and forms its own lifestyle. The surgery life and work envt is no less and no more valid than the psychiatric one - just accept that you'll like some and not like others. It's probably not a general medical school thing! I do hope you enjoy the rest of the attachment more than this week.
Posted by: Lucia | Sep 1, 2008 2:38:19 PM
The only thing worse than stupidity, is institutionalised stupidity masquerading as an elitist complex. Speaking as a patient, I don't want anybody near me who isn't well rested, fed, and able to do their job. Yes, sometimes it happens that that's not the case - it should never happen as part of standard operating practice.
We don't let people operate dangerous machinery in this state. We don't let them drive, we certainly don't let them fly commercial aircraft. Do OSHA rules not apply to the medical profession?
Posted by: warlock | Sep 2, 2008 3:02:28 PM
If it were easy everyone would do it!
Posted by: | Sep 2, 2008 3:03:22 PM
Aren't you glad you decided to abandon your pink mohawk for a while?
Posted by: N | Sep 2, 2008 3:12:31 PM
I had a similar experience--except for the fact that, despite trauma surgery being brutal with indifferent residents, I decided that I liked being in the OR/ER and using my hands.
I figured out that it is "tradition" to treat students poorly, but I don't plan on being that way. It is an easy abuse of power propagated by precedence.
I liked psychiatry too, but decided that I would rather use my hands than spend a career being frustrated about the effectiveness of my treatment. Keep in mind that psychopharmacology is my favorite subject.
I adapted to abuse by premptively commenting on my lowly status as a student, how "I am always wrong as a student, even if I'm right," and volunteered to be blamed should anything go wrong in the future. Of course, this wasn't really an invitation for abuse, but rather an acknowledgement that I had learned and understood their behavioral algorithm.
2 important social medical career lessons thus far:
1. avoid pointing the finger at someone or other colleagues because all the self-righteousness in the world isn't going to make them want to work with you next time around--which could ultimately translate into diminished quality of patient care.
2. understand your arbitrary, assumed place in the hierarchy and maintain respect for your upper-levels because they will grade accordingly...even if some of them may know less than their underlings.
Posted by: Pimpadelic | Sep 2, 2008 3:38:19 PM
Hazing is always a ridiculous and barbaric way of training. It is a form of bullying and ridiculous. Come on now, where are we anyways ancient Sparta?
The Latin word for Doctor is Docere, which means teacher. A teacher should be caring, fostering learning and creativity. It doesn't mean name calling, yelling, and emotional devastation.
Some may argue that it is "tradition" I say break away from tradition and create a positive learning and work environment. It is a waste of time to yell at a student for something as trivial as using an electronic filing system (the hospital should have a day for all new students/employees on the basic protocols, this would save time and create efficiency)
In no way am I advocating "hand holding" but what I am advocating is a POSITIVE environment which fosters learning.
To piggyback off of Warlock's post...would you want a doctor assessing you after being awake for 24+ hours and no food? Doctors have a huge responsibility to help patients, they are not gods but HUMAN BEINGS that require the same needs as everyone else.
It is difficult enough to learn the information, why complicate it with food and sleep deprivation? This is not wilderness survival for the Marine Corps or Navy Seals.
Keep your head up Kendra, maybe it's time for students to speak up against the hazing...it's not right. Next time you get yelled at for an idiotic reason you should make a profession comeback calmly and intelligently. If not right then ask to have a meeting with the Chief of Staff, the resident and yourself. Express your concerns. It's time for a CHANGE!
Naturopathic Medical Student
Posted by: David Hamilton | Sep 2, 2008 3:56:12 PM
Why aren't you eating?? There's absolutely no reason not to eat or drink while at the hospital - bring granola bars with you, get soda from the vending machines, etc. It's common sense, just expect that you won't have time to sit around eating and prepare accordingly. If you don't know how to access a computer system, ASK. ASK what's expected of you, ask nurses to help you find charts and information, ask other residents to show you what to do and how. It's that simple - it's not easy, and it takes a lot of work, but it's not difficult to survive surgery. I know you're frustrated, but if you want to be a physician you will have to get over many hurdles: wipe off those tears, pull yourself together, roll up your sleeves, and get to work. That's why you're here.
Posted by: Sarah | Sep 2, 2008 4:37:00 PM
The res is just covering his own butt...and used the prime example of displacement. HE is the one responsible for the pt, not you. He is the Dr. You are there to learn, and b/c you were never taught how to use their system, you're not getting the education you deserve. Don't let this one incident make assumptions about the field.
Posted by: wada | Sep 2, 2008 4:46:37 PM
I am intern, and just know that the hazing tends to continue into residency. There's no excuse for it. Just remember, you will be a resident in 2 short years, and will have the opportunity to interact with med students. Hopefully you will be able to set a good example for others to follow-- I say the Golden Rule applies. So, if enough of us decide to change the environment, it will happen. Good luck.
Posted by: Emily | Sep 2, 2008 5:58:02 PM
You do not have to put up with such unreasonable, inhumane RUDE behavior. I would call the person on their rudeness and remember you are PAYING for an education, you can always switch to another service; people do it all the time. But it is always up to you to be in charge of your own education; go to the nurses, they usually know more than the residents both about medicine and how their particular hospital works. I know you, you are tough; don't take on others' unfilled ego needs as your responsibility.
We'll all get thru third year!Remember what your dogs have taught you, listen to your own heart. Good Luck, we all need a bit of it.
Posted by: Gabriel | Sep 2, 2008 6:29:34 PM
Bullying such as this is unacceptable in any business format, including medicine. This type of rudeness should not be tolerated. And for those of you who think it is a lot of complaining, look at the research: Bullying such as this has a long lasting negative effect on learning, patient care, and an increase in the number of mistakes made with patients, and a decrease in the patient's confidence in the caregiver who acts this way. Bullies are no longer acceptable. As an older medical student I have refused to tolerate this behavior, and since I can give as good as I get, often such exchanges end in a truce. Do not trust or suffer a bully; it will hurt you if you do. Stay professional, but demand the respect you deserve as a student and human being.
Posted by: Roxanne Lewis | Sep 2, 2008 7:19:04 PM
Your article came after a long day of a pedi rotation where I felt so tired and so useless I don't know why I ever wanted to be a doctor in the first place. Then, thinking about surgery and ob/gyn rotations, which are notoriously difficult, I was even more unsure as to how I would make it through the next year. I still don't know... But am hoping my original enthusiasm for the profession and those few moments when you actually change a patients life for the better will carry me through the next two years and onto residency. I am not a quitter; nor do I want to spend the next 2 years of my life devoid of energy and any semblance of happiness just to make it to the end of this black tunnel. I hope this all gets better with time. Your article title resonated with my feelings today; I hope our spirits are lifted by that which drew us to the profession in the first place.
Posted by: Alison | Sep 2, 2008 7:38:15 PM
That resident is probably an idiot - his response as you described it is totally inappropriate.
Posted by: A surgery resident | Sep 2, 2008 7:53:29 PM
Friend, you have got a good point. I know some people think that this is an isolated incident with some rogue resident, but the truth is, it's not. As medical students we recieve some of the most difficult training imaginable in any field. Eventually it becomes difficult to enumerate the times we've been berated, insulted, doubted, and generally crushed by doctors and residents. The rationale seems to be "we went through this too" so suck it up. It's like when we talk about children in abusive homes growing up to become abusive themselves. Some might laugh at that comparison, but truthfully, because of the time and energy and LIFE that we invest in medicine it's pretty safe to assume that not one of us goes through the process unchanged, and that too in a most profound way.
I remember back when I started college I read about discussions in the medical community to make training less grueling for students, to get out of this vicious cycle of violence we're stuck in. I wonder what ever happened to those great intentions.
Posted by: Bhaijan | Sep 2, 2008 10:58:13 PM
Hey Kendra, I don't really have a whole lot to add to what people have already said above, but I just want to tell you to hang in there. I've followed your posts for a while and I think that you're a great person with some great ideas and viewpoints. the medical profession needs you. I'm a med student too and at my school it's the gen med rotation that's horrible. I ended up in the worst unit ever and the associate professor tore me apart tooth, fang, and claw pretty much every day. she really made me hate myself. But after I finished it, I realized that she really made me learn and demand more of myself. Not that it was ever okay for her to treat me that way, but I'm here for a reason and I'm not going to let some frustrated, bitter professor ruin my life. And you shouldn't either. You can get through it, and you'll come out stronger for it.
Posted by: N | Sep 2, 2008 11:22:07 PM
the truth is that real doctors work long hours, but you have to keep your head clear. Find food, learn to be efficient in eveything and still make time to research your patients medical issues. As an attending, I completely disagree with treating students as underlings. If this behavior you are reporting is truly that malignant than it should be reported. But, not having information, or missing aspects of your patient's care is not excusable in the real world either. No one is there to yell at you, or to remind you, so now is the time time to learn.
So, keep your chin up and find some food and sleep. It is hard to think when your hungry. That can easily be fixed. Sleepy, that's something your just going to have to get used to. And I believe that you can.
Posted by: | Sep 3, 2008 5:14:34 AM
Don't despair.. surgery and trauma are "dog-eat-dog" but not everyone is like that..find a resident (this will take observation on your part)..and I found that most are better one-on-one...and befriend them.
For your other needs.. always keep either water bottle or gatorade bottle in your lab pockets along with some snacks. I would have a mixture 0f almonds and raisins plus water. When there is downtime.. and there will be.. eat, drink, and sleep. Also remember..while walking to a patient's room or to surgery..or charting.. can be considered as downtime..so eat or drink. And don't forget to befriend the nurses!!
Stay positive! Most residents are really nice..but let their frustration get the best of them.. and they can't "shout" at their Attendings..so we, as the medical students get it..it's not personal, it's heirarchy so-to-speak.
Posted by: Anupama | Sep 3, 2008 5:15:59 AM
Interestingly enough, I went through this in Pediatrics of all places. It was because I had taken a day off for my child being sick. After that, I was totally blackballed and received this kind of treatment on the floors. I empathize with your feelings they are valid because this sort of stuff happens in medicine. It like a sickness that passes from generation to generation. I am sorry that you had to experience this. I know it is hard to adjust in the rotation once this has happened. But I would advise you to regroup. Pack granola bars and water in your white coat and adjust. I found that one resident in particular would not come off my back, no matter what I did. However, find someone to confide in and do your best. This too shall pass.
Posted by: Camille | Sep 3, 2008 7:03:05 AM
Hi Kendra -- Thanks for sharing. I really enjoy your blog.
Let's take a step back here, and think about the larger issues. The system of hazing med students goes back generations -- and has produced the doctors we have today. And how are they doing? Are we satisfied with our doctors? Do we feel that our doctors spend enough time with us, get to know and understand us, CARE about us? ARE WE HEALTHY??
There are certainly exceptions, but on the whole, Americans answer NO to all of these questions. So what good is all of the hazing doing? It's not benefiting the patients, and it's certainly not giving the doctors the skills they need -- because medicine is an art and a science -- and being technically proficient is only half of the job requirement.
First, do no harm applies to everyone we come in contact with -- patients, students, and doctors.
Posted by: Leslie | Sep 3, 2008 8:02:04 AM
cheer up...on the other side of the world, here in Southeast asia, we are doing 36 hours straight duties for some rotations....so yeah..it's a torture..i keep on forcing myself to stand up even if i am already so sleepy...
Posted by: Princess | Sep 3, 2008 8:19:34 AM
I have been a nurse for 27 years. In July, I will take USMLE Step 1. Personally, I would sue without giving it a second thought if I learned that I suffered injury from medical care provided by an overworked, tired, starved, emotionally abused resident. Who's to blame? Hospital administration, medical administration, including nursing administration if they are aware. Who can truly measure the value of human life? I will not allow senior residents to put my new career and more importantly, my patients lives at stake. My advice to all caregivers, know your institutions policies and the state regulations. You, as physician or nurse are a patient advocate. You have the power to stop the bullying and hazing. I dare anyone to toy with human life!
Posted by: Joyce Richards | Sep 3, 2008 8:21:40 AM
So, ive just read most the comments above.. and yeah surgery is quite tiring..
i just finished my rotation in pediatric surgery, where ive been only some couple of time in the ops but therefore mostly in the emergency station..
i never had to work 24 hours straight, but ive done 12-13hours, so i know what it is like not to eat and not to drink... i worked a trick..every 15 minutes i would just go to the kitchen and drink a glass of water, nobody would ever notice that you need 1minute longer to go back to your station... and if you drink quite often, you just have to go pee. NO one would stop you from going to the loo for 3minutes, it is better than you peeing your trousers..and while you have this 3 minutes, you can just sit down and enjoy it.. yeah i know, it is a cheesy trick, but it worked all the time..
and try to get some voltaren ointment and just rub it on your knees and triceps surae.... it reduces the pain from all those walking.
so good luck =)
Posted by: Oscar | Sep 3, 2008 9:29:38 AM
Cheer up or as we say this side of the pond suck it up. Think of med school and medical training as jumping through hoops. It's no different to any other field, think of for instance investment banking. All the bull you get in surgery actually serves to make you a tougher individual. Maybe it makes you care less but when you are in a mass trauma situation and have to decide who you treat and who is already a gonner that lack of empathy actually helps.
Also the hazing that you get serves to teach you your place in a team, and as a med student like it or not your less important than anybody else. And the added bonus is that it teaches you to put up with the inevitable abuse you will eventually get from patients. Like it or not you have to learn how to deal with it, and despite what you think, for every person who falls apart into tears there will be a group of tougher people who have gone through the same experience laughing at them as they run out the hospital. That is in its simplest form nature and natural selection and is seen throughout the animal kingdom. Like other people have said, different fields, different character types excel. What makes a good surgeon can make for a rubbish say GP or psychiatrist. The only problem we all face is to become a doc you have to go through it all. But at the end of the day that is what makes us doctors and not nurses!
So my advise is suck it up, forget about having a life for a few years (unfortunately that’s the commitment we made) and before you know it you will be doing a speciality that you really enjoy and will have figured out what you don’t enjoy. It's a long hard road but anything worth doing is never going to be easy.
Posted by: Myron | Sep 3, 2008 9:30:36 AM
add oil coz u're doing great thing!
and i bet u will soon appreciate it!
Posted by: hotterchan | Sep 3, 2008 9:44:41 AM
when you are sleep deprived, working under hard conditions, care, compassion etc are luxuries, never challenge what you can't change. instead of those, mother nature gave you other abilities: adaptation, detachment:) after 12 hours in trauma or er, you will be vacuumed empty anyway, so use them effectively, only gray matter, no limbic system, machine like, cold reasoning... no emotional outbursts, reactions, nothing. give that "what the hell" fish like blank look to problem resident, he will back off, learn the hospital routine(nurses, i love you all:)), this will create time for your bodily needs, naps, snacks, liquids namely. be a pro caffeine person, if that doesnt help, smoking does;) anyway, after 3 weeks you'll notice that sleep deprivation is not that devastating, in fact i'm always a bit euphoric after 30 hours, intoxication? maybe, interesting neurologic effect though..
its difficult to survive surgery, not because they're elites, just because they are different. i'm on my way of becoming one, i'll keep your resident in my bad example museum. i visit it on verge of "dark side", then i think of my nap time, everything becomes as fine as it could be:) you see, i too don't challenge what i can't change, but when i'm a senior resident, that department of surgery will be a merry place, otherwise behold that weakling of a $½$#$£!!!!!!! grrrrr!! :D
Posted by: zeynep | Sep 3, 2008 10:06:09 AM
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