Dear Dr. Wible,

Thank you for the work that you do. I have been following your push for humane medical education for several months now. I finally decided to contact you after reading your article about how “burnout” is actually abuse. I am a med student entering my third year. I have been consistently hearing horror stories from other students about the treatment we will receive on our clinical rotations — doctors belittling us, calling us names, screaming and yelling everyday, throwing scalpels in the operating room, not giving bathroom or lunch/dinner breaks, manhandling patients under anesthesia, and many other things that students are too scared to even describe.

When I have brought these concerns up, I have been told by peers and even administration that the best way to handle this behavior is to “keep my mouth shut and my head down.” The school is very aware of the problem. We’ve asked the administration to establish a formal student mistreatment policy (we currently do not have one), but I sincerely doubt that any changes will come as they claim that they don’t have less abusive clinicians to teach us.

I came to medical school specifically to work with underserved populations and to further social justice in health. I am very concerned about being broken by this abusive system in my third year. I am already exhausted, experiencing depression and anxiety, having panic attacks and insomnia. I am torn between my intrinsic desire to fight against abuse and what everyone is telling me; to stay quiet to survive. I know that it will kill a part of me to “just take it,” but I don’t know how I can get through this training any other way. I honestly don’t know what writing you will accomplish, but you seem to be one of the few people willing to acknowledge the rampant and ingrained culture of abuse in medical school.

Thanks again,

Matt

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Dear Matt,

Silence will not save us. The health care cycle of abuse is perpetuated by those who do nothing to stop it. Victim blaming and shaming with labels such as “burnout” actually perpetuate the mistreatment by deflecting attention from institutional abuse and making individuals feel defective.

You are having the normal reaction anyone would have to an inhumane health care system. Here’s what I recommend (in no particular order):

1. Keep a daily journal. List all incidents of abuse and mistreatment of students and patients. Writing has been the best therapy for me. Helps you process and get the pain out of your system.

2. Publish your experiences in training. You can do this (even anonymously) through popular blogs such as mine or KevinMD. Submit an op-ed to local, regional, even national newspapers (under a pseudonym if you must). I called my med school and residency out on their cruel vivisection experiments in the local newspaper — and still graduated! (Some of my superiors even thanked me for being courageous).

3. Start a petition with your classmates to present to your dean demanding that your human rights be respected during training. There’s power in numbers. They can’t scapegoat the entire class. I petitioned for my rights successfully in med school. Read how I did it here.

4. Advocate for humane treatment of attendings. They are injured and need help too. So many docs have Stockholm syndrome, and see themselves as strong and capable, while seeing med students as whiny, lazy kids who need to grow thicker skin. They need to be cared for and educated so that they see themselves as survivors of abuse — and empowered to break the cycle of abuse.

5. Remember that you are not defective. Don’t take threats and abusive comments personally. Most of what they say has nothing to do with you. Theses folks need therapy.

6. Invest in your health so you can help others. Get routine counseling and massage. Sleep and eat well. Do what you can to stay resourced and strong so you can think clearly.

7. Report unsafe and inhumane working conditions to OSHA and other oversight agencies that are involved in accreditation of our medical institutions.

8. Give positive reinforcement when abusive instructors actually behave. Your feedback may help them to be better teachers. These folks are seriously wounded. As weird as it seems, they need your help.

9. Start a Balint group, peer counseling, or other support system among your classmates. Maintain cohesion. Intimidation and public humiliation work best when students are divided and conquered. Stick up for your peers. Speak out as a group if a student or patient is mistreated.

10. Most importantly — do something. 

Hope that helps!

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. She is the author of Physician Suicide Letters — Answered and Pet Goats and Pap Smears. Watch her TEDx talk, How to Get Naked with Your Doctor. She hosts the physician retreat, Live Your Dream, to help her colleagues heal from grief and reclaim their lives and careers.

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