Our medical school recently completed its licensing renewal process, organized every five years by the Liaison Committee on Medical Education (LCME). The LCME is the organizational body that licenses medical schools to give out MD’s, and they set the requirements and goals that all medical schools need to meet. Otherwise, a school can be subject to probation or lose its accreditation, a result that can obviously have enormous consequences.
One of the issues that rose to the top of the heap was the issue of student “mistreatment”. I put this word in quotes because to a certain extent, that word could mean a multitude of different things to different people. We can all agree that transgressions such as sexual harassment or physical violence are clearly mistreatment. But what if an attending physician sharply calls out a junior medical student in front of everyone on “rounds” and asks him or her a question to which he/she clearly does not know the answer? Is that mistreatment or just not kind?
At the medical school, I work on a committee that seeks to promote a respectful work environment and to identify and intervene in instances of mistreatment. From sitting on the committee, there are indeed instances where the line in the sand can be murky. Overall though, I think the committee’s proactive approach to establishing a safe work environment has left a positive impact.
However, far and away the largest source of mistreatment comes not from co-workers but from patients. From my experience, most medical students and healthcare workers are at some point cursed at, subject to racial/ethnic/sexist slurs, or even physically threatened by patients. For example, when we rotate through the psychiatric ward, there are often patients suffering from psychosis spewing offensive phrases, and in the emergency room, patients under the influence of substances are often physically combative against staff.
Yet I and most students with whom I’ve spoken don’t seem much offended by very offensive comments or actions when they come from patients. It is striking, because the bar for what gets under our skin is light years apart when it comes from patients versus co-workers.
I see the difference stemming from two reasons. The first is that it’s difficult to establish norms outside of the hospital, but it is feasible to change our workplace. To make sure that every patient that enters a hospital or clinic is respectful is an impossible undertaking, but ensuring respect amongst co-workers is possible. Secondly and more importantly, we all went in to medicine to serve our patients. It’s a bond that is difficult to break. We are trained to expect patients to be imperfect people, and to then continue to be their advocates under the circumstances. It is a deeply held mission, and one that is often not broken by mistreatment.
I vividly remember one of my first instances of this phenomenon as a college student volunteering with the Red Cross in Mississippi. I transported a 60 year-old large man with diabetes to the hospital for a foot infection. He was wearing a sleeveless ribbed undershirt, and as I pushed his wheelchair, all afternoon a giant swastika tattoo on his right shoulder stared back at me. We spent the day traveling to his different appointments, and we ended up getting along quite well. He realized I was the person most looking out for his well-being for that afternoon, and he also realized I was Jewish. The former was more important to him than the latter.
