Culture of Respect In Medicine is the Responsibility of All Caregivers

In an excellent article, Darrell Kirch MD, President of AAMC, recently reminded all practicing physicians of the examples we set, and therefore responsibility we have, to our students when it comes to modeling a culture of respect in medicine. In his September post on the AAMC website,  A Word From the President: Building a Culture of Respect, Kirch shares not only his own memory of being disrespected as a student, but also the results of the AAMC 2012 Graduation Questionnaire which shows that 33% of respondents confirm being humiliated by those in a mentoring role. Kirch comments:

When things like this happen, we compromise the learning environments of medical students and residents. Tomorrow’s doctors must be able to learn in a safe and supportive culture that fosters the respectful, compassionate behavior we expect them to show their future patients.

As physician educators, we have an opportunity to shape the culture of medicine. The disservice we do to our profession when we choose to break-down versus build-up our students, and one another for that matter, are missed opportunities to lead and provide a positive role model for those we are enlisted to enlighten. I remember a faculty member at one of the Telluride Summer Camps reinforcing that it’s not just disrespect down the power gradient, but peer-to-peer disrespect that also occurs in medicine. As such, it’s truly going to take educating the young on the “right way” to interact with colleagues, but also re-educating “the old” on tenets of professionalism and the impact disruptive behavior has in creating toxic safety cultures. And it’s going to take all of us to create the change needed and to challenge our peers who believe intimidation is part of the medical education learning culture. As Kirch points out:

As educators and leaders in the medical profession, we have an obligation to eliminate any mistreatment of medical students. The solution starts by addressing the  culture and climate at each institution… at UCLA’s David Geffen School of Medicine…implementing stricter policies and faculty workshops were somewhat effective…not sufficient by themselves. What is needed to eradicate medical student mistreatment is, they concluded, “an aggressive, multipronged approach locally at the institution level as well as nationally across institutions.”

In the end, no work environment should include humiliation and bullying. Other industries do not tolerate the disrespect medicine has been willing to accept for many years. Darrell and I  have both referred to Dr. Pauline Chen’s piece in the NY Times, The Bullying Culture of Medical School  and here on ETY, Bullying In Medicine: Just Say No, about how this negative sub-culture exists during training. Why would we accept this disruptive behavior by a few of our peers in a profession where caring and compassion is at the core of why we chose to pursue it? It’s counter-intuitive and, in the end, always reaches the patient–the person we have sworn to protect. Patients and families see this disruptive and professional behavior and wonder why it exists. Sometimes we have to hit bottom, look in the mirror, and say enough is enough. We need to acknowledge that the disruptive behavior of a small minority of our contemporaries reflects on all caregivers and our profession as a whole. I applaud Dr. Kirch and  the AAMC for continuing to bring this unprofessional and unproductive behavior into the open–this is how change begins and care becomes safer for our patients.


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