I notified the resident physician and endorsed my findings. This particular resident was an intern’s monitor and projected himself as “pro-student” and having oriented us during the beginning of the rotation, I thought he, of all people would be more tolerant.
“Ano ‘to?” (What’s this?) He said as he looked at my chart entry. I explained how I did my physical exam, and since I did my clerkship in another institution, the order of my eye exam was not the standard one in the current institution.
I apologized and explained that I was confused with the order of the eye exam, but I thought as long as it was complete, it would not be that of an issue. I believed that we settled the matter then, but when he learned I used a fine print instead of the Snellen chart to check the visual acuity, he launched into a full tirade.
“Saang school ka ba graduate?” (What school did you graduate from?) He asked loudly, while we were in front of the patient and his family. He crushed out my entries.
I was aware of the particular culture in certain institutions that medical school of origin was a big deal, such that interns are judged based on where they came from. It would have not been a problem if I came from one of the top schools like University of Santo Tomas or Cebu Institute of Medicine, but I came from a modest medical school Remedios Trinidad Romualdez Medical Foundation in Tacloban. I have gotten used to people replying with, “Saan yun?” (Where’s that?). And then I had to explain where my Alma Mater was. I thought it was offensive to me why I needed to explain where I came from, I mean it is not my fault I was born in Leyte and I chose to go to school there, in fact I am proud that I am Waraynon. It was certainly nobody’s business to embarrass me by looking down on my credentials while in front of the patient and his family. The family member looked away, sensing the tension.
“Mas magaling pa sa iyo ang mga third year dito!” (Third year students here are better than you!) He said.
I was trying to hold my composure, and still tried to assist him while he was examining the patient. My vision was starting to cloud. I have very shallow tears, I tried not to blink because I was afraid my tears would fall directly to the patient’s face.
Before we were done, I curiously checked the findings he scribbled on the chart particularly the visual acuity. It turned out my findings which he crushed out were exactly the ones he wrote on the chart. It was one of those instances when I experienced bullying in the medical setting as a novice. It would not be the last.
Different forms.
Abuse comes in different forms. It could be verbal, negligence, or unjust treatment or unreasonably long hours. It is as old as the medical profession itself. People have gotten so used to it that it sometimes feels like the “norm.”
Some of my friends who took their internship in different institutions in Manila experienced being “runners” and personal servants of some of their seniors. Some interns were assigned to make coffee, some clerks designated as the “takeout person” or ones assigned to bring the bag/s of their senior while the senior strutted like a fashion model.
There is a fine line between doing a few favors and being a compete personal slave. I don’t mind holding the door open or making coffee for someone now and then, but when the tasks are not training related or nothing remotely geared towards improving one’s medical skills, then we have a problem.
As a clerk, a male surgeon once refused to be assisted by me and wanted a “pretty female clerk” (his words) who could do surgery with him all day in the Operating Room. At the end of the day, we felt sorry for our petite female colleague who had to retract all day at three nephrectomies just because she was a pretty female. The jokes and vague sexual innuendos are another thing. Hospitals have advocacies on gender sensitivity and sexual harassment, but somehow the practice is still thriving.
When Tables Turn
In the private institution where I had my clerkship, we clerks did majority of the work because interns have protected time of five hours for their board review, and when we get patients in the Emergency Room, we clerks do the history and primary intervention first before we endorse to our interns.
Since I had my internship in a large public teaching hospital, I never had the chance to experience being a “senior” because no such distinction existed between roles of clerks and interns. Only during the time when I became a resident did I experience being in a position of authority.
I remember that incident in the Emergency Room of my Ophtha rotation, and I realized every resident physician who work closely with interns and clerks actually have a choice: they can continue to perpetuate that culture or they can choose to stop the culture of bullying.
Being in a training institution meant we had an obligation to teach, rather than berate juniors when they make mistakes which is expected in the learning curve.
Far-Reaching Consequences
The consequences are not limited to the aspiring doctors who, sadly take the brunt of the abuse. These would-be doctors experience depression, feelings of inferiority, and possibly lead to more serious consequences like quitting the training program and even suicides in severe cases.
Patients also become the unwitting ultimate victims. The quality of care becomes compromised as clerks, interns, and residents focus more on avoiding the wrath of their seniors, rather than providing the utmost care. I remember a certain Emergency Medicine resident who gets severely agitated and rude when there are many patients for admission, that the interns would spend time convincing the relatives of patients to just transfer to another hospital. Sadly, some of these patients had nowhere else to go because of poverty, and in the end some do not make it at all.
As a Pathology resident now, I was surprised how other specialties also bully their way in the laboratory. Some choose not to follow the policy of 24 hours’ notice for frozen sections, which require Pathology consultants to read the slides and thus need to be properly scheduled. Some just operate on their patient and decide at a moment’s notice, which requires a written explanation by policy but such is a rule that some surgeons choose to ignore. Several times, residents of other specialties would barge in the cutting room while we are dissecting to demand that we prioritize their particular case as if we were their employees or that other cases deserved any less of our full attention. Newsflash: we are all Medical Officers- same position, different department.
Even the menial task of providing complete information on the Surgical Pathology form has a lot of benefit for the patient, which unfortunately some fail to give. I once received a modified radical mastectomy specimen which had only one phrase written on the history. I processed the specimen as usual but when I examined it microscopically, there were only fibrous tissue and very scant foci of tumor cells. My consultant had me repeat the sections of the breast thinking that I just missed the lesion but the other possibility was that the patient probably had chemotherapy beforehand which could help explain the altered morphology.
I tried contacting the surgeon to no avail. I visited the General Surgery office with a written letter inquiring about the patient’s history, but they provided no response. I went to the ward to try to see the patient and the chart but she was already discharged. Finally, I personally went to the Medical Records and dug through the bulk of files to retrieve the chart and found what I was looking for, the line that said:
“History of Invasive Ductal Carcinoma, status post 6 cycles of chemotherapy (2016).” It was all I needed and was able to sign-out the case. The morphology was altered because she had already undergone treatment and had responded well- there was only microscopic tumor foci left and all the margins were clear. Just like that, our final diagnosis hit the mark.
I was disappointed that because of the lack of information given, the patient had to wait for a longer period before we could sign out the case. Had I not investigated further, the case would have dragged on. Perhaps the surgeon thought it was only their job that mattered, when it is the pathologist who will give the final anatomic diagnosis on what the lesion is and ascertain if they had adequately treated the patient.
No doubt doctors are intelligent people, but what escapes me is how we never realize how much of a disservice we are doing to patients by bullying juniors or fellow doctors, thinking that one specialty is more superior than another. The lack of respect ultimately results in delay of patient diagnosis or inadequate treatment, something all of us should avoid at all costs. It also goes against the principle of teamwork of all members of the health care team. Lastly, let me echo the words of one of our mentors: “We all stand on the shoulders of those who came before us.” Let that be a reminder of the responsibility we have to train the younger generation of doctors and uplift the medical profession.
- Lifted from Thad Hinunangan
