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06 Sep 2017

“Rob, when you applied for University do you think that you ticked the right box?”

Recently, my soon to be professional colleague Mr Rob Thomas wrote an article for Medical Observer on the distress he sees in medicine. I made the error of delving into the comments section, which is a rookie mistake in such a connected age. There were mostly positive comments and some negative comments. What struck me about the negative comments though was the ad hominem attacks, my favourite being the opening line: did you pick the right University degree?

It’s a different world we face today. Online, we are the targets of one thing and one thing only: websites and apps designed to capture our attention. In an age of such fleeting online contact (by the way, my thanks for reading this article in particular) we’ve become well versed in jumping from point to point, without stopping every now and then to talk about what we see. I’d like to stop at this point. I’d like to understand why when a medical student who devotes the majority of his spare time to the advocacy of all of Australia’s medical students, and he shares his observations on his experiences talking to medical colleges and politicians all over the country, that some want to attack him rather than his argument. I’m stopping here because this is incredibly relevant to the wider problem of the culture we have in medicine.

I can hear some people in the depths of the YouTube comments section sharpening their knives. “Toughen up”. “Work harder”. “Find an easier job”. Without the slightest understanding of a person and their context, people are willing to attack them rather than address the issue that they raise. What I have never understood about these kinds of people is that it would take them seconds to respond to a workforce survey that would equip us with the information that we need to help shape a better medical workforce, but they’ll skip the survey to tell people like Rob how wrong they are. How people have the free time to serve vitriol the way of those trying to fix the problem while they instead do not very much about it has always perplexed me. Do they have some control over the space time continuum that I am yet to discover? Have they cloned themselves? If that’s the case, we could use those extra resources to fix the culture we have in medicine. Thanks very much.

We don’t like talking about this problem because the discussion has primed us to think that everyone who has a grievance is being bullied and harassed. This just simply isn’t the case. Every single one of us has worked with a student or doctor who is selfish and self-entitled. Instead of talking about how we can change culture, we get side tracked talking about that one frustrating person that we all used to work with. It’s not helpful, and the ones who actually need our help get lost in the system.

Culture change isn’t about making medicine a super happy kindergarten where everybody gets “you ran in a race” ribbons. Let’s take the drama out of the discussion and focus on the problem. Culture doesn’t change personalities, but it does magnify our qualities. An unhealthy culture is one in which students and doctors are not afforded the chance to develop. This culture is a product of unsafe hours, irrelevant assessment and poor professional development. This culture leads to snarky registrars berating other doctors over the phone. It leads to fatigued doctors crashing their cars. It leads to families falling apart and our brightest leaving the profession.

Instead of asking the AMSA President whether or not he chose the right degree, maybe we could put that energy into addressing the very problem he raises, and build a better culture in medicine. A culture that fosters mastery, autonomy and purpose. A culture of fatigue management. A culture of fair assessment that promotes those who deserve to progress and holds back the lazy and the vexatious.

As for you, Rob? Yeah, you chose the right degree mate. The fact that you’re willing to have a public discussion about mental health and the culture of a profession that you’re seeking to join means you’re light years ahead of those that won’t. I started with a reply to your article, so I’ll finish with one: “Better to light a candle than curse the darkness".

Until next time,

Z

Dr John Zorbas

Chair AMA Council of Doctors in Training


Published: 06 Sep 2017