Ask physicians about their medical school and residency training and many have horror stories about devastating criticism from superiors. Healthcare can feel like a dog-eat-dog world; with a hierarchy and rituals that must be respected.
It’s been a decade since my internship and I still find myself thinking about 2008. It was a significant year in my path to becoming a physician; I worked long hours, had amazing teachers, and was privileged to take care of an under-served patient population in New York. I also met a remarkable cohort and made lifelong friends. Despite this, I also had some interactions that left me on the verge of tears, shaking with anger, and doubting whether I could truly be a physician.
“Why don’t you just get a shot gun and blow his brains out next time!!! Better yet, stay the hell away from my patient and fall on your sword!” What just happened? I was frozen, and the ICU Attending wasn’t even talking to me. My poor co-intern had barely gotten a few words out during morning rounds, and she was assaulted with damnation. Mind you – the patient had a senior resident, a pulmonary fellow, and a team of nurses who had all been involved in the care. Yet the intern was the one who bore the brunt of the criticism. Medicine is often like this.
A week earlier, I had been the first to arrive at a rapid response in the dialysis unit. I examined the patient (who was fine), reviewed the chart, talked to the unit staff, and ordered some IV fluids. When I saw the Nephrology Attending I walked over expecting praise; thinking myself quite the hero having managed the syncopal episode. Instead I was met with a raised voice: “You are the worst intern I have ever encountered!” What? “No one has acted like this in 30 years.” I was frozen, I felt like crying, and I could feel my entire face quivering. Acted like what? What had I done that was so terrible? I knew I wasn’t encyclopedic in my medical knowledge, and I probably needed a haircut and shave… but “the worst” seemed harsh. He continued his attack while nurses looked on at the nursing station. “That is my patient, and you didn’t even come here to talk to me…” I mustered up enough courage to say calmly “I’m sorry – you’re right.”
In reality I wasn’t sorry. I was sorry that I had to read my superior’s minds to keep them happy. Nonetheless, I explained that I was doing the prerequisite work to gather information, talk to and examine the patient, and formulate a plan before I would dare approach an Attending physician. (I also knew for a fact that recently a co-intern had been admonished for not doing so by the same person). He said he accepted my apology and hoped this was just a misunderstanding. Nonetheless, I felt hurt. I avoided that Attending for the next six months until my internship ended. His words echoed in my mind; “worst in 30 years.” I’m ashamed to say that rather than have a desire to better myself, I wished that he would be struck down by divine retribution on my behalf.
I’ve been a hospital medicine attending since 2012 and for the most part I don’t get berated in front of others. Despite this, I do deal with scared and angry patients and their families, as well as with overworked and stressed healthcare professionals. Nowadays the criticism I get is from department heads, hospital administrators or the patient relations department.
This is my advice for dealing with devastating criticism:
1/ First, Look Within
Either you’re hurt because the criticism is undeserved and your integrity is questioned, or you’ve done something wrong and are hurt because you’ve been caught. Determine first whether you indeed did something wrong – because ultimately patient safety depends on your performance.
During my first week of internship I was a part of two preventable errors and the feedback I received helped shape my learning for the rest of my career. My team admitted a patient with uncontrolled diabetes in diabetic ketoacidosis and I wrote an incorrect insulin dosing schedule. It was 2008 with paper orders, and they were faithfully executed overnight by nurses. Unsurprisingly, our patient was not better by the morning. My teaching Attending came to me on rounds and said: “I’ve been where you are, I know you’re new… but this cannot happen again.’ That was it: No raised voice, just genuine concern for our patient.
A week later, another patient, and another blunder. Somehow I had ordered a long acting blood pressure medication, and neglected to discontinue the short acting drug. Again, my doctors orders were faithfully executed by the nurse from the paper chart. Again, the patient was in danger, but thankfully after some careful monitoring – ultimately no harm resulted. I’ve been obsessed with medical errors since then, and in implementing strategies to reduce the chances that I become a factor in them.
2/ Learn The Rules Of The Game
Dr A likes labs presented a certain way, Dr Z likes medical students to be at the front and center of case presentations, and Dr Q wants you all to shut the hell up, be invisible and listen to the “real doctors.” All of it is irrelevant in the end, and yet all of it is vitally important for your training. Millions have come before you through this gauntlet. Repeat after me: Learn the rules of the game, and you will survive!
3/ Realize That Most Times Criticism Is Not Personal
Dr C was mercurial. He was a distinguished surgeon I had been assigned to follow for 6 weeks during my third year of medical school. One time he smashed his fist against the table when I forgot to photocopy a handout he had told me to share with my fellow medical students. Another time, he yelled at me in the O.R. after a 5 hour case because I didn’t seem interested in what was going on (and wasn’t retracting properly). On a particularly terrifying occasion he put down all of his instruments, stopped the case, and stared down an Anesthesia Attending Physician and simply said “this is my patient – don’t do a Goddamn thing without me telling you to.” Her only crime? Being worried about tenuous blood pressure readings and wanting to initiate a blood transfusion. After the case was over she simply turned to me and said “he’s an excellent surgeon, and it’s not personal – you will get used to him.”
Your tormentors may have personal problems, some may have personality disorders, and most other factors affecting them outside of the hospital are out of your control. Be resilient and learn to let it all wash over you. Maintain your composure, focus on your duty, and then talk to your supervisor, HR and colleagues to formulate solutions.
4/ Resolve To Be Better In Your Own Interactions
Having now worked as a hospitalist in 10 different hospitals around the US – I’ve made it a goal to not turn into one of the people I hate. Despite this, everyone can momentarily become the tormentor. In one of my first attending jobs doing locum tenens in Upstate New York – I was extremely short with a nurse. I interrupted her abruptly when she openly questioned my treatment plan in front of a family. After this I reminded her who the attending was and then stormed off dramatically. However, I returned to the unit 10 minutes later to apologize for my actions when I remembered how horrible the Nephrologist had made me feel. It’s amazing how easy it is to become exactly that which you despise. We should all strive to make conscious efforts to emulate the physicians we most admired during our training.
Varun Verma M.D. Twitter | LinkedIn
Dr. Verma is a board certified internal medicine physician. He believes that quality healthcare is a human right and has worked around the United States and internationally.