Teaching by Shaming and Bullying Is Dangerous
In addition to treating physicians in my clinical practice, another hat I wear as a specialist in physician health is an educator. I lecture my fellow physicians who teach medical students and resident physicians about the ways in which their methods might backfire and how they inadvertently or unintentionally harm trainees.
To drive home my point, I have repeatedly shared a disguised case from my private practice. It’s a compelling story and one that invariably captures the attention of even the most cynical doctors in the audience. Here it is:
Dr. Gin was a third-year resident in general surgery. He came to see me six weeks after he began to slip into a clinical depression. He described his mood as flat and dull, he had lost about seven pounds of weight, he was having trouble concentrating, he was waking up very early in the morning, and his self-confidence had gone into free fall. He wasn’t struggling with hopelessness or thoughts of suicide. Because he had lived through a similar bout in medical school and had received treatment, he knew what was wrong. I started him on the same antidepressant that had worked for him before and scheduled a return visit with him in a week.
The night before that appointment I got a call from his partner, Dr. Rand, who was also a resident. He was in a panic. Dr. Rand had come home from work, startled to find Dr. Gin standing on the balcony of their 21st-floor apartment. It was dark, the middle of winter, and Dr. Gin seemed to be in a sort of “dazed, altered state.” He grabbed hold of him and coaxed him back inside, locked the sliding door, and made sure he was safe. They talked for a few minutes and that seemed to help. Dr. Gin calmed down, they ate a light dinner, but, still worried, Dr. Rand phoned me. I made a house call.
When I asked Dr. Gin about being out on the balcony, he said: “I was debating whether to jump or not.” He sighed, took a deep breath, and another, and added: “Thank god for Alex, coming home when he did, I’m not sure what might have happened. I’m okay now, that was scary.” I expressed my relief too and asked him what might have led up to this. Here’s what I learned.
“We were making afternoon rounds with my team. I wasn’t at my best, I was tired, I had been up all night in the operating room. My attending physician started grilling me at the bedside of one of my patients. I was trying to explain her test results but I guess I wasn’t doing it right, or fast enough, he kept interrupting me and asking me questions as if this was an exam. I could feel myself getting more and more anxious, getting things wrong, contradicting myself, and then he just blew up:
'Gin, what’s your problem? This is a pathetic performance. How’d you get this far in your training? I won’t embarrass you by asking one of the medical students to answer my questions, questions that any medical student could ace.’ He kept going on and on, seemed like an eternity. No one said a word. I think they were stunned. Do you know what happened? My patient spoke up and said to him ‘Doctor Ames, forgive me for butting in, but aren’t you being a little hard on my doctor?’
He stopped. Nothing more was said. We finished the rounds. He left. Two of the other residents talked to me and that helped. I walked home. But I kept thinking about what happened. As pissed as I was at Dr. Ames, I thought he was right, that I did do a horrible job at presenting my patient to him, that it was inadequate and inferior. I let myself down, I let my patient down, I let my team down. I began to doubt if I had what it takes to be a good doctor, a capable surgeon, the balls to be tough, not show any weakness. Next thing I knew, I was on the balcony.”
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I re-assessed Dr. Gin and concluded that he was safe at home. This came as a relief to him and Dr. Rand. He did not want to be hospitalized. We all agreed that he needed a good night’s sleep. I saw him the next day in my office, and he felt much better, but I put him on medical leave. He needed more time for the antidepressant medication to start working. In two weeks, he was almost back to baseline and he returned to work.
I strongly believe that Dr. Gin could have killed himself. Dr. Rand’s coming home when he did was fortuitous, and quite possibly saved his life. My message to attending physicians is blunt: “Teaching by shaming is unprofessional, never acceptable, and can be dangerous. Even if you were trained this way, and obviously survived it, does not make it right. Your trainees may be battling with depression or other illnesses, and although not 100 percent, they’re still able to work and function effectively. Abusive teaching is enough to push them over the edge.”
At the end of the day, my educational meetings with the doctors in the various branches of medicine at our medical school (and in other sites across North America where I lecture) have been well received, according to evaluations by both faculty and trainees. What’s most gratifying is being the mouthpiece for my patients. Sharing their painful stories not only aids their healing but prevents others from being traumatized.