Trainees Are People, Too
Medical education is a double-edged sword. On one hand, it's an incredible expanse of knowledge that grows with each passing year, and it takes pluripotent medical students and helps shape them into the residents and then licensed doctors they will some day be. On the other hand, it is extremely difficult, often taking a toll on students' and residents mental health, as well as their social lives and relationships (family, friends, love, you name it). September 17th was National Physician Suicide Awareness Day - that's how serious it gets.
When I was growing up, my father subscribed to the same platitude that so many healthcare professionals did - that medicine was "a calling." He never pushed me into medicine, but he was honest about the commitment (though I still did not fully understand until I actually got there). I love my job now, but medical training was the hardest thing I have done in my life thus far. Medical school is essentially a full-time job that we pay for and residency is woefully underpaid (barely minimum wage).
At that time, however, I was under the impression that clinical medicine - taking care of patients' medical problems - was the only aspect of the job, and that politics and social issues were not part of it (hell, even social media was taboo for physicians). Partway through medical school I was disabused of that notion by a classmate.
Earlier this week I was invited to speak to a group of medical students about misinformation in social media. They had insightful questions and it was an enjoyable experience. Among other questions, one was about how they, as students, can be activists and make their voices heard as trainees; another was simply about the transition from being a student to a resident, and a resident to an attending, and how things changed at that time. So this post is going to talk first about someone that gave bad advice about what residency should be, and then an example of how medical students made their voices heard.
Recently a couple of events occurred that tested the idea that while medicine may be a calling (emphasis on "may"), medical school is just that - school - and residency is a job. Neither of these things, nor medicine in general, should define one's entire life. The best doctors and other healthcare professionals are well-rounded people with interests outside of their job. Further, the last two years have taught us that no matter how much you devote to this job, the job itself will only go so far in rewarding you (and those around you may call you heroes, but that only lasts so long and it can take a dark turn into exploitation or abuse), and that the system must change.
Okay, let me get to the actual reasons I started writing this.
Recently a Twitter user named Rx_Ed (who…may have been passing as a physician? But is actually a PharmD, and a PhD candidate. Those are both impressive degrees, but his Twitter presence gives false the impression that he is medical residency/admissions leadership as he sells a study product) created a thread of "the top 10 mistakes most of you make that result in a residency experience that is even harder!"
Residency is hard enough without blaming those going through it. I've attached screenshots, but essentially he tries to state "residency is a calling!" (again - that distinction between residency and medicine is important).
He encourages trainees to let residency define/shape them, to take it personally because they are personally responsible for each patient (a personal touch is important, but taking it too personally is the culture that has led to so much trauma, burnout, and suicide). That tweet also dismisses the entire medical team, every member of which is important.
He upholds that everything learned in medical school, even the most basic of memorized science facts, is still essential in residency (you know…the stuff he teaches in the course he sells). This also does a nice job of playing into the stereotype that doctors “just memorize a bunch of stuff.” Yes, there is a great deal of basic science involved, but not all of it will be directly relative to patient care (even for the patient or subspecialist).
He then tries to hype up research as a resident, failing to acknowledge that not everyone needs to or should do research and the limited time in residency doesn’t always lend itself to quality research.
Did I need to go Tweet by Tweet on this? No. But the thread is full of contraindications and rose-tinted views of a training that often stretches people to their breaking point, written by a guy who didn’t go through that training but is selling study aids for it.
We need to change the culture of medicine and part of that is changing medical education.
On July 24th of this year, the University of Michigan’s incoming medical students walked out of the keynote speaker’s address. Dr. Kristen Collier spoke at this year’s White Coat Ceremony, but prior to that, students had petitioned that a different speaker be chosen because Dr. Collier is anti-reproductive choice. Now, she wasn’t planning to discuss abortion at the keynote, and others have reported that her message that day was inspiring. However, per the petition (started by incoming students and signed by both incoming and current), “While we support the rights of freedom of speech and religion, an anti-choice speaker as a representative of the University of Michigan undermines the University's position on abortion and supports the non-universal, theology-rooted platform to restrict abortion access, an essential part of medical care.”
Dr. Collier claims to be anti-abortion from a feminist view, but that assertion loses its legs as we look at the way anti-choice laws oppress anyone with a uterus or who was assigned female at birth.
Students were criticized for the walkout. Vinay Prasad is an oncologist who has found infamy minimizing the pandemic, demanding unrealistic levels of evidence for any stance that doesn't earn him more clout, and then blocking anyone (including me, a relative nobody) who disagrees with him or counters his points with real life (or even evidence). Which makes it all the more ironic when he responded to the walkout with a Tweet stating, "The culture of rejecting everyone w whom [sic] we disagree is poisonous and will tear apart this profession & nation". If you're wondering, he also is one of the docs that complains about being censored...on his Twitter account (>200,000 followers), his podcast with ZDoggMD (also problematic these days), his substack (with thousands of subscribers), and multiple appearances on other folks' shows.
It is not "poisonous" to reject disinformation and those who spread it at the cost of patient lives. Medical students used their voices (quietly at first, and then more demonstratively) to speak out against someone who, despite her attempts at justification, is advocating for stripping rights away from their future patients. We report disinformation in Tweets and we write letters of protest against certain podcasters, and we speak out on issues like abortion and gun violence despite being told mockingly to "stay in our lane." These issues ARE our lane, because we take care of the victims of anti-science laws that make it easier for people to die from restricted access to one and unfettered, unregulated access to the other.
The practice of medicine is a heavily flawed (in many aspects, broken) system. Part of the reason it got that way is because of what we know now are incorrect attitudes and forcing ideology on patients. It is up to those of us in it now to change it, and it will soon fall to those entering the field in just a few years. I'll be damned if I don't encourage them to do that, and to stand up to those who try to preserve those harmful attitudes and ways.