Not only do some senior doctors abuse students
but here, in the National Health Service in
England, many hospital groups of poor quality
have proved to be unassailable to attempts at
reform over many years. For example, in nearby
Bristol we had one of about a dozen units in the
country that specialized in advanced surgery on
babies and young children with defective hearts,
etc. Understandably, there were deaths even
though it had several "brilliant" surgeons. The
unit prevented the hospital from releasing any
data, however. Gradually, intuitively, some
parents who'd lost their children felt that all
was not quite right and wanted to know more.
Finally, after three or four years of pressure,
data was dribbled out. The proportion of deaths
appeared high but, not being specialists in any
way, the parents had no way of judging these with
similar units in NHS hospitals in the rest of the
country. The problem was that they, too, would
not release their figures! More years of
campaigning followed, and in other parts of the
country, too. Finally, after 20+ years of such
efforts by parents, the Department of Health
suddenly announced last year that four of a dozen
of such specialist children's units had closed
down -- pronto -- no delays. Because I have never
taken a close interest in these sorts of medical
matters I am not sure whether comparative data
have been published but I think we can take it
that the four sub-standard units must have been
extraordinarily deficient in their operational skills, etc.
Whether a country's medical system is mainly
nationalized or freemarket doesn't seem to matter
as regards quality of service. Bad practice can
arise in both. Far more important than the
"ownership" of such systems is how transparent their data are.
Keith
At 18:39 12/08/2012, Arthur wrote:
Subject: The Bullying Culture of Medical School
The Bullying Culture of Medical School
* by PAULINE W. CHEN, M.D.
* Aug. 9, 2012 NY Times
*
Powerfully built and with the face of a boxer,
he cast a bone-chilling shadow wherever he went in the hospital.
At least that is what my medical school
classmates and I thought whenever we passed by a
certain resident, or doctor-in-training, just a few years older than we were.
Dr. Pauline Chen on medical care.
With the wisdom of hindsight, I now see that the
young man was a brilliant and promising young
doctor who took his patients conditions to
heart but who also possessed a temper so
explosive that medical students dreaded working
with him. He had called various classmates
stupid and useless and could erupt with
little warning in the middle of hospital halls.
Like frightened little mice, we endured the
treatment as an inevitable part of medical
training, fearful that doing otherwise could
result in a career-destroying evaluation or grade.
But one day, one of our classmates, having
already been on the receiving end of several of
this doctors tirades, shouted back. She
questioned one of his conclusions in front of
the rest of the medical team, insisted on
getting an explanation, then screamed back when he started yelling at her.
The entire episode unnerved us all; and over the
next few weeks, we marveled at her courage and
fretted over her potentially ruined career
prospects. But there was one aspect of the event
that disturbed us even more. One classmate who
had witnessed the screaming match described
how our fellow medical student had raised her
voice and positioned her body as she threatened
the doctor. It was weird, he recounted. It
was like watching her turn into him.
For 30 years, medical educators have known that
becoming a doctor requires more than an endless
array of standardized exams, long hours on the
wards and years spent in training. For many
medical students, verbal and physical harassment
and intimidation are part of the exhausting process, too.
It
<http://jama.jamanetwork.com/article.aspx?articleid=380396>was
a pediatrician, a pioneer in
<http://www.pahx.org/silver-henry->work with
abused children, who first noted the problem.
And
<http://www.nytimes.com/1990/01/26/us/wide-abuse-of-medical-students-found.html>early
studies found that abuse of medical students was
most
<http://jama.jamanetwork.com/article.aspx?articleid=380396>pronounced
in the third year of medical school, when
students began working one on one or in small
teams with senior physicians and residents in
the hospital. The
<http://jama.jamanetwork.com/article.aspx?articleid=380398>first
surveys found that as many as 85 percent of
students felt they had been abused during their
third year. They described mistreatment that
ranged from being yelled at and told they were
worthless or the stupidest medical student,
to being threatened with bad grades or a ruined
career and even getting hit, pushed or made the
target of a thrown medical tool.
Nonetheless, many of these researchers believed
that such mistreatment could be eliminated, or
at least significantly mitigated, if each
medical school acknowledged the behavior, then
created institutional anti-harassment policies,
grievance committees and educational, training
and counseling programs to break the abuse cycle.
One medical school became a leader in adopting
such changes.
<http://journals.lww.com/academicmedicine/Abstract/publishahead/Eradicating_Medical_Student_Mistreatment___A.99583.aspx>Starting
in 1995, educators at the David Geffen School of
Medicine at the University of California, Los
Angeles, began instituting a series of
schoolwide reforms. They adopted policies to
reduce abuse and promote prevention; established
a Gender and Power Abuse Committee, mandated
lectures, workshops and training sessions for
students, residents and faculty members; and
created an office to accept confidential
reports, investigate and then address allegations of mistreatment.
To gauge the effectiveness of these initiatives,
the school also began asking all students at the
end of their third year to complete a
five-question survey on whether they felt they
had been mistreated over the course of the year.
The
<http://journals.lww.com/academicmedicine/Abstract/publishahead/Eradicating_Medical_Student_Mistreatment___A.99583.aspx>school
has just published the sobering results of the
surveys over the last 13 years. While there
appears to have been a slight drop in the
numbers of students who report experiencing
mistreatment, more than half of all medical
students still said that they had been
intimidated or physically or verbally harassed.
Students described being yelled at, pushed and
threatened. One student recounted being slapped
on the hand by a more senior doctor who said,
If teaching doesnt help you learn, then pain
will. Some students wrote about racial insults,
with senior staff members making noises to mimic
a foreign language; others reported being
grabbed, asked out on a date or passed over because of their sex.
We were really crushed when we saw the
results, said Joyce M. Fried, lead author of
the paper and assistant dean and chairwoman of
the Gender and Power Abuse Committee at the
medical school. We were disappointed that it was so difficult to change.
U.C.L.A.s experience is not isolated. In fact,
<http://www.ama-assn.org/resources/doc/medical-schools/sms-a11-mistreatment.pdf>national
medical education surveys that include questions
about mistreatment indicate that the environment
at that school is about average. And the
striking similarity of experiences across a
generation of students suggests problems not
just with one institution, but with the culture
of medical training itself. This is a national
problem, Ms. Fried said. Our faculty and
doctors-in-training come from all over,
including schools where some of them might have been mistreated.
While their findings are disheartening, Ms.
Fried and her colleagues continue to believe
that medical student mistreatment can be
significantly reduced but only if all medical
schools come together to work on the issue.
Were talking about the really hard task of
changing a culture, and that has to be done on a
national level, Ms. Fried said. Such an effort
would include shared training programs, common
policies regarding mistreatment and greater
transparency about the mistreatment that currently exists in medical schools.
There are a lot of really good people and role
models out there, Ms. Fried said. But the
culture for all these years has been to just
take the mistreatment and not say anything.
It wasnt right back then, and it shouldnt be tolerated anymore, she added.
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Keith Hudson, Saltford, England http://allisstatus.wordpress.com
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