Breaking the Cycle of Abuse in Medicine

Research on the psychological abuse suffered by nurses, medical, students, and residents suggests that physicians are especially prone to be nasty to their less-powerful co-workers.  I talk about some of this research, and what Dan Denison and I saw years ago when we did an ethnography at a hospital in Michigan, in my post on Dr. Gooser and Asshole Poisoning in Hospitals. 

The great power that doctors have other others are one the forces that turns them into jerks, because as a long series of studies shows, it isn't just a myth that power turns people into insensitive jerks.  This is especially true among surgeons, who are often the alpha dogs in hospitals.
A related reasons that so many doctors turn into jerks is that like members of all professions, they imitate their mentors -- and if your mentors are assholes, you are in great danger of becoming just like them.   

BUT it doesn't need to be that way. Look at this note that I got from a former surgical resident -- and now  renowned surgeon -- about how he and his peers fought the temptation to fall prey to asshole poisoning, and how it has had positive effects 20 years later.  This report suggests that it is possible to apply and enforce The No Asshole Rule, even against powerful structural forces and social pressures to act just like your demeaning superiors.

This is the exact email that he sent me.  I use it with his permission, with only his name is removed as he requested:

Thanks and an Anecdote

I just finished your book The No Asshole Rule in about 4 hours. Thanks for writing it. Every page resonated with my work experiences. I am a surgeon and have worked in academic medicine my entire career. I trained at an "elite" training program at an Ivy League teaching hospital. As you can imagine, my specialty has been a haven for assholes and, even worse, sociopaths. My training program was better than most; but, we still had our share of assholes. During my training, I witnessed episodes of unbelievable mental cruelty on a daily basis. As residents, we met every Friday for a few beers at a local bar after another arduous work week. We kept a leather-bound journal book. The highlight of the happy hour was nominating and electing the "Attending Asshole of the Week" or "AAOTW.”  Each aggrieved individual would recount their episode with an attending that would merit their nomination as the “Asshole of the Week.” The group voted and the “winner’s” name was entered into the journal book. A brief synopsis of the "asshole incident" was also placed in the journal. We had one attending who was such an asshole, he automatically won if there was a tie. It didn't matter if he was in the running that week or not. The journal was passed on every year to the new Chief Residents. It was a closely held secret among the residents. I understand they still have a journal.

This was 20 years ago. It is possible to look at these sessions as "bitch" sessions with no meaningful result. However, every one of my resident colleagues learned from those sessions. We learned how destructive "asshole" behavior was in our specialty. We vowed not to imitate the pathologic behavior we encountered daily. 20 years later, we are now the program chairs and department chairmen. We are spread across the country. I am proud to say that everybody who was a part of that Friday group runs their training programs with an unwritten "no asshole" rule.

Comments

[Elvira Black]

Hello Bob:

I'm a writer for Blogcritics Magazine. I just happened upon a link to your book and website and I'm quite intrigued indeed.

.I'd be very interested in reviewing your book and your website. However, I can't access your e-mail address with my software.

Speaking of assholes in medicine: the whole Walter Reed scandal has uncovered a long-standing but mostly well-kept secret amongst patients and their families who have received substandard care and followup at military and VA hospitals nationwide. My boyfriend has been using the VA hospital system (despite my protests) for decades, and he has, quite literally, nearly been killed several times due to their indifference and incompetence. I am looking forward to seeing some heads roll on a national and local level, and am also heartened by the newfound opportunity now afforded vets and their families to finally have their voices heard in the media and at congressional hearings on this matter..

As a matter of fact, I am preparing to begin a series at Blogcritics entitled "VA Horror Stories," based on my personal encounters with the Manhattan and Bronx VA hospitals where my boyfriend receives his medical care. I already have so much material that I could likely write a book of my own!

Another series I started at Blogcritics called Adventures in Real estate highlights asshole mortgage and real estate brokers and lawyers I've had the misfortune to encounter in the course of helping my friend find a coop. Some real estate companies are nothing much more than "asshole factories" which mainly function as a haven for greedy and inept employees who wreak havoc on potential buyers, sellers, and the companies they work for.

In any event, I commend your work--I'm certain your book and website will help to address a long-standing problem that many have "suffered through in silence" up til now. My background is in academia (as a writer/administrator) and I've had my share of close encounters of the asshole kind over the years as well. And, in retrospect, as you say, the fact that I felt abused and used led me to be at least an occasional asshole myself. One might indeed call it the "trickle down" asshole theory (though the imagery this conjures up is rather unfortunate). I think almost everyone who has worked for a living has at least a few stories in them.

In any case, if you could drop me a line to discuss a book/website review and/or interview for Blogcritics Magazine, that would be great. Many thanks.

Best,
Elvira Black
bowlegarivle@yahoo.com

Elvira Black
Writer, Blogcritics Magazine
http://blogcritics.org
http://elvirablack.blogspot.com
http://elviradark.blogspot.com