I blogged last year about the challenges facing the newly qualified doctor on Black Wednesday, their first ever day at work and today sees a new batch take their first leap into a lifetime of being a doctor. One of the joys of getting older is that I have a marvelous sense of perspective that was lacking when I was in my twenties. I am struck by the contrast between school students hoping to become medical students and medical students. One group is eager, enthusiastic, even desperate to get into med school and those that are there seem lethargic, pissed off and desperate for the day to finish. They certainly seem to lose that lethargy on day 1 as a doctor and the ones I have today are keen to impress, work hard and not fuck anything up.
They are scared of getting it wrong, as of course they should be. They are scared of the consequences of getting it wrong too, including being told that they have cocked up. There is an art to this, I tend to tell them something they have done well and then talk about what they have done wrong, which seems to work, this technique is known informally as a shit sandwich. Other colleagues are more forceful. It is very difficult to know where correcting and pointing out errors tips into bullying. Bullying has no legal definition in the UK, but is of course the use of force, threat, or coercion to abuse and intimidate or aggressively impose domination over others. The behavior is often repeated and habitual. One essential prerequisite is the perception, by the bully or by others, of an imbalance of social or physical power, which in medicine and our hierarchy, is inbuilt.
One of my bosses used to rap me across the knuckles if I did the same thing he didn’t like for a third time. He had a three strikes rule. It was light hearted, it was fun, it was done so he didn’t have to say for a fourth time “don’t grab the suture material with your forceps” and it made me stop doing it. I like him, he likes me, we have a great working relationship and he is not, in my mind, a bully.
The problem is that bullying is in the eye of the beholder, one persons friendly knuckle rap is another’s physical assault. How we teach and encourage trainees in a setting that is not designed for this (there is no time to go slowly, to allow mistakes, to debrief) and avoid allegations of being a bully is very difficult. Apparently it is a huge problem in surgery and perhaps we need to separate service from training and have those that are good at teaching and training doing so and those that can’t keep their temper delivering only the service.
I am heading back to the ward now, where I am always nice and never get angry with anyone.