Breaking a sweat - part 2

1 December 2021

As you could expect from the blog being ‘part 2’, there is also another side of the concept ‘breaking a sweat’. It was obviously my luck to be trained as a surgeon in safe surroundings (see previous blog). But there is another, darker side to the issue. And I notice emotions are running high on this subject. Very recently I defended someone online who, in my opinion, expressed a very nuanced view on the balance between the trainer’s and the trainee’s responsibilities, in that one may expect some degree of robustness and resilience in a doctor-to-be. Immediately someone lashed out, calling me old-fashioned and ignorant of the still existing problems in medical training. I did not say that at all, but the fact it evoked such a response demonstrates there are ‘some issues’ there, which I can confirm. In my idea, these issues lie in the delicate power balance between trainer and trainee. That is even more outspoken due to the fact the trainer is also the judge. Effective learning requires safe surroundings and a high level of trust, that is not necessarily safeguarded.

There is a thin line between training and intimidating, as I already mentioned in part 1. Not everybody’s intention is to support you to grow into a stronger position. Some prefer to keep you small, as not to outgrow them. Which may involve scary, intimidating behavior. It turns out to be rather difficult to discuss this kind of behavior in the professional arena and it interests me why that is so. My impression is that power is the key. A doctor inherently possesses a powerful position and not everyone is capable to deal with that properly. That power is in place partially due to the knowledge gap; only few direct colleagues can adequately judge decisions and behaviors such as towards junior doctors. Addressing one another on these issues is not always that easy. So how to prevent a culture that allows for deviant behavior? And I am not just addressing clear-cut abuse of powers, also and perhaps mainly where powers are easily slightly abused, as can also be observed in initiation rituals that result in hazing. Where exactly lies this ‘thin line’ between challenge and intimidation? What could be considered part of thorough training, and what crosses the red line? And does that border-crossing behavior increase when one has resided in a powerful position for a longer time? On the other side, to be the devil’s advocate, one may expect some degree of stability and robustness from a doctor in training. The outside world is neither very kind, meaning you do need to learn to survive. A good listener can understand what I am about to say; this implies that the attending specialist needs to possess integrity. That this supervisor is aware of the thin lines and knows how to balance his or her powers right(eously).

To develop integer behavior requires self-insight. To finetune your own behavior, you need to be able to wonder and look honestly towards your own motives and ways of expression. Even when it is confronting. My experience is that not everyone is capable or willing to do so. There I suspect lies the core of the problem; the unwillingness to actively take responsibility for the effects of your own behavior. Whatever the reason, such as being too self-obsessed or solely being interested in your own gains. I unfortunately encountered his type of narcissistic behavior on the workplace. The effects I saw (and felt) were devastating. The confusion, the elusive fear, the downgrading of your self-esteem due to sophisticated manipulation such as gaslighting and isolation. The classical tactic to divide and conquer. The best defense lies in recognition, which is not always so easy. This manipulative behavior may be covered under a charming personality that easily exploits your vulnerabilities. Just one tip for free: when something seems too good to be true, it isn’t true. What I find frightening, is that only so little of these people are needed to impose a lot of damage. Not just to the unlucky individuals that are put under their wings, but also to the working place culture. Proper communication comes to a halt and with that the ability to function, to learn and to connect. Which immediately negatively affects patient safety. When you do no longer trust your colleagues, who do you ask for help? If you start doubting yourself, do you dare to take the necessary though decisions? Can you do your work properly? If you need to be constantly alert for your own position, would you share information on (near) mistakes? No, exactly. That is why it is more than just a personal problem; it is worth the attention of the professional medical community.