Paul L. Caron

Thursday, February 27, 2020

Medical School Mistreatment Of Students Is Tied To Race, Gender, And Sexual Orientation

Journal of the American Medical Association, Assessment of the Prevalence of Medical Student Mistreatment by Sex, Race/Ethnicity, and Sexual Orientation:

Question  Does the self-reported prevalence of medical student mistreatment vary based on student sex, race/ethnicity, and sexual orientation?

Findings  In this cohort study of 27,504 graduating medical students, the following students reported a higher prevalence of mistreatment than male, white, and heterosexual students: female students; Asian, underrepresented minority, and multiracial students; and lesbian, gay, or bisexual students.

Meaning  These findings suggest that there is a differential burden of mistreatment that must be addressed to improve the medical school learning environment.

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So what else is new?

Posted by: Mike Livingston | Feb 28, 2020 4:31:05 AM

Did these researchers have the sense to realize that those self-reported differences in alleged mistreatment might be based on either the attitudes of the students themselves or in differences in the behavior of those students? I suspect not. And quite frankly, if they so cavalierly rule out those other options based on mere self-reported numbers, I wouldn't want them caring for me. They'd diagnosis me with Disease A when I might have Disease B or C.

The study also has other problems, including generating its numbers based on as little as a single incident in four years of medical school, and the fact that most students in the various identity groups (typically around three quarters) reported no such incident. The first seems to be an effort to deliberately bias the result by setting the bar very load. The second makes a lie of any claims that there was systematic mistreatment. If that were true, there'd be multiple incidents involving most of the students in those identity groups, not a single digit number of incidents among a minority of them. There's certainly little evidence to support the article's claim that these particular students "bear a disproportionate burden of the mistreatment reported in medical schools."

How would I sum that up? That this article is typical of much contemporary research. Data was collected with a particular end in mind, creating a bias so great that its conclusion is not only worthless, but wrong. What the numbers actually indicate is that students of all sorts in medical school are treated remarkable well, and that even the attitude of victimhood that is constantly being shoved on certain identity groups isn't enough to cause most members of those groups to regard themselves as being mistreated.
There's another factor, one that's even more worrisome because it indicates a failure in medical school clinical training. Sick people and their families are under enormous stress and can often be difficult. I recognized that when I began working nights on a pediatric Hem-Onc unit caring for children from birth to nine with leukemia. I had a carefully defined role I planned to adopt should that be the case, one that boiled down to my listening and not taking offense no matter what was said. To my surprise, during the thousands of hours I spent on the unit, I never had to take up that role. Why was that so?

Because I made sure that the care I gave was never about me. I constantly reminded myself that these kids might die, and at that time one-third of them did. In comparison to that nothing that happened to me mattered. All my attention was on them not me. Here are examples.

I hated that our induction chemotherapy typically meant a kid would be vomiting his guts out about 1 a.m. when our specialists were home in bed, but I never let that 'mistreatment' by them shape my attitude. When the vomiting began, I stuck with those kids, holding the bucket so the parents didn't have to. I never had a parent say, "No, I'd rather do that." They were happy not to be associated in their child's mind with all that suffering. That's how my relationship with those families began.

My 'mistreatment' as the unit's sole night nurse tech extended to dying children. When our treatment failed, the doctors backed away. There was nothing more for them to do. When nurse-only treatments like morphine weren't required, the nurses also pulled back. Caring for a dying child isn't easy, so that was understandable, particularly given all the other kids needing care. That left me as their sole caregiver. I could have easily regarded that as 'mistreatment.' Instead, I saw it as an opportunity to give them the best possible care. It wasn't about me. It was about that child.

That attitude was one that the children and their parents picked up on. It meant they didn't blame me when the situation turned bad. They knew I wasn't to blame.
Contrast that to some of the medical students of today, particularly when they're told that they should be treated well because, as that article claims, medical schools should "promote diversity, equity, and inclusion in medical education." Sorry, I thought when I read that I thought of saying instead: "Those sorts of feelings on your part don't matter a twit in comparison to the suffering and sorrows your patients will be going through. And if your patients pick up on your entitled, self-obsessed, narcissistic attitude, they may give you hard time that you deserve. They don't like that 'it's all about me' attitude you display." In short, medicine has no place for these easily offended little snowflakes.

A news story a few years back illustrates that problem. It seems that a recent woman medical graduate was on a flight in which one passenger got into trouble and a flight attendant asked if there was a physician on board. When that recent graduate came forward, the flight attendant was skeptical about her credentials, leading the recent graduate to go ballistic and generate those news stories. When I first heard about that, two thoughts passed through my mind.

1. The flight attendant was right to be skeptical. Physicians are typically not eager become involved in such situations. They lack the support they'd have in their hospital or clinic and may not even be specialized in what the passenger has. The flight attendant, shrewd in her observations about people, was right to suspect this too-eager recent graduate wasn't really a doctor. She wasn't acting like one.

2. The recent graduate's thin-skinned attitude indicated a lack of professionalism. True professionals don't demand respect, they earn it by their behavior. To give an example, later I shifted to working days on the adolescent unit. Occasionally, when I was going to lunch I'd come on a mother upset that her child's IV pump was beeping. Even though I was an unknown, these mothers greatly appreciated my help. Why? Because I'd dealt with hundreds of similar situations on Hem-Onc. My hands and eyes could fly through that IV's fluid path, diagnosing and fixing the problem, while at the same time reassuring her that all was well. I obviously knew what I was doing.

In short, I knew how to project confidence. I'd spent 16 months caring for desperately ill children and convincing their parents that they could sleep soundly, that I'd take good care of their child. That carried over into other areas of my work This recent graduate had none of that. What she had was a diploma, an attitude of entitlement, and a most unprofessional thin-skin that didn't earn nor deserve respect.

--Michael W. Perry, author of My Nights with Leukemia

Posted by: Michael W. Perry | Feb 28, 2020 11:18:18 AM

diagnosing and fixing the problem, while at the same time reassuring good

Posted by: sohbet | Mar 1, 2020 10:11:09 AM