Doctor, Crying Will Not Be Tolerated on the Premises

Neil Chesanow

Disclosures

April 27, 2015

Physician Bullying: "Not Allowed to Cry"

"If you decide to commit suicide, do it right so you do not become just a burden to society."

This was the advice of a professor of anatomy who "stood before an auditorium filled with 125 eager, nervous, idealistic would-be healers," as family physician Pamela L. Wible, MD, recounts in a recent Medscape article on physician bullying. "He then described in anatomical detail how to commit suicide."

"It's midnight, and I'm speaking to a psychiatry intern," Dr Wible writes in another anecdote. "Bullied by residents and her attending, she cries, 'I've lost my self-confidence. I'm depressed. On psych meds now. But I don't feel better."

"The truth is, doctors are suffering," Dr Wible asserts. "Surrounded by sickness and death, we watch families wail, shriek, and cry while we stand silently—sacred witness to their sorrow—until we're called to the next room for a heart attack, a gunshot wound, a stillborn. Week by week. Year by year. And when do we grieve? Never."

Dr Wible recalls a physician upbraided by a superior for unprofessional conduct. "Why? She was seen crying. Her boss told her, 'Unless you are dying, crying is unprofessional behavior and not to be tolerated.'"

Such treatment results in a high incidence of suicidal ideation and suicidality in physicians, Dr Wible observes. It's a subject she explored in another Medscape article, "Physician Suicide 101: Secrets, Lies, and Solutions."

Her meditation on physician bullying ripped the scab off a wound borne by a great many doctors, inspiring hundreds of physicians, male as well as female, to pour out their emotions—often pent-up for entire careers—on the subject.

"As a psychiatrist who has treated many residents, I am quite concerned about the nature of medical training," a doctor wrote. "I regularly see the effects of the bullying, and I myself was bullied during my year as an internal medicine intern."

Yet many doctors who feel victimized are afraid to seek psychiatric help.

"One HUGE step toward remedying this situation would involve the destigmatization of physicians who seek mental health care," a family physician observed. "Physicians who do so have to use fake names and drive long distances to avoid being 'outed'—which would result in medical board scrutiny and possible license restrictions. They are forced to deny that they are in treatment on credentialing and license-renewal questionnaires. This sort of discrimination needs to stop before things will improve."

"I remember being shouted at in med school and residency," an anesthesiologist recalled. "One day the head of anesthesiology was so abusive I ended up in a stall of the ladies room, holding the walls and hyperventilating. Nothing I did was right!"

A commonly cited cause of bullying is expressed by the Japanese proverb, "The nail that sticks out gets hammered down."

"I am a female physician who has been bullied since residency," an internist commented. "The bullying continues. I am nonconforming, and I therefore am made to suffer." Unlike many commenters, however, she found a way to deal with it. "My new attitude is: They do not exist. Ignore them and their jealous pettiness. They are pathetic pompous asses."

"Unfortunately, physician bullying is very common and in fact supported by the establishment—ie, residency programs," an internist contended. "There is almost no accountability for attending physicians who are guilty of this, and the punishment tends to fall on those with less power: the trainees. In medicine and science, power is given to those in seniority, and this is openly acknowledged. If you don't follow the herd, you will be an outcast, and just like on the schoolyard playground, you will be targeted for abuse."

But not all bullying comes from the top down. It can also come from the bottom up.

"I have been bullied at work for the past few years," a pathologist revealed. "My bullies are people who rank below me, and so the bullying did/does not exist. I cried in front of my physician supervisor for being wrongly accused of creating a 'hostile work environment' after I reported a serious behavior incident involving a staff member, who retaliated. I was then brought before the chief medical officer and chief of staff. They told me that I had to 'get help for stress.'"

The consequences of bullying can be severe.

"I tried and failed to commit suicide last May," an emergency physician confessed. "I felt like I was disposable—just an expensive set of initials trying to meet a hospital corporation's impossible demands. Depression took a toll on my family: It cost me my first husband, and my second one decided to leave 9 months into that marriage. Doctors have not been allowed to be human, to meet basic bodily needs of rest, nutrition, or socialization. We give and give, until eventually we give up."

The sight of a physician crying seems to bring out the bully in many doctors.

"As a surgical resident in the neonatal intensive care unit, we saw a baby die whom we had tried so hard to save, and I shed a tear," a surgeon recalled. "I was told it was unprofessional to cry." Now she asks, "Would you really want a physician who lacks emotion when a human being dies?"

"As for crying being 'unprofessional,' I completely disagree," a psychiatrist insisted. "I have cried at times with patients, and when we have talked about it, in every case the patient has said that they felt 'understood' and comforted to feel the human connection. Obviously, I do not cry often with patients," she hastened to add, "but I think it is not unprofessional."

Out of hundreds of commenters, only one was unsympathetic.

"I'm really sick of the 'bullying' narrative," a family physician wrote. "In some cases, it's warranted," he allowed, "but most of these comments seem to come from poor residents and students looking for validation. Like it or not, some degree of toughness is required to practice medicine."

This sparked a pointed reply from a neurologist. However, it's not fit for publication.

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