COMMENTARY

Ending Resident Suicides Starts With More Humane Training

William S. Gould, MD

Disclosures

December 10, 2018

In This Article

Does Stress Really Build Character?

I started resenting patients, just as the majority of residents eventually did. A percentage of the instructors were fantastic; from many, though, there was essentially little teaching. The latter were too tired or too supercilious, usually both, to take the time to think back to why they chose medicine. We were basically cheap, unquestioning labor for which the hospital and doctors charged insurance companies full freight, and worse, psychological fodder for those who humiliate to satisfy their own emotional shortcomings.

When I tried to talk about it with the upper-class residents, young people 10 years my junior, they cautioned that if I couldn't handle the trial by fire, I ought to seek other work. The years as trainees had already worked their magic.

I finally told my program director that residency had stolen more from my heart than when I was a twice-wounded, captured, armored cavalry captain in Vietnam. He was outraged.

I finally told my program director that residency had stolen more from my heart than when I was a twice-wounded, captured, armored cavalry captain in Vietnam. He was outraged. I explained that all of the co-residents in my year, great young people, allowed that they had contemplated suicide at one time or another during the training. He waved his hand and told me that stress builds character.

But that training was 40-some years ago. Things have changed in medicine. These days, nurses have more power, and ill-tempered physicians no longer get away with bellows of profanity in the operating room or hurling instruments in fits of pique. Violators wind up in the medical director's office for counseling, and then on extended vacations without pay for repeat offenders.

Residents Get No Relief From Disrespect

Medical students and residents, though, enjoy no such clout. They still go to work, 80-plus hours a week, year upon year, knowing that sometimes they must face belittlement and humiliation no matter how hard they work to be the best they can.

How can that be? Even our military has worked to abandon such behavior. If an officer demeans troops publicly or acts with conceit toward subordinates, his or her career will be flushed away in the barracks latrine before the bugler sounds "Taps."

Not long ago, a man in his 30s, a West Point graduate, shadowed me for a week. He had just left the Army after serving two combat tours in the Middle East. He wanted so badly to become a doctor. I asked him over and over whether that craving was worth not just 10 additional years in school and the $250,000 debt, but more daunting, the decade of potential disrespect and derision he might stomach at the hands of a corps of professorial physicians, most of whom had no combat experience.

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