The Medically Misguided Approach to Mistreatment

By

In 2013, I entered medical school, fresh out of the incubator of all-girls school education and liberal arts college. Given the bubble I grew up in—“empower a girl to serve and shape our world” was emblazoned on posters in every single one of my high school classrooms—it is safe to say that I had some unrealistic notions about the world. My college years coincided with the first Obama presidential term, which made race seem like a minor obstacle in the game of life. And surrounded by female deans and faculty at Brown, gender was but a social construct to be overcome. Determined to achieve on the basis of merit alone, I did not identify with being a woman of color, regardless of my South Asian heritage and femininity. Did it really matter what I looked like in a golden era of women and minorities reaching the upper echelons of their chosen professions? But as I would soon learn, this gilded age existed primarily in my head.

Part of medical school orientation involved attending an interactive lecture on the hospital’s mistreatment policy. Nervous about whether my classmates would like my polka-dot dress-clad self, I barely remember the hypothetical scenarios we were led through. I do, however, recall that the phrase “on the rag” caused several giggles because most of us did not know what it meant, which is perhaps testament to the generation gap between students and administrators who created the presentation. We were of the Playtex Sport years, playing beach volleyball on our periods like a television commercial, unaware of the shame and cloth-washing that preceded us.

In 2017, we repeat the lecture on mistreatment right before graduation. Having lived through our third year of medical school when students are unleashed on the unforgiving residents, doctors, and nurses of the hospital, most of us have endured some form of denigrating comment that would fall under the school’s definition of mistreatment. One classmate tells the story of how she was asked to close an incision during an operation, something considered a great honor given that the medical student’s role during the surgical rotation is not to touch anything. My classmate relays that she was minimally supervised by a resident, but when the attending surgeon returned to the operating room, displeased her sutures could leave a deep scar, he said she “ruined the patient’s life forever.” My classmate did not report the incident, internalizing that the result of her inexperience was somehow her fault.

We return to the “on the rag” scenario as final-year medical students. The hypothetical resident is taking too long to complete an operation and the attending surgeon asks her if she’s menstruating, or on the rag, as though that would affect her surgical technique. We are asked if this constitutes mistreatment. Yes, my group votes unanimously. What was offensive about the scenario? The usage of “on the rag,” my group seemed to decide. The implication that women are somehow lesser surgeons for an inherently female trait is lost to the group.

 

It is fall of 2014 and the West African Ebola virus epidemic is underway. My humanities and medicine class holds a discussion on the ethics of Ebola or rather, how to incentivize physicians to volunteer to treat a contagious, deadly disease. Ebola is very bad, we all agree. The treatment is supportive management, which is the medical way of saying there is no treatment, there is only giving IV fluids and pain relief and praying for the best. Any physician, in theory, should have enough training to administer supportive management.

“Maybe infectious disease specialists should be mandated to go,” one of my classmates loudly proclaims. This classmate of mine likes to argue. When we took a quiz to identify our conflict resolution styles, he scored highly in “confrontational,” while I scored highly in “avoidant.”

“What if the infectious disease specialist is a young parent?” another classmate counters. “Infectious disease doctors are the most qualified,” he continues in an even louder voice. There are no further rebuttals, but I cannot help but think that infectious disease specialists in the United States must be far more familiar with the common cold than with Ebola.

 

Back to the mistreatment lecture in 2017. We are shown a video clip of an Asian medical student, struggling to obtain intravenous access in a patient. A nurse is watching him and tells him to stop as he fails in his next attempt for access.

“Stop!” she repeats, slapping his arms away. “Do you even understand English?”

We are asked if this constitutes mistreatment. Yes, my group says, appalled by the apparent racism.

The next case describes a female student who wishes to ask her plastic surgery attending for a letter of recommendation for a residency program. The scenario takes care to describe that the attending is well-known in the field. He invites the student to lunch at a restaurant off-campus from the hospital. The hypothetical scenario then goes to describe that the student felt uncomfortable with her interaction with the attending and reports it to the administration. The scenario does not delve into the nature of the interaction. Does this situation constitute mistreatment?

“Maybe she was wearing a low-cut shirt,” one of my classmates says.

“Some medical students can be really whiny,” another asserts.

My group is ambivalent and votes “Maybe.” The power dynamics of the case are not discussed.

 

It is 2015. I am on my surgery clerkship and the course director asks each of us what medical specialty we are thinking about pursuing. I have been warned about this question—it will later be on the list of things attendings cannot ask because of the students’ worry that their answer may influence their grade. But no such list exists yet, and this course director is not known for his adherence to the rules. I defer answering, saying that I need to experience more clerkships before I can make a decision. This is known as a bullshit response. The attending tells me this and then says he will guess which medical specialty is best for me. But I already know he is going to say Pediatrics. Although the attending has never seen me act nurturing with anyone under the age of fifty (we are at a Veterans’ Affairs hospital), I am female, and therefore I belong with the children.

 

For our mistreatment seminar at the end of medical school, we are split into groups based on our intended medical specialty. One student voices her concern that this will decrease a diversity of opinions.

“Ugh, she must be going into peds,” my group mate says derisively.

“What’s wrong with peds?” I ask, knowing that I could have easily been that student, having already been stereotyped as a future pediatrician.

“Too many feelings,” my group of future anesthesiologists jeers.

 

It’s the day after the 2016 presidential election. Our dean of students has sent us an email after teaching a group of second years who seem on the verge of tears.

“Again and again, we were exposed to bigotry, sexism, and other forms of hatred,” he writes about the campaign season. “Regardless of our political orientation, these ideologies are difficult to hear amongst a group of people who are dedicating their lives to helping others; in this we have solidarity.”

A few of my classmates “like” this post within our email server. Several of us put post-election reflections on Facebook. However, a school-wide discussion does not take place. I think back to our school’s White Coats for Black Lives lie-in just a two years prior. With less than twenty percent participation, it seems a blind eye to social justice among young healers was evident even then. We became doctors to help others, but through medical school we learned to confine or altruism to the four walls of the hospital. Should I truly feel shocked by the Trump election? But I am also one of those crying students—I spend the entirety of November 9 tearing up in bed.

After the election, it feels like everything has changed, but we find ourselves still doing the same mistreatment seminar that we completed four years prior. The definition of mistreatment is so broad that we cannot fully grasp what it is. Instead, we are parroting back the answers we have memorized as though we are taking another medical school exam. We do not think about the weight of these mistreatment scenarios, the implications hidden within the words. There is no increase in reports on mistreatment in 2017, even though it is surely still happening. Everything has changed, but nothing has changed at all.

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Rumpus original art by Mark Armstrong.


Shara Azad is an anesthesiology resident who lives in New York and Boston. Her writing can be found online at the Huffington Post and the ABC News Medical Unit. You can reach her through her website, www.sharaazad.com, or via Twitter @sharaazad. More from this author →