There's been some discussion about this within my professional and social circles recently.
Are we becoming too soft with our juniors, and is this turning out to be a bad thing?
When I was a medical student, houseman and medical officer, stern seniors were pretty much the norm. Oftentimes it was something subtle, like a raised eyebrow or a frown, maybe a pause or a cryptic "Really?" in response to your statement.
Of course, there were a handful of explosive characters - surgeons who throw instruments, internists who pass sarcastic remarks, the occasional screaming session ( all of which I haven't personally experienced ).
The general impression I get is that such behaviour was tolerated in the past, but not anymore. I'm not saying it should be tolerated as a rule, but worry that being too nice is having a detrimental effect on our juniors.
It isn't my imagination that I'm encountering an increasing number of MOs, HOs and even med students who give me attitude even though I far outrank them. It seems no amount of telling off works unless you send an email directly to his/her Head of Department and threaten his/her chances of a) getting a good performance appraisal grade, b) securing a traineeship, or c) becoming a registrar.
I recall my first MO posting with a medical specialty notorious for its no-nonsense, obsessive-compulsive consultants and demanding work ethics. It was a rotation that was nowhere on my list of requests, and I started my first day with great trepidation.
It took me a month to get into the swing of things, but found myself adopting my seniors' attention to detail and constant sense of urgency. The consultants were extremely strict but also reasonable. Laziness and disrespect were considered cardinal sins.
Perhaps this paved the way for my current work ethos. I'm willing to grant an adjustment period, and always start off believing the best of my juniors. But if you demonstrate no interest in learning, slack off every chance you get, take advantage of your colleagues or show no remorse after making a mistake that jeopardizes a patient's life, I guarantee a severe reprimand.
Over the years, I've noticed a shift from simple rebukes to milder admonishments, even for cases where a junior doctor was clearly reckless. Peers who used to fry MOs for sloppy work now opt for gentle counselling, while some take the easy way out, i.e. act oblivious.
I have also toned things down somewhat, though I'm still considered one of the most sharp-tongued among my colleagues. However, that first MO posting I did 10 years ago taught me that:
a) if you're not performing up to a certain standard, it's only natural that your senior won't be happy;
b) you can choose to mope / curse / swear and stay in a rut, or you can evaluate your own shortcomings and rectify them;
c) earning the respect of a senior who is almost impossible to please is an extremely rewarding experience.
My bosses subscribe to the soft approach - or what I like to call the "New Age style of teaching" - and encourage me to do the same.
I try to humour them, but still have a reputation for being "a little too fierce" for my juniors' liking.
Doesn't bother me one bit. :)
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19 comments:
I'm so glad someone finally decided to voice this out. As a patient, I've increasingly noticed the arrogance and disrespectful attitudes of younger MOS/HOs/MOTs shockingly appalling.
I personally wonder if this attitude has been encouraged since medical school with it's teaching pedagogy?
It isn't encouraged at all, but an increasing number of young doctors have developed a type of narcissistic arrogance which I find extremely distasteful, probably as a result of their upbringing, and the adoption of this "New Age" style of teaching I mentioned.
There are solutions to the problem, of course. Just doesn't make you very popular. :)
We received 4 additional comments from readers over the weekend, but they were accidentally deleted.
My sincere apologies. Would appreciate it if the readers can repost their remarks so I can publish them.
Thanks.
I think what strikes me most is how the young doctors don't demonstrate any remorse when their errors are pointed out to them. I guess nothing is a mistake anymore - it's a learning experience.
Accidentally deleted?
I spent quite some time typing my comments!
So how? Should I hit you hard or go gentle?
Any to cut it short, here are the points I had:
1) Feedback goes both ways. Junior feedback on senior, senior on junior
2) Feedback plays a part on grading and promotions. If excessive bad feedback, the senior also gets "counselling"
3) To put a very bad grade, one has to justify and write long essays. Why bother with more work?
4) Whether a young doctor develops well or not doesn't change how much seniors earn or get promoted. So why bother?
5) A lot easier to just tread the middle ground. All say everyone is ok not too bad not too good. Everyone is happy.
Please don't delete this again!
I don't believe in tough love.
It is quite well known the if you want to get a person to do something or acknowledge/learn from his mistakes, shouting/screaming/sarcasm/abuse rarely gets the job done.
It may have in the past secondary to fear, however the younger generation is less susceptible to fear-inducing tactics.
IMHO it is far better to engage in positive reinforcement, constant positive motivation and encouragement and geniune praise and concern for staff.
I find that doctors who manage to achieve this command FAR more respect and staff tend to work harder for and with them.
I think one problem with the system is regardless how poorly a MO performs...as long as he stays in the system he will still get promoted albeit slowly. Even if mistakes are pointed out to them, it doesn't have any true consequence.
we should sack those who are not performing well then there will be less mistakes in hospitals
Imagine going to a hospital and seeing a useless dr.
We should set up quality committee headed by layman so that lousy drs get sacked from hospitals and patients can only see good and experienced drs whether they are subsidised or not.
I suspect hospitals assign lousy drs to subsidised pts to force them to upgrade to private and see real drs!
dave: I believe in positive reinforcement, but only up to a certain point.
If the HO / MO / registrar improves, then positive reinforcement may continue.
However, I've encountered bad apples who refuse to change even after multiple counselling sessions. Scolding probably won't help either, but being nice to them is definitely out of the question.
http://www.straitstimes.com/Breaking+News/Singapore/Story/STIStory_475247.html
It is about time PAP do something to punish doctors for overcharging and causing deaths to their patients.
Hopefully, this act will weed out the bad aples and doctors will serve their patients and not be self serving!
My opinion is this. Junior docs who exibit such an attitude is due to faulty role modelling during the developmental years or during the medical student years. Some, (in fact many) of my fellow medical school classmates come from filthy rich families where they are brought up as princes and princesses with a silver spoon. As they get what they want, when suddenly what they want gets taken from them, of course they are going to display some form of attitude
Now more importantly, there are also many senior crudmudgeon docs who exibit such similar behaviour. i'm sure all of us in the medical profession find them all too familiar a sight. Being in such senior positions naturally make them role models for their juniors and since young docs see their profs lashing out at ppl, throwing attitudes etc, why shouldn't they?
I have seen such docs myself in numerous postings and while attending clinic sessions with them. Fortunately, the way i view these ppl with attitude problem is that they are ppl whom i should learn not to be in future.
That being said, i wonder how many of these bad habits have younger docs today picked up from them?
Interesting article from Prof Lee Wei Ling in the Straits Times today. Talked about junior doctors becoming less hardworking and not being able to cope despite the same workload being shared among an increasing number of new house and medical officers.
Sad, isn't it?
Now, i beg to differ from the opinions of Prof Lee Wei Ling. An increased in recruitment in foreign doctors doesn't mean that workload is the same.
One thing for sure is that over the years, the medical needs in singapore has changed, patient loads has increased and are going to increase with more hospitals being built and more importantly patients are now more demanding compared to the past.
I personally feel that although her articles are sometimes nice to read, at many times, it doesn't really reflect what's really happening on the ground.
How does she actually define less hardworking? i read the article too and i found it disturbing that she's actually not really acknowledging the hardwork that her juniors are doing daily. She talked about how junior docs, despite doing less night calls today, are complaining. I'd like to add that night calls, by virtue of it being a situation where a doctor is overworked a whole day or even more, is a potential hazard. There shouldn't even be a night call system should there be proper mobilization of clinical manpower.
Thirdly, the salary difference which she claimed where earlier generation of doctors receive less than what docs today take home. If you take into account inflation, the salary hasn't changed. More importantly, i'd say if one has a 25-year HDB loan to pay, sick parents to look after, a typical doc's salary in the public sector can barely pay enough to make ends meet.
as a junior doctor, i like fierce but reasonable seniors. as long as they teach the right stuff, i don't care how they deliver it, as long as i learn. however, some are just plain bad-tempered and unreasonable/unpleasant and hard to work with, let alone learn from. as long as you know there's a clear distinction between the two. also junior doctors today get less and less teaching/learning/hands on. in the old days the housemen would be running the ward. nowadays, we just ask for a consult for every single thing, there's no more learning, just covering your ass.
realisticstudent: I did my housemanship 10 years ago. My observation over the past decade is that the workload has indeed increased, but so has the available manpower.
Patient demands, on the whole, have remained more or less similar, but that's just my opinion.
I tend to agree with Prof. Lee in her assessment. I belong to the generation that did 9-10 calls a month, sometimes without post-call. Though far from an ideal situation, I was grateful for the training and clinical exposure. And while my peers and I found it tough at times, we didn't kick up a fuss and got through our postings intact.
It seems with each new graduating cohort, more "protective measures" are implemented, and I remember being a cardio MO back in 2002 ( a posting that doesn't have HOs ), eating in the staff room while a large group of medical HOs sat nearby enjoying a long leisurely lunch, answering pages as they chatted.
Mind you, this was on a weekday.
And I couldn't help thinking how I never enjoyed such luxury during my housemanship.
As for the latest post by Anonymous, I totally agree that clinical practice in Singapore is moving inexorably towards the dreaded "defensive medicine" variety.
While it benefits patients to a certain degree, in the long run we are merely producing doctors who can't manage even simple medical / surgical / paediatric conditions - vital in GP practice - and happily refer such cases to the A&E and hospital specialists.
I've seen blue letter referrals in the wards to neurology for a minor headache, to respiratory for the flu, to cardiology for a borderline ECG in an asymptomatic patient.
Maybe it's all the unnecessary paperwork causing our junior doctors this "stress".
I don't really think the increase in manpower has came to such an extent that it is alleviating the workload. Not at least since i last did my student internship about half a year back. Things may have changed in a short span of time, but that i do not know for sure.
The need to do calls, like i've mentioned earlier, just meant that the manpower system in the healthcare sector has not evolved to suit night requirements. Nurses do 8 hour shifts and there's no need to have an overworked nurse working 36 hours at a shot. Why are docs not spared this ordeal? Much more so since there is already this influx of foreign docs, the increased manpower to help alleviate the current situation?
I know our seniors like to boast about the fact that they survived the war-like times where they did 9-10 calls. But hey, in today's context, is this necessary? From a patient's perspective, i'll really find that doctors who can hardly keep their eyes open during their ward rounds are potential health hazards for their patients.
Training can be done in proper environments where you'll be in a suitable situation to receive and digest the information. I don't think anyone would find that learning under extreme fatigue and stress to be a fruitful learning experience.
first, i don't think "boast" is the right term.
i too have often heard MY seniors comparing their rosters with mine, and i don't consider it boasting. they're merely stating facts.
shift systems for ward doctors are already in place at departments like NUH internal medicine, which accounts for its popularity among the HOs and MOs. why this hasn't been implemented at other busy hospitals is something that should be addressed.
and if you "don't think anyone would find that learning under extreme fatigue and stress to be a fruitful learning experience", then you'd better not become a surgeon.
Like i said earlier, learning should be done at a time when it is the right time to do so. This means that the student should be lucid, attentive and also be at the right place and time for learning.
While i believe too that doing night calls give you a view of how things are done in an emergency setting and also opportunities on how one takes charge with little support at night when the majority of docs aren't in the hospital, i don't think that extreme fatigue and stress in doctors are something desirable for our patients.
if anything, tired docs will make one more prone to medical errors and endanger patients' lives.
It should be left to the senior drs to decide whether the "new age" or "tough love" approach would be more appropriate. One approach may be effective for some but less so for others because human beings all operate differently, don't they? It takes all kinds of people to make up a team. Senior drs should be able to exercise their good judgement about which approach is best for each individual junior. I am sure both approaches have their uses, and no one is more right than the other because there is no one approach that will fit for all. Some juniors can be responsive to gentle counselling, while ohers will definitely need a greater push. Being firm and tough with your juniors does not necessarily entail being abusive. Likewise, gentle conselling does not mean being tolerant and lenient on the junior doctors for the inexcusable mistakes they make. What matters at the end is for our system to be able to train up good doctors.
On another note, the value of hardwork can certainly never be over-emphasised enough. If it means having to work longer hours and to go through more rigorous training, I hope doctors will rise to meet the challenge. I am sure that most of us in society hope that our system will continue to produce competent and effective drs.
This is a very interesting blog... Do keep us readers posted! =)
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