How not to train a doctor

Training is simply defined as transferring a skill or competency. For humans, it is one of the fundamental evolutionary traits that enabled so much that they have today.

The concept of health care is as old as human society. Aristotle is often given the credit of regularizing the care of sick and covering the skill with ethics and laws. However, history can be traced to 4000 BC Mesopotamia, where religious figures had the responsibility of taking care of the sick with magic and medicine.

With time, however, taking care of sick became regularized as a profession and later a whole Industry. We now know these professionals with different names like doctors, physicians or surgeons and several other names related to different specialities.

Modern care of ill has changed from an entirely humanitarian act to a skill set that has economic and legal consequences.

There are two extreme rationales of becoming a doctor. One is philanthropic, where you work to serve humanity, other is capitalist where you work to make a good economic fortune. In reality, however, the real reason lies in between these two extremes, balancing philanthropy with economic fortune.

The process of training of doctors remains in shadow, away from the vision of public.

The path to the destination of being an expert physician is bumped with hurdles at every next corner. Part of these bumps is the complexity of knowledge and skill of modern health care. The other part, however, is the troublesome attitude of trainers, commonly known as senior doctors.

The senior doctor is the immediate senior in most instances. He or she is the one juniors report to almost everything they do at work. Senior is also junior to next in hierarchy and this goes on to the top.

Work in a hospital setting is complex and draining, topped up with little room of mistakes. Junior doctors are often short of practical knowledge in their learning phase and therefore more prone to mishaps. This is a source of anxiety and stress. The senior doctors, understanding the vulnerability of juniors, attempt to make sure no mistakes are done. How do they do it? Harsh words, insult, bullying and mistreatment, in the name of teaching and training, to keep them vigilant and discipline.

Some stress serves to keep vigilance and attentiveness at work, but an overdose of it isn't helpful at all.

Why they should insult or bully a person to make someone learn something? In the military, it might be true because one has to be tough in war and might face even worse in the enemy's hands. But, In health care, one needs to be vigilant, knowledgeable but equally important, soft, empathetic and mindful. Doctors in practice are supposed to deal with sensitive issues of patients where compassion and empathy are of central importance. In contrast, they are dealt with insult and expected to deliver empathy.

This paradox has profound implications for well being of doctors and their patients. Workplace burnout is commonly reported among health care personals in general and doctors specifically and junior doctors more specifically. Family and relationships take the brunt of over-stressed culture. Patients, on the other hand, face an irritating attitude of physicians, augmenting their troubles and miseries.

The culture of taking and giving stress is infective. A typical day starts with early morning ward rounds, where the junior doctors are supposed to give an update on the previous 24 hours and report about previously given orders by consultant physician. That means the junior doctor has to come early in the morning and make preparations and gather all relevant information before the round starts. This early engagement is constant irrespective of when the doctor left last night for home. In short, a mostly sleep-deprived person is tasked to prepare a brief report on patient progress.

After the challenge of morning rounds, the doctor can have different engagements ranging from clinics to busy operation theatres or emergency department. At each of these places, the junior doctor is tasked to perform most basic jobs, such as patient identification, collecting records, counselling, communicating to other departments, writing operative notes and following other orders by the consultant. This multitasking is interrupted by ward round orders and changing status of patients in various parts of the hospital under the doctor care. While performing all this doctor has to constantly update the immediate senior and take necessary orders and measures as advised.

The mentality of subordination posed by hierarchy culture put the interests of the patient at risk.

In reality, a lot of things a junior doctor does are guided by the thought of what the senior might think or say or want rather than what should be done in the best interest of the patient. This mentality of subordination and reporting posed by hierarchy culture put the interests of the patient at risk. The junior doctor often ends up short of taking necessary actions or taking unnecessary additional actions, based on the expectations of his seniors. This can seriously compromise patient care.

The toxic environment in which doctors are trained has to be changed. An air of understanding and cooperation should blow not only for patients but also for doctors who intend to serve them to the best of their abilities.

We can't expect an empathic doctor if we keep subjecting them to apathy.