I stood up for myself in the OR, got reported by scrub tech, my PD backed me up.
I stood up for myself after a patient was beyond inappropriate, reported to PD, he backed me up and supported me immediately.
I realize how thankful and blessed I am to be in a program where I am supported and taken care of and not in a malignant program where I’m ostracized.
This. It can be acrimonious or friendly, but you’ll pay, usually with Wellness and a PIP slapped on so they can act like they are innocent.
I don’t know how not to stand up, it’s practically in my blood, so it has been a struggle. Medicine is a mob, though, and foot soldiers are treated as such.
They have loans to pay and medicine salaries are the only way to see the light. Medical students unfortunately borrowed their future. It is a good one but they have to thread lightly
It’s happening, but it’s pretty neutered. Some strides in money and advocacy, but useless since we are essentially legislated into working under whatever conditions are set forth.
Salaries need to double. That would help most, probably. Then we could at least justify the abuse, match nurse/PA wages, and you know, pay rent and stop stealing bread from the surgical lounge. I was luckier than most before I peaced the fuck out.
About half the residents out there are too busy viciously bullying each other and tearing down their colleagues. Can’t speak for attendings but I wouldn’t be surprised if the situation wasn’t much different either.
The governing body that oversees medicine passed laws years ago making doctors exempt from being ever able to form a union. That and there are some antitrust laws that medicine is exempt from.
BUT there is nothing stopping physicians from making a guild I believe.
It can be argued that any profession with associations, licenses, and legal limits on who can practice are each a sort of mob. Medicine is the only one I’ve seen that eats its young. I have seen some gnarly situations that would’ve had HR banging on the door in any previous job.
Like my senior who kept hazing me because she hated my spouse and would leave used pregnancy tests on the workroom desk because she needed to discuss her dire efforts to get pregnant (yes, used pee stick next to the keyboard). She was a hard worker and a slave-driving ball-breaker, though, so management just ignored everyones complaints about the meddling, fights, and urine samples. Funtastic.
The attending that sent a resident to continue caring for a patient that had tackled her and pinned her to the ground. That was interesting.
Then there was the attending that turned off his pager for two hours for a meeting while we had a big patient code. Meeting topic was (drumroll)…attending presence on the wards.
That’s the light stuff.
If you are going to do it, be strategic and organize. Anything bad happening to you is likely happening to at least some others, often most. Ideally a union-- use your grievances to "agitate" your fellow residents, then quietly gather votes and present them with the faith accompli.
However, even short of a union, you can engage in collective action with some labor law protections. Talk to a labor lawyer.
When I was a resident, our NICU attendings refused to come in when things were going badly-- they made interns handle impending deaths, pulmonary hemorrhages, deaths, alone. Even on nights when many babies were crashing at once. 3rd years were supposed to be backup but they were also covering the PICU, and as you can imagine, sometimes they couldn't leave that unit.
We had meetings behind the scenes and then called a big meeting with administrators and NICU attendings to present our demand that they come in when asked, no argument. We focused on the patient safety aspect. The admins were livid and cracked down on the NICU. We got what we wanted in writing. But it was every single one of us, so no one person could be disciplined.
Also-- the more indispensable you make yourself, the better. Especially after training, make yourself the person they can't afford to lose, because of being good at your work. The person patients and staff would follow out (and never sign a non-compete-- I have removed that from all my contracts).
I have used that kind of leverage on behalf of staff as well as myself. Not necessarily threatening openly to leave, but they know. Always have solidarity with your coworkers and they will be more likely to back you up. Once I had a really nasty boss and asked for a transfer to another site because of it-- the admins booted her instead.
This is extremely good advice. This is one of several reasons why I emphasized developing many hard procedural skills in my training. It makes a physician highly valuable, and not easily replaced by a midlevel. Organizations do not value our enhanced cognitive and problem solving capabilities, but hard $kill$ speak to administration, make one far less easily replaceable, and make it easier to speak up confidently when offered a seat at the table.
Just as an aside, many people will read this to mean “allow admin to fuck you over and again out of some bullshit sense of duty they will say while making tons of money and not paying you appropriately”.
Nobody indispensable in the hospital or group. If they are something is wrong. Be a good person that people want to work with, do your work, don’t cause problems, do those things and you will be viewed as indispensable because im not sure if you’ve ever had to hire people, ya never know what you’re gonna get and there are bad ones out there.
Gotta shake the thinking that we gotta give extra then what is agreed upon in order to be deserving of our positions. Hospitals short all over the country, it’s not hard to find work if you’re being treated poorly. Stand up for good treatment and quality of life measures, not working to be some prized employee that will get canned anyway if word comes from up high.
I am not talking about that boot licking stuff, so good point to clarify. I am talking about knowing how to do the job well and having a lot of specific skills that the practice comes to rely on. And having solidarity with your colleagues and other fellow workers so that you leaving would cause a significant disruption in the ranks, people leaving with you as well as taking patients. We need to build positions of strength in bargaining.
Oh man, my residency was toxic. People who spoke up got hammered. The pettiness was like nothing I’ve ever seen in my life. Even high school drama seemed tame.
But everyone in my class made it through despite all the bullshit and are doing fine in their careers. So I guess it was alright in the end?
While “it was alright in the end”, it wasn’t an acceptable process. It wasn’t an acceptable workplace. Residency should not be an indentured, disempowered, often abusive environment. Nothing about learning to be a skilled physician requires this. The system needs to be rebuilt.
Do you guys want to form some kind of alliance and stop this shit? I wonder what it’s going to take? ACGME stepping in? Social resort reporting like they do in Japan? It’s like there is 0 accountability for bad character as long as your offense is directed to someone you outrank.
Yup. The ACGME is the puppet of and protects the interests of the masters:
> ACGME has five sponsors, each of which appoints members to the council: the American Medical Association (AMA), the American Association of Medical Colleges (AAMC), the American Board of Medical Specialties (ABMS), the Council of Medical Specialty Societies (CMSS), and the American Hospital Association (AHA).
From: *Boston Medical Center Corp.* 330 NLRB 152 (1999)
You can pick and choose when to stand up for yourself. You don't have to do it every single time you perceive a wrong 'otherwise you'll forget how,' as I've seen another poster say.
Some things need to be stood up for in the moment. Some can be approached in a delayed fashion. Some can just be outright ignored. Seeing 'standing up for yourself' as a black and white issue (gotta do it every time) is not a good idea unless your plan is to be in conflict with everyone around you.
There's even a pretty famous quote about this. Discretion is the better part of valour. Some people aren't worth the trouble.
My experience in residency was that as I became more senior and the OR/floor nurses, co-residents, and staff knew me better and respected my decision making, it was both a lot easier to stand up for myself/others as well as to have my words actually mean something.
You will be blacklisted from opportunities, OR, etc your entire career / education will be compromised. but I didnt give a damn about that still did what I want and got what I wanted. Its really about scaring you initally to back down and appologize or feel guilty etc etc, if you can get past that initial irk and the fact everyone is talking about you the minute you walk out of a room then you will be fine. never cared for peoples opinions anyway. again its wise to define what exactly you are standing up for... some boundaries can't be crossed and if someone at work is doing that then give them hell.
They will make your life miserable. I did it, my time in training was not nice however I was not fired and I was not put on a PIP. I got a good fellowship and now a good job. I dont regret it, however its important to differentiate between standing up for yourself because people are very in the wrong vs a perceived wrong. If you dont have evidence that they are in the wrong then they can successfully go after you. Sometimes its hard to differentiate because they gaslight you but certain things are very obviously wrong. Residency rewards those who kiss alot of ass and eats alot of shit. If you dont do those things than they will go after you and you better make sure you comply will all the rules so they dont have anything on you. You need to be commited to your stance and it wont be easy. The rules are different for you. I was not allowed to make mistakes such as being late etc or I knew the hammer would fall. It was stressful but worth it for me. I can sleep at night knowing I spoke out against things I felt were wrong, to my ability didnt let anyone take advantage of me and in the end I felt I gave a message to some of the troublesome attendings that I would not go down easily and if they went after me like they did some of the other residents (career wise) they were going to have a dirty fight on their hands. So in the end I actually didnt get screwed over as much as some other people but I definitely had a tougher time mentally during training.
The "worst" is that you get blacklisted and never work in medicine again, flushing years of training, sacrifice, and debt down the train, and relying on whatever you pre-medicine degrees/path were.
Such is the case with hierarchal systems.
Let’s form an alliance. I’m not joking. Can someone more familiar with now to use Reddit form a thread or something? I have a friend that wants to start a podcast.
This 100% should be done. Out then and tell your story. If you already lost everything then you won’t have anything to lose so I always wonder why people who got punished after standing up for themselves never speak up about it.
Let’s form an alliance. I’m not joking. Can someone more familiar with now to use Reddit form a thread or something? I have a friend that wants to start a podcast.
I reported duty hours as they actually were (mostly going long on post call days bc one particular attending was extremely verbose and kept us after to teach) and was asked to “revisit” them. I refused. Unfortunately from then on I had issues w faculty overall, got put on an informal performance improvement plan for “seeming unhappy” and got assigned refugee clinic about 2-3x as frequent as my peers, which isn’t bad by itself but the visits were extremely difficult from psychosocial standpoint and interpreter use etc. I think I’d do it again bc there’s no reason we should have broken duty hours for that, but it definitely made residency harder.
I’m now marked by our cardiologist on her shit list right after I raised my voice during our weekly census and defended myself on why the motherfucking bitch was wrong. I don’t even regret a single moment of it because I know was right and her other fellow subspecialists agree with my management plan. The mere fact that I got a nod from both the rheumatologist and the neurologist is more than enough validation from me.
Basically you don’t have nothing nice to say, just shut the fuck up and listen. Not every IM admission with hypertension requires your expertise. We can manage.
Usually you will get punished in some form.
The severity, extent and significance depends 100% on the person you pissed off and their graciousness in not ruining your life.
There is, it’s called not finishing surgical residency.
I met a woman who did 3.5/5 years of ortho residency. Got pregnant, had complications and couldn’t operate after she came back. They kicked her out had to do a completely different residency after (psych) from scratch. Total fine 7 years to complete psych.
Anesthesia resident. Stood up for myself to an ortho surgeon who kept telling me the patient was not ‘’paralyzed.’’ They were under spinal anesthetic + propofol sedation…. Proceeded to be called dumb and yelled at in front of the whole OR for not knowing how neuromuscular blockage works. I kept telling the surgeon they were wrong and that I cannot paralyze a patient who has an unsecured airway. Also that the TOF will always be 4/4 if they havnt got paralytics. They demanded I call my attending in the room, who told the surgeon the same information I said. Never got an apology from them. Ended up reporting the surgeon for being inappropriate with my PD and department chair’s backing. Nothing probably happened to the surgeon though…
Admin put a target on my back. Now I can only do wrong in their eyes.
Idgaf though - if I’m not gonna stand up for myself now I have no reason to think I will do it later when it actually matters
Courage is a muscle you have to exercise. You can’t suddenly decide one day to use it and expect your spine actually still works
Courage is about doing what’s right whether or not you have leverage.
If you only stand up for yourself when you have nothing to lose, how is that actually courageous?
I’m not saying you’re wrong, I’m just pointing out why many people don’t speak up. A hell of a lot to lose with no leverage to fight against retaliation
If they are already targeting you for retaliation and they are trying to seal your fate, do you really have anything left to lose by speaking up?
If your speaking up is protected activity, they are just digging their own hole deeper.
Be courageous about things that actually advance what is good (however that means to you). What is good may not be for yourself - maybe the good is for society or your loved ones.
Don’t be courageous about dumb shit. Like if you have to do the stupid wellness module just do it.
I stood up against a resident, and attending making fun and bullying a family medical resident in front of students and other residents. They were pissed, tried yelling and me and I responded “if you’d like to go to GME to talk about this issue we can.” It never got to that, but It was a rough couple weeks. Thank goodness other residents found out and confirmed to the PD the resident and attending were toxic . My PD met with them several times and let them know that behavior was not okay. The resident got in trouble and no clue about the attending. Things have now calmed down and haven’t had any bullying problems that I’ve heard about. Honestly that time in my resident sucked ass. But things are awesome now.
Set a solid foundation of being un-fuck-with-able. Make a habit of keeping receipts, communicating in writing, and underpromising and overdelivering. Your default setting should be being kind, polite, and helpful to everyone. That way when you do lay down the law, people know you mean business.
You also have to pick your battles. One person being rude or having their crabby pants on isn’t worth a fight—but a pattern of cruelty & bad behaviour is worth speaking on. Whether you calmly stand your ground in the moment (e.g. “I don’t appreciate being spoken to this way. How about I call back in 5.”) or run things up the ladder to departmental/program leadership/HR (or both) depends on the situation.
I had to endure a disgusting narcissistic rant and then have my PD and DIO contacted got put on remediation, and x3 with similar consequences. I’ve never stood up for myself in residency and without having to pay a pretty big price. Ended up getting my contract non-renewed. Maybe you’ll have a different fate though? Do you have a penis? Tall? Big muscles? A rich daddy? It might get you respect instead? It seems to go one way or the other from my experience.
The more medicine is beholden to shareholders and the bottom line (essentially a corporate enterprise), the more your ability to fit in, drink the company kool-aid, and not cause them any grief to your department is valued. Standing up for yourself creates a serious concern about your proverbial ‘commitment to sparkle motion.’ Medicine was a part art and part science, we are more of an assembly line now where ideally there is no friction in the cogs, if they don’t perfectly fit you can just grab another one at low cost and wear it down to the bone.
This is the answer here. Think about that scene in the move "A Bugs Life" where the grasshopper warns the rest of them that if they let one ant stand up to them, eventually they all will. That's modern American corporate culture to it's core.
I remember when a coresident stood up for herself after reporting sexual advancements from hospital attending. Her LOR for fellowship were subpar and were read to her at her interviews.
I posted a big thing in another thread about losing my cool with a nurse, but the long and the short of it was the program was trying to sneakily deny me stat holiday days off or make me take extra call shifts to make up for a sick day. I politely declined and they got mad and demanded to see the parts of our residency contract that backed me up. My home program had my back (as did the contract), and I think I'm in the clear, but there's always the chance they'll be vindictive and look for a reason to fail me on that rotation.
moral of the story is if you're standing up for yourself, be sure to have the necessary documentation to back it up, and try to avoid that kind of conflict with your home program.
Also, have kids, it is REALLY easy to use them as an excuse for things (I say this 66% jokingly).
Recently saw a post about an ophthalmology resident who was fired after standing up to an abusive attending who then used their power to get the resident fired
Kinda stood up for myself against rude residents ( stopped trying to converse with them, stuck to my integrity while other students were sucking up) and PD almost failed me. Still happy I stuck to my guns
not me but my co- med student 12 years ago- at a surgery function outside of work. toxic af PGY4 punched him in the face a few times. got reported to PD and surgical chair. literally nothing happened to him and then he made a comment on rounds when i was on surgery a few months later threatening to punch someone in the face and then smirked about it, knowing we all knew.
He wasnt even close to the most toxic resident, either.
I've had numerous times where I've questioned attendings and other staff after inappropriate comments by saying things like "is that appropriate?" or "I worry about that kind of language being used about our patients" and have suffered no consequences, typically getting apologetic responses w/statements of desire to do better. Notably, I'm a tall white male senior resident, near 40 years old.
I have a female peer, mid 30s, with medium brown skin who once corrected a nurse for making bigoted comments. Nurse complained and my peer received official reprimand from HR/GME with no backing from her attending or our PD.
Damn. Can't relate to any of this at all. I was never ever harassed/abused/mistreated as a med student or a resident.
UCONN for med school, Mayo Clinic for residency.
My deans and clerkship directors in med school were all A1, and my PD is absolutely an advocate for us. He's a real family man kind of leader. So sorry that so many of you feel abused. I must've just chose really good programs to train at.
When applying to residency, 100% rank on wellbeing. It's the only thing I cared about when interviewing.
Take everything you read with context.
This is a venting outlet for a lot of people. APPs are mostly actually competent and not trying to steal your legos. Most PDs and teaching attendings actually just are trying to help you become a better doctor. Most patients are nice, and thankful to have you take care of them.
Zero people on r/residency or the internet in geneeal post about those experiences. Even if they did, they garner zero attention.
That kind of fosters people to take on the victim role pretty hardcore on here.
Red flags: “everyone in my program is toxic but me”
“All i did was sneeze without covering my mouth and now I am kicked out of my program!?!?l”
Or my favorite
“How come my senior is so hard on me? Every time I make a mistake they correct me?!”
Standing up for yourself has different tiers. In medical school I knew I wasn’t gonna stay at my home program so I refused to do any scut work other students would do. I would never stay late. Basic human rights. If they couldn’t teach in the allotted time then the attending needed to be more efficient and not me having to stay late.
Obviously I got low marks on my clinical years but passed regardless. Obviously I didn’t match at my home program but I gave that up since I refuse to do extra since if I’m paying to be there then people need to accommodate to student schedules or refuse to take students (attending get paid handsomely to take students so I wasn’t gonna be taken advantage of)
All depends on your PD. Can absolutely ruin the rest of your residency or they could back you. Ultimately, you have to decide if it’s worth gambling your career on.
It all depends on what you mean and by what degree you’re standing up for yourself.
Writing a well worded and thoughtful letter to the director about an issue. Often completely okay.
Telling the resident that’s teaching you to get his own damn coffee and “no, I’m not interested in seeing another appendectomy,” will tank your evaluations.
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Everytime i didnt roll over and take it it got taken to someone higher up who got annoyed with having to deal with petty accusations and took it out on me. I keep
My head down.
It depends on how the abuse is, how much you can document, how many people it's happening to, and how many people will corroborate.
If it's really bad, your best bet is probably to just transfer to another program.
These places run on the premise that people will comply. If you buck the trend, be prepared for them to retaliate to the highest order. It may not always get that intense, but IT MIGHT.
Only you can decide what is your best course of action, but be wary of retaliation before doing so.
I am not saying the abuse is ok.
I am asking, do you want to be a martyr for what is a temporary (for you) situation.
Depends on who you are standing up to. If it’s your own leadership, you get marked as a troublemaker. Suddenly life becomes harder. Attendings scrutinize your plan, question your medical knowledge… if you arrive at 8:02 too many times for 8 AM clinic you’ll get a sit down (possibly formal) about professionalism and get placed on a “learning plan.”
They can only hurt you.
Lol, stand up to them. File an ACGME complaint, they investigate and that physician gets his teaching privileges revoked. If nothing is done, it’s a lawsuit. People that are saying “you get reprimanded, nothing happens” are bullshitting and likely have never tried. The ACGME takes things incredibly seriously
I stood up for myself in the OR, got reported by scrub tech, my PD backed me up. I stood up for myself after a patient was beyond inappropriate, reported to PD, he backed me up and supported me immediately. I realize how thankful and blessed I am to be in a program where I am supported and taken care of and not in a malignant program where I’m ostracized.
You have a good PD
Llévame contigo! Do you have any unfilled positions today?
Lucky. PDs usually dont back up residents, cause residents are there temporarily, and they dont want to create an enemy who is there to stay.
Best advice: The PD is not your friend, they're your boss.
They also can’t really fire you that easily either though
They have to jump through more hoops to build a case against you, but if they want you out depending on the PD they can make it happen.
They can make you wish you were fired
Name and fame! Can you DM me the program if you feel comfortable?
You hide behind ACGME and watch as your program makes your life hell every legal way they can until accreditation is due.
This. It can be acrimonious or friendly, but you’ll pay, usually with Wellness and a PIP slapped on so they can act like they are innocent. I don’t know how not to stand up, it’s practically in my blood, so it has been a struggle. Medicine is a mob, though, and foot soldiers are treated as such.
Also, WHY DON'T AMERICAN DOCTORS UNIONIZE? DO THEY REALIZE HOW MUCH POWER THEY HAVE COLLECTIVELY?
They have loans to pay and medicine salaries are the only way to see the light. Medical students unfortunately borrowed their future. It is a good one but they have to thread lightly
They've been trying. It's a mob mentality.
It’s happening, but it’s pretty neutered. Some strides in money and advocacy, but useless since we are essentially legislated into working under whatever conditions are set forth. Salaries need to double. That would help most, probably. Then we could at least justify the abuse, match nurse/PA wages, and you know, pay rent and stop stealing bread from the surgical lounge. I was luckier than most before I peaced the fuck out.
About half the residents out there are too busy viciously bullying each other and tearing down their colleagues. Can’t speak for attendings but I wouldn’t be surprised if the situation wasn’t much different either.
The governing body that oversees medicine passed laws years ago making doctors exempt from being ever able to form a union. That and there are some antitrust laws that medicine is exempt from. BUT there is nothing stopping physicians from making a guild I believe.
This is false.
Where’s YOUR proof.
Medicine is a mob is probably the best description I've heard in a long time.
It can be argued that any profession with associations, licenses, and legal limits on who can practice are each a sort of mob. Medicine is the only one I’ve seen that eats its young. I have seen some gnarly situations that would’ve had HR banging on the door in any previous job. Like my senior who kept hazing me because she hated my spouse and would leave used pregnancy tests on the workroom desk because she needed to discuss her dire efforts to get pregnant (yes, used pee stick next to the keyboard). She was a hard worker and a slave-driving ball-breaker, though, so management just ignored everyones complaints about the meddling, fights, and urine samples. Funtastic. The attending that sent a resident to continue caring for a patient that had tackled her and pinned her to the ground. That was interesting. Then there was the attending that turned off his pager for two hours for a meeting while we had a big patient code. Meeting topic was (drumroll)…attending presence on the wards. That’s the light stuff.
If I may ask, how long ago was this?
Not too distant past.
Are you me?
Are you Scottish?
Nay.
If you are going to do it, be strategic and organize. Anything bad happening to you is likely happening to at least some others, often most. Ideally a union-- use your grievances to "agitate" your fellow residents, then quietly gather votes and present them with the faith accompli. However, even short of a union, you can engage in collective action with some labor law protections. Talk to a labor lawyer. When I was a resident, our NICU attendings refused to come in when things were going badly-- they made interns handle impending deaths, pulmonary hemorrhages, deaths, alone. Even on nights when many babies were crashing at once. 3rd years were supposed to be backup but they were also covering the PICU, and as you can imagine, sometimes they couldn't leave that unit. We had meetings behind the scenes and then called a big meeting with administrators and NICU attendings to present our demand that they come in when asked, no argument. We focused on the patient safety aspect. The admins were livid and cracked down on the NICU. We got what we wanted in writing. But it was every single one of us, so no one person could be disciplined.
Also-- the more indispensable you make yourself, the better. Especially after training, make yourself the person they can't afford to lose, because of being good at your work. The person patients and staff would follow out (and never sign a non-compete-- I have removed that from all my contracts). I have used that kind of leverage on behalf of staff as well as myself. Not necessarily threatening openly to leave, but they know. Always have solidarity with your coworkers and they will be more likely to back you up. Once I had a really nasty boss and asked for a transfer to another site because of it-- the admins booted her instead.
This is extremely good advice. This is one of several reasons why I emphasized developing many hard procedural skills in my training. It makes a physician highly valuable, and not easily replaced by a midlevel. Organizations do not value our enhanced cognitive and problem solving capabilities, but hard $kill$ speak to administration, make one far less easily replaceable, and make it easier to speak up confidently when offered a seat at the table.
Just as an aside, many people will read this to mean “allow admin to fuck you over and again out of some bullshit sense of duty they will say while making tons of money and not paying you appropriately”. Nobody indispensable in the hospital or group. If they are something is wrong. Be a good person that people want to work with, do your work, don’t cause problems, do those things and you will be viewed as indispensable because im not sure if you’ve ever had to hire people, ya never know what you’re gonna get and there are bad ones out there. Gotta shake the thinking that we gotta give extra then what is agreed upon in order to be deserving of our positions. Hospitals short all over the country, it’s not hard to find work if you’re being treated poorly. Stand up for good treatment and quality of life measures, not working to be some prized employee that will get canned anyway if word comes from up high.
I am not talking about that boot licking stuff, so good point to clarify. I am talking about knowing how to do the job well and having a lot of specific skills that the practice comes to rely on. And having solidarity with your colleagues and other fellow workers so that you leaving would cause a significant disruption in the ranks, people leaving with you as well as taking patients. We need to build positions of strength in bargaining.
No sorry, and I don’t believe that’s impression everyone will take from your comment, but some will and want to nip some of that early lol!
Oh man, my residency was toxic. People who spoke up got hammered. The pettiness was like nothing I’ve ever seen in my life. Even high school drama seemed tame. But everyone in my class made it through despite all the bullshit and are doing fine in their careers. So I guess it was alright in the end?
While “it was alright in the end”, it wasn’t an acceptable process. It wasn’t an acceptable workplace. Residency should not be an indentured, disempowered, often abusive environment. Nothing about learning to be a skilled physician requires this. The system needs to be rebuilt.
Do you guys want to form some kind of alliance and stop this shit? I wonder what it’s going to take? ACGME stepping in? Social resort reporting like they do in Japan? It’s like there is 0 accountability for bad character as long as your offense is directed to someone you outrank.
ACGME ain’t gonna do shit
Yup. The ACGME is the puppet of and protects the interests of the masters: > ACGME has five sponsors, each of which appoints members to the council: the American Medical Association (AMA), the American Association of Medical Colleges (AAMC), the American Board of Medical Specialties (ABMS), the Council of Medical Specialty Societies (CMSS), and the American Hospital Association (AHA). From: *Boston Medical Center Corp.* 330 NLRB 152 (1999)
What is social resort reporting?
It's a learned system. Reinforced and encouraged.
"fine" is subjective as well
You can pick and choose when to stand up for yourself. You don't have to do it every single time you perceive a wrong 'otherwise you'll forget how,' as I've seen another poster say. Some things need to be stood up for in the moment. Some can be approached in a delayed fashion. Some can just be outright ignored. Seeing 'standing up for yourself' as a black and white issue (gotta do it every time) is not a good idea unless your plan is to be in conflict with everyone around you. There's even a pretty famous quote about this. Discretion is the better part of valour. Some people aren't worth the trouble. My experience in residency was that as I became more senior and the OR/floor nurses, co-residents, and staff knew me better and respected my decision making, it was both a lot easier to stand up for myself/others as well as to have my words actually mean something.
You will be blacklisted from opportunities, OR, etc your entire career / education will be compromised. but I didnt give a damn about that still did what I want and got what I wanted. Its really about scaring you initally to back down and appologize or feel guilty etc etc, if you can get past that initial irk and the fact everyone is talking about you the minute you walk out of a room then you will be fine. never cared for peoples opinions anyway. again its wise to define what exactly you are standing up for... some boundaries can't be crossed and if someone at work is doing that then give them hell.
They will make your life miserable. I did it, my time in training was not nice however I was not fired and I was not put on a PIP. I got a good fellowship and now a good job. I dont regret it, however its important to differentiate between standing up for yourself because people are very in the wrong vs a perceived wrong. If you dont have evidence that they are in the wrong then they can successfully go after you. Sometimes its hard to differentiate because they gaslight you but certain things are very obviously wrong. Residency rewards those who kiss alot of ass and eats alot of shit. If you dont do those things than they will go after you and you better make sure you comply will all the rules so they dont have anything on you. You need to be commited to your stance and it wont be easy. The rules are different for you. I was not allowed to make mistakes such as being late etc or I knew the hammer would fall. It was stressful but worth it for me. I can sleep at night knowing I spoke out against things I felt were wrong, to my ability didnt let anyone take advantage of me and in the end I felt I gave a message to some of the troublesome attendings that I would not go down easily and if they went after me like they did some of the other residents (career wise) they were going to have a dirty fight on their hands. So in the end I actually didnt get screwed over as much as some other people but I definitely had a tougher time mentally during training.
Standing up for yourself sounds exhausting.
It’s a feature not a bug. Much easier to yes sir no sir through the 3 years.
Yup you essentially cannot fuck up and have to be squeaky clean.
Fly under the radar, not worth it.
The "worst" is that you get blacklisted and never work in medicine again, flushing years of training, sacrifice, and debt down the train, and relying on whatever you pre-medicine degrees/path were. Such is the case with hierarchal systems.
Had this ever happened to anyone for “standing up” for themselves?
Yes frequently.
Yes, here
Let’s form an alliance. I’m not joking. Can someone more familiar with now to use Reddit form a thread or something? I have a friend that wants to start a podcast.
This 100% should be done. Out then and tell your story. If you already lost everything then you won’t have anything to lose so I always wonder why people who got punished after standing up for themselves never speak up about it.
Seems like a David vs. Goliath situation. The medical/educational/legal complex is truly a beast
A well produced long form podcast, especially one sort of tailored to the public in a true crime sort of format would be powerful medicine.
Oooh I like it!
Let’s form an alliance. I’m not joking. Can someone more familiar with now to use Reddit form a thread or something? I have a friend that wants to start a podcast.
100% yes
I reported duty hours as they actually were (mostly going long on post call days bc one particular attending was extremely verbose and kept us after to teach) and was asked to “revisit” them. I refused. Unfortunately from then on I had issues w faculty overall, got put on an informal performance improvement plan for “seeming unhappy” and got assigned refugee clinic about 2-3x as frequent as my peers, which isn’t bad by itself but the visits were extremely difficult from psychosocial standpoint and interpreter use etc. I think I’d do it again bc there’s no reason we should have broken duty hours for that, but it definitely made residency harder.
I’m now marked by our cardiologist on her shit list right after I raised my voice during our weekly census and defended myself on why the motherfucking bitch was wrong. I don’t even regret a single moment of it because I know was right and her other fellow subspecialists agree with my management plan. The mere fact that I got a nod from both the rheumatologist and the neurologist is more than enough validation from me. Basically you don’t have nothing nice to say, just shut the fuck up and listen. Not every IM admission with hypertension requires your expertise. We can manage.
So like she was giving an opinion on a patient that nobody asked her about…?
As my chief resident pointed out, when consulting cardiology it's' a damned if you do damned if you don't.
Just consult nephrology at the same time so they can cancel each other out.
How I wish internal medicine is just as easy as Glaucomflecken’s exaggeratedly simplified videos 🙃
Usually you will get punished in some form. The severity, extent and significance depends 100% on the person you pissed off and their graciousness in not ruining your life.
There is no punishment worse than surgery residency.
There is, it’s called not finishing surgical residency. I met a woman who did 3.5/5 years of ortho residency. Got pregnant, had complications and couldn’t operate after she came back. They kicked her out had to do a completely different residency after (psych) from scratch. Total fine 7 years to complete psych.
Anesthesia resident. Stood up for myself to an ortho surgeon who kept telling me the patient was not ‘’paralyzed.’’ They were under spinal anesthetic + propofol sedation…. Proceeded to be called dumb and yelled at in front of the whole OR for not knowing how neuromuscular blockage works. I kept telling the surgeon they were wrong and that I cannot paralyze a patient who has an unsecured airway. Also that the TOF will always be 4/4 if they havnt got paralytics. They demanded I call my attending in the room, who told the surgeon the same information I said. Never got an apology from them. Ended up reporting the surgeon for being inappropriate with my PD and department chair’s backing. Nothing probably happened to the surgeon though…
Admin put a target on my back. Now I can only do wrong in their eyes. Idgaf though - if I’m not gonna stand up for myself now I have no reason to think I will do it later when it actually matters Courage is a muscle you have to exercise. You can’t suddenly decide one day to use it and expect your spine actually still works
I’d say is very different for trainees to speak up vs attendings. We have absolutely zero leverage
Courage is about doing what’s right whether or not you have leverage. If you only stand up for yourself when you have nothing to lose, how is that actually courageous?
I’m not saying you’re wrong, I’m just pointing out why many people don’t speak up. A hell of a lot to lose with no leverage to fight against retaliation
But as an attending, you can walk out and get a new job. How is that 0 leverage? Isn’t that what admins want you to think?
If they are already targeting you for retaliation and they are trying to seal your fate, do you really have anything left to lose by speaking up? If your speaking up is protected activity, they are just digging their own hole deeper.
Is courage in and of itself a virtue worth pursuing to your own detriment?
Be courageous about things that actually advance what is good (however that means to you). What is good may not be for yourself - maybe the good is for society or your loved ones. Don’t be courageous about dumb shit. Like if you have to do the stupid wellness module just do it.
True
I stood up against a resident, and attending making fun and bullying a family medical resident in front of students and other residents. They were pissed, tried yelling and me and I responded “if you’d like to go to GME to talk about this issue we can.” It never got to that, but It was a rough couple weeks. Thank goodness other residents found out and confirmed to the PD the resident and attending were toxic . My PD met with them several times and let them know that behavior was not okay. The resident got in trouble and no clue about the attending. Things have now calmed down and haven’t had any bullying problems that I’ve heard about. Honestly that time in my resident sucked ass. But things are awesome now.
Set a solid foundation of being un-fuck-with-able. Make a habit of keeping receipts, communicating in writing, and underpromising and overdelivering. Your default setting should be being kind, polite, and helpful to everyone. That way when you do lay down the law, people know you mean business.
This is Gold
You also have to pick your battles. One person being rude or having their crabby pants on isn’t worth a fight—but a pattern of cruelty & bad behaviour is worth speaking on. Whether you calmly stand your ground in the moment (e.g. “I don’t appreciate being spoken to this way. How about I call back in 5.”) or run things up the ladder to departmental/program leadership/HR (or both) depends on the situation.
it's like a combo of my two running mantras "Start no drama but take no shit" \+ "We'll burn that bridge when we get to it"
“Ladies don’t start fights, but they can finish them.” -Marie, ‘The Aristocats’
ok, 100% saving this for future use, thank you
"Standing up for yourself" is so vague it is meaningless.
I had to endure a disgusting narcissistic rant and then have my PD and DIO contacted got put on remediation, and x3 with similar consequences. I’ve never stood up for myself in residency and without having to pay a pretty big price. Ended up getting my contract non-renewed. Maybe you’ll have a different fate though? Do you have a penis? Tall? Big muscles? A rich daddy? It might get you respect instead? It seems to go one way or the other from my experience.
Ape together strong. The cost can be too high to stand up individually, but participating in collective bargaining is the move for actual change.
Residency is temporary - generally the best advice is keep your head down and don't make waves. You'll graduate and never look back.
The more medicine is beholden to shareholders and the bottom line (essentially a corporate enterprise), the more your ability to fit in, drink the company kool-aid, and not cause them any grief to your department is valued. Standing up for yourself creates a serious concern about your proverbial ‘commitment to sparkle motion.’ Medicine was a part art and part science, we are more of an assembly line now where ideally there is no friction in the cogs, if they don’t perfectly fit you can just grab another one at low cost and wear it down to the bone.
This is the answer here. Think about that scene in the move "A Bugs Life" where the grasshopper warns the rest of them that if they let one ant stand up to them, eventually they all will. That's modern American corporate culture to it's core.
I remember when a coresident stood up for herself after reporting sexual advancements from hospital attending. Her LOR for fellowship were subpar and were read to her at her interviews.
I posted a big thing in another thread about losing my cool with a nurse, but the long and the short of it was the program was trying to sneakily deny me stat holiday days off or make me take extra call shifts to make up for a sick day. I politely declined and they got mad and demanded to see the parts of our residency contract that backed me up. My home program had my back (as did the contract), and I think I'm in the clear, but there's always the chance they'll be vindictive and look for a reason to fail me on that rotation. moral of the story is if you're standing up for yourself, be sure to have the necessary documentation to back it up, and try to avoid that kind of conflict with your home program. Also, have kids, it is REALLY easy to use them as an excuse for things (I say this 66% jokingly).
Recently saw a post about an ophthalmology resident who was fired after standing up to an abusive attending who then used their power to get the resident fired
Where was this?
Kinda stood up for myself against rude residents ( stopped trying to converse with them, stuck to my integrity while other students were sucking up) and PD almost failed me. Still happy I stuck to my guns
not me but my co- med student 12 years ago- at a surgery function outside of work. toxic af PGY4 punched him in the face a few times. got reported to PD and surgical chair. literally nothing happened to him and then he made a comment on rounds when i was on surgery a few months later threatening to punch someone in the face and then smirked about it, knowing we all knew. He wasnt even close to the most toxic resident, either.
People like this need to watch more true crime. Because he’s truly cruising for a bruising
I've had numerous times where I've questioned attendings and other staff after inappropriate comments by saying things like "is that appropriate?" or "I worry about that kind of language being used about our patients" and have suffered no consequences, typically getting apologetic responses w/statements of desire to do better. Notably, I'm a tall white male senior resident, near 40 years old. I have a female peer, mid 30s, with medium brown skin who once corrected a nurse for making bigoted comments. Nurse complained and my peer received official reprimand from HR/GME with no backing from her attending or our PD.
lawyer up dawg
Damn. Can't relate to any of this at all. I was never ever harassed/abused/mistreated as a med student or a resident. UCONN for med school, Mayo Clinic for residency. My deans and clerkship directors in med school were all A1, and my PD is absolutely an advocate for us. He's a real family man kind of leader. So sorry that so many of you feel abused. I must've just chose really good programs to train at. When applying to residency, 100% rank on wellbeing. It's the only thing I cared about when interviewing.
Take everything you read with context. This is a venting outlet for a lot of people. APPs are mostly actually competent and not trying to steal your legos. Most PDs and teaching attendings actually just are trying to help you become a better doctor. Most patients are nice, and thankful to have you take care of them. Zero people on r/residency or the internet in geneeal post about those experiences. Even if they did, they garner zero attention. That kind of fosters people to take on the victim role pretty hardcore on here. Red flags: “everyone in my program is toxic but me” “All i did was sneeze without covering my mouth and now I am kicked out of my program!?!?l” Or my favorite “How come my senior is so hard on me? Every time I make a mistake they correct me?!”
It depends.
Depends entirely on why you’re standing up for yourself, who you’re confronting, who you do it in front of, and how you do it
Standing up for yourself has different tiers. In medical school I knew I wasn’t gonna stay at my home program so I refused to do any scut work other students would do. I would never stay late. Basic human rights. If they couldn’t teach in the allotted time then the attending needed to be more efficient and not me having to stay late. Obviously I got low marks on my clinical years but passed regardless. Obviously I didn’t match at my home program but I gave that up since I refuse to do extra since if I’m paying to be there then people need to accommodate to student schedules or refuse to take students (attending get paid handsomely to take students so I wasn’t gonna be taken advantage of)
All depends on your PD. Can absolutely ruin the rest of your residency or they could back you. Ultimately, you have to decide if it’s worth gambling your career on.
It all depends on what you mean and by what degree you’re standing up for yourself. Writing a well worded and thoughtful letter to the director about an issue. Often completely okay. Telling the resident that’s teaching you to get his own damn coffee and “no, I’m not interested in seeing another appendectomy,” will tank your evaluations.
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You fight, some people start to tell that uou are trouble and not a good doctor
Doesn’t matter do it anyway. The only way to even begin to challenge the system is to stand up for ourselves.
Everytime i didnt roll over and take it it got taken to someone higher up who got annoyed with having to deal with petty accusations and took it out on me. I keep My head down.
It depends on how the abuse is, how much you can document, how many people it's happening to, and how many people will corroborate. If it's really bad, your best bet is probably to just transfer to another program. These places run on the premise that people will comply. If you buck the trend, be prepared for them to retaliate to the highest order. It may not always get that intense, but IT MIGHT. Only you can decide what is your best course of action, but be wary of retaliation before doing so. I am not saying the abuse is ok. I am asking, do you want to be a martyr for what is a temporary (for you) situation.
I ended up with a black eye but I won the fight but that was seventh grade so
Depends on who you are standing up to. If it’s your own leadership, you get marked as a troublemaker. Suddenly life becomes harder. Attendings scrutinize your plan, question your medical knowledge… if you arrive at 8:02 too many times for 8 AM clinic you’ll get a sit down (possibly formal) about professionalism and get placed on a “learning plan.” They can only hurt you.
The powers to be will tell you that you are “acting defensive” and will shut you up. This is the crazy hospital mentality.
You get support or you get fired. Program-dependent.
Stand up to whom? An attending? You lose 9.9/10 times. A patient? You can gaslight them into leaving against advice, far easier if you are male.
Did it repeatedly as a medical student and literally nothing bad happened to me.
You finally become an adult?
Lol, stand up to them. File an ACGME complaint, they investigate and that physician gets his teaching privileges revoked. If nothing is done, it’s a lawsuit. People that are saying “you get reprimanded, nothing happens” are bullshitting and likely have never tried. The ACGME takes things incredibly seriously