Toughen Up – Tough Love or Bullying in Medicine?
A senior medical student ponders when does tough love blur into bullying territory? Is it used to excuse bad behaviour or can it push us to be more resilient?
The registrar was getting ready to close the patient on the operating table and asked if I wanted to scrub in to assist. I was two weeks into my surgery rotation and trying to do my best not to have a panic attack.
After several close calls by the scrub nurse who did her best to make sure I didn’t contaminate myself or breach the sterile field, I was in.
However, not long after my agoraphobia started up— pinning me by the throat against the wall, causing my chest to tighten, my breath to shorten and my forehead to sweat like Niagara Falls at the thought of not being able to escape the operating table once scrubbed in.
A few moments of silence.
“Would you describe yourself as a high-stress person?,” asks the surgical registrar.
“Yeah I guess,” I reply.
The registrar splits his attention between suturing the patient’s fascia; steadying his hands to ensure he doesn’t nick the vital organs underneath, and considers what to say to me.
“I don’t mean to come off as rude. But you do need to hear this.”
Another pause as he ties off another suture.
“You need to be prepared for a lot of people to be angry at you. Sometimes I’ll say something harsh and I can see you freeze up, and take it really personally.”
True. Already I feel like I need to prepare a defense. I force myself into a calm and let the words flow over me, trying to hear what he has to say and not react to them straight away. But I already know it’s true. So often, I’ve ruminated on some criticisms this registrar has given me, which has sometimes gone on for days, with me catastrophising on said thoughts, letting it impact my mood.
“You’re going to have a lot of harsh bosses, some people who are going to yell at you, and you can’t be so reactive,” the register adds.
Some feedback I had received from my last consultant had talked about a certain fragility from my end, which I dismissed at the time in righteous indignation, but perhaps I shouldn’t have been so dismissive.
“You need to be able to brush off what people say. Take on what they’re saying, because they will have some feedback you need to take on, but not let their tone get to you,” the registrar goes on.
There was a lot of truth to what he was saying. He also commented on how I was so rigid around him, and even walking into the sterile field, I was just so stiff and on edge, which was true, I was anxious as heck, but I wasn’t going to tell him that.
The next hour was spent in gracious frustration— the oxymoron is most certainly real. I was shown how to suture, and how to properly assist in closing up. “You’re getting better,” he reassures me.
Later that day I went home, and slowly digested the conversation I just had.
I came to the conclusion that I was unnecessarily anxious in theatre. Seriously, what was there to be anxious about? I attempted to banish my agoraphobia and come to the realisation that there was honestly nothing to be so worked up about. With this in mind, I tried to change my mood for the rest of the rotation. And I did, which is a miracle by all standards relating to my mental health experience. As the rotation progressed, my anxiety lessened while I became more familiar with the theatre and the staff. I acknowledged this is how I work and actively tried to initiate a change in my behaviour. I almost forced myself to be more relaxed, putting things in perspective, questioning why I was actually anxious, and for once, actually settling. I got through the rotation, not having the best time, but I got through it.
Two weeks later
I was chatting with two of my friends who were also doing their surgical rotations and we were all bringing up what our experiences had been like.
To some degree, we had all been bullied.
We all agreed we had it tough, but for different reasons. On top of the bullying, one of us was being neglected, another was being made fun of by the seniors on the team, two more were being guilt-tripped to stay overtime. I believe 12 hour shifts for medical students are unnecessary when they aren’t contributing to the team because they can't be at the tail end of the shift, nor are they actually actively being taught, but they’re expected to be there.
I had brought up my conversation in the theatre, and my friend was outraged.
“They’re literally only saying that to excuse their bullying.”
This isn’t new, the culture of bullying and unsupportive environments in medicine are well documented. According to the 2020 Australian Health Practitioner Regulation Agency (AHPRA) survey one in three trainee doctors in Australia have experienced or witnessed bullying, harassment or discrimination in the 12 months prior, but just a third have reported it. Furthermore, the survey found that Aboriginal and Torres Strait Islander trainee doctors were nearly twice as likely to have experienced or witnessed bullying, harassment and discrimination.
While the culture is slowly changing for the better, and some rotations are by far better than others, there are still seniors that tell juniors that they need to “toughen up” to criticism or “be more resilient” when it comes to being overworked and underpaid. Unfortunately we’re seeing this play out in the recent class action filed against Victorian hospitals over the systemic and widespread underpayment of junior doctors. With junior doctors saying they were repremanded or labelled as “incompetent” or “inefficient” if they tried to claim regular unpaid overtime hours.
Tough Love or Bullying?
Was my registrar trying to be helpful with some tough love or was he trying to excuse bad behaviour? I’m sure most seniors think they’re doing the best by you. Even if their means aren’t the best way of going about it. Maybe it’s learnt behaviour from how they were trained? But is it the best way to help us grow?
Did I need to ‘toughen up’? Most definitely. I think everyone needs to be able to show some perseverance in hard times. You can’t control others, but you can control yourself, and doing so requires some perseverance.
But does being tough mean you need to endure unnecessarily harsh behavior or excuse bullying? Oh lord no. No one should be bullied, belittled, or unduly disrespected.
In spite of all these musings, I did appreciate the conversation I had with the registrar. I think those were words that I needed to hear and I felt that I grew from the encounter. I don’t think tough love is always the answer, but sometimes it is - as always, however, where the message is coming from, and how it is delivered makes a massive difference.
Did the registrar have the conversation to excuse his behaviour? I think partly so. I think he did want to help, but my observations tell me that if he didn’t have to be nice or patient with junior staff, he wouldn’t have to.
In the end, I feel ambivalence in my heart. On the one hand, immediately following the conversation with the registrar, I became noticeably calmer and more relaxed. On the other hand, my despondence with the system that allows harsh behaviour to exist has only grown.
Hopefully there is enough momentum in place to completely rid hospital culture of systemic bullying, and any remaining cases become only unfortunate outliers. As for me, I hope I have learnt something in these past six weeks, and have grown from this conversation. I’ve taken the good from it, that being too anxious in these situations is unnecessary and I've disposed of the unhelpful elements—harsh or rude behaviour is still inexcusable.
What do you think? Head over to our community forum to discuss with fellow med students and junior doctors.
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