As someone who's been on both sides of the reg line an unaccredited surgical registrar gives an insight into what to do when you cop those blunt or harsh comments as a junior doctor and how we can work together more harmoniously and effectively.

Time and again I hear junior doctors complaining of their registrar being mean to them and the unspoken culture of sarcasm and bluntness that some registrars lead with.  Now that I am a junior registrar, I have straddled both sides of this – I have been the junior doctor exasperated after my registrar has had a stern word to my co-intern/resident and me for not achieving what seemed like a small unimportant task in amongst the time critical and other vital tasks we completed over our 12-hour shift.  I have also been the registrar catching myself when I feel frustrated, taking a deep breath and trying to respond with neutrality when I really want to show my annoyance instead.  But here’s the thing, (almost) no one jumps through the hoops to become a healthcare worker because they want to spend their days being mean to their junior co-workers.  So why are registrars so mean?

Before we dive in, let’s be really clear that there is no place for bullying, discrimination, harassment, sexism, racism or any of the other prejudice in medicine.  There is no place for unacceptable behaviour in the modern workplace (with all training colleges in support of healthy workplaces).  If this is happening you should absolutely escalate this situation to your supervising consultant, if you experience behaviour that crosses the line. 

What is more nuanced with the mean registrar, however, are those situations leaving you feeling deflated and anxious. Those situations where microaggressions, passive aggressive statements, shortness and sarcasm leave a sting and not only make your day harder. These are also more difficult to characterise and explain to someone else (and at times yourself) why it left you feeling so defeated.  Other situations you may face as a junior doctor are displays of ego-driven poor behaviour by an outlier example of a registrar, which is unacceptable and thankfully uncommon.

Here are some factors which may influence a registrar’s experience and approach. 

Imposter Syndrome

Have you ever been grilled by a registrar about the specific ins and outs of a rare presentation, or had a registrar refuse to take your referral until you had every last snippet of information?  Sometimes these responses from registrars are driven by their own feelings of fear, self-doubt or feeling out of their depth.  

Taking the step up to being a registrar is challenging and at times can be overwhelming – particularly in your first registrar role, which may be compounded by other factors such as being in a rural hospital or a lack of support from your supervising consultants.  Sometimes the mean registrar is suffering from imposter syndrome (Read this article if you don’t know this term!) and may not realise that their own anxieties are coming across that way to their juniors.

Securing a Training Position is HARD

The modern registrar has multiple competing interests.  In addition to competently fulfilling their job requirements, prioritising safe patient care and being a team leader and team player, your registrar is also trying to secure or stay on a training position.  The challenges and bottlenecks in training programs in Australia means that your registrar may be undertaking formal education degrees, preparing to sit multiple exams, attend training courses and conferences, conducting research and writing up publications, fulfilling teaching requirements to medical students and junior doctors, completing unit meetings and audits, all in addition to the personal commitments that can be as variable as anyone navigating their late 20s -early 30s.  I am exhausted just listing the things I am currently undertaking as an unaccredited surgical registrar – and this list looks very similar for my colleagues training to be physicians, anaesthetics, emergency department doctors, general practitioners, radiologists etc. 

Getting accepted onto training programs is increasingly difficult, competitive and erroneous.  In fact, many consultants will often remark – “I wouldn’t get accepted into training if the requirements were like this when I was applying!” So spare a thought for that mean registrar, as they may just be really tired (and need some food and water)!

I am exhausted just listing the things I am currently undertaking as an unaccredited surgical registrar.

It is almost never about you (and often about them)

Sometimes people just have a bad day, but in medicine the incidence of burnout is incredibly high. It can mean that sometimes the registrar being mean to you isn’t ok themselves.  Burnout is characterised by feelings of total exhaustion, depleted energy, feelings of cynicism or negativity towards work, and reduced professional efficacy.  So, when the surgical registrar you call from the emergency department with a referral is unnecessarily blunt to you, or when the radiology registrar denies your urgent imaging request until you come up with another reason why, or when the medical registrar chastises you for not knowing every detail about the pathophysiology of atrial fibrillation, maybe that registrar is struggling more than you realise.  

My biggest advice if you are on the end of a mean registrar is to take a deep breath and remember it is almost never about you. Next, keep it fact based when reflecting on the situation, are they giving you constructive feedback that will make you a better doctor for your team and patients (eg, asking for more information so they can triage a patient referral)? This is very different advice from something that was said to my junior recently, a condescending, “have you even heard of the ISBAR handover format?” 

Keeping it fact based can also be a really good tool when responding to a mean registrar – avoid generalisations and reactive emotional responses.  It is also good to remind them that we are all focused on patient care, so being dismissive or making things personal, is not appropriate in the workplace. 

I strongly encourage you to not only debrief and vent to your fellow junior doctors, but to also ask for help from a senior registrar if this is a pattern of behaviour that you are experiencing over and over from a particular registrar.  As previously mentioned, bullying, harassment and discrimination are not acceptable in the workplace, so if you think it is beyond someone having a bad day, then seek help.  If you aren’t getting support from senior registrars, don’t forget that everyone has a boss, so escalate this to the consultant assigned to supervising interns in your unit, or your intern supervisor at your hospital.  

I know that seeking help and reporting bullying, harassment or discrimination is an impossible task for a junior doctor who precariously relies on seniors for clinical referees, future job contracts and support in securing a training program position.  Fortunately, the culture of medicine is changing, so find an ally in a fellow or a consultant who can help guide you through this process if you do need to escalate the situation – and don’t forget this is a stepwise approach and may not need to escalate to a formal complaints process, if the initial conversation is enough to improve a doctor’s behaviour. 

Finally, the day-to-day challenges of hospital life and being a junior doctor are easier to manage when you are well rested, fed and watered, and have had a break! Don’t be afraid to step outside and grab a coffee and food with some fresh air if you have a negative experience at work – this mental reset will make the rest of your day easier! 

If this strikes a chord and you need support, DRS4DRS promotes the health and wellbeing of doctors and medical students across Australia. They’re here to help you find the support you need. Find out more at: www.drs4drs.com.au