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Demoralization in the Process of Medicine?


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Came across a post on another web forum (R E D D I T) talking about how along the general process, demoralization commonly occurring within the learning setting, starting as early as they enter 1st year medicine. How true is this within Canadian medicine and what advice(s) would you insist to those who have not yet/beginning their journey?
 

*https://www.r e d d i t.com/r/medicine/comments/a6b840/this_made_me_sad_and_angry_thoughts/

*erase the spaces. 

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Demoralization is highly individual, as everyone perceives and reacts to stress differently. There are some things that can't be taught, but are nonetheless important to have, like motivation, mental toughness and a good attitude. Some people will shrink in the face of their difficulties, but others will keep smiling regardless of what's thrown at them. For this poster, there seems to have been a large disconnect between their expectations of training, and the reality of what it actually was. The negative interactions with their attending seem particularly problematic for them. 

I did my clerkships in the United States, but completed residency training in Canada. During this time, I have rarely been treated poorly, or had the degree of burnout commonly expressed by many learners. I fully acknowledge that my experience may not be typical of others though. Having been in both countries, I can say that in Canada (or at least where I was), there was a bit more interest expressed in my personal well-being, but otherwise it was similar. It's worth noting that I did my residency in family medicine, so I'm going to make the not-unreasonable assumption that my attendings on average had slightly nicer/smoother demeanors than what might be found in other specialties, which I'm sure certainly helped.

My advice to anyone starting medical school is to remember that this training process is what you make of it. There is something to be learned from every experience, good or bad. You can learn important things from bad instructors, even if the only thing is how not to behave later on. Medical training is long, but it's also finite. Your problems didn't come to stay, they came to pass.

My advice to preceptors and instructors is to keep in mind the difference between being on hard on someone for constructive reasons, and being hard for the sake of being abusive, and to make sure it's not the latter. Treating learners well is also an extension of civility; a concept making its resurgence from an unspoken to explicit requirement for being a truly competent medical professional. There is a Golden Rule. Please follow it.

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8 hours ago, JustSoYouKnow said:

Came across a post on another web forum (R E D D I T) talking about how along the general process, demoralization commonly occurring within the learning setting, starting as early as they enter 1st year medicine. How true is this within Canadian medicine and what advice(s) would you insist to those who have not yet/beginning their journey?
 

*https://www.r e d d i t.com/r/medicine/comments/a6b840/this_made_me_sad_and_angry_thoughts/

*erase the spaces. 

It depends. 

 

You will learn a lot of things as you go through medicine:

 

a) doctors aren’t great people. They are greedy and petulant and don’t get long (ie OSA/COD)

 

b) everyone wants to work less and be paid more. Nothing a doc hates more than a non-OHIP patient 

 

c) patients and families are more demanding than ever. They trust us less and less and think Google knows more and more each day. They increasignly ask for more and more 

 

d) there is a lot of politics  Hospitals are run by suits who get paid to drink coffee. Even though you are 10 times smarter and make more money and went to school longer they are your boss. 

 

Yet despite all this there there is still a great motivation knowing you will learn some really cool things, you will help people, you will make a comfortable living and you will be a hero to some people.

 

I think the good outweighs the bad. Just don’t have too romanticized view of things. Doctors are usually just the most competitive premed jerks you knew :)

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18 minutes ago, Aconitase said:

It depends. 

You will learn a lot of things as you go through medicine:

a) doctors aren’t great people. They are greedy and petulant and don’t get long (ie OSA/COD)

b) everyone wants to work less and be paid more. Nothing a doc hates more than a non-OHIP patient 

c) patients and families are more demanding than ever. They trust us less and less and think Google knows more and more each day. They increasignly ask for more and more 

d) there is a lot of politics  Hospitals are run by suits who get paid to drink coffee. Even though you are 10 times smarter and make more money and went to school longer they are your boss. 

Yet despite all this there there is still a great motivation knowing you will learn some really cool things, you will help people, you will make a comfortable living and you will be a hero to some people.

I think the good outweighs the bad. Just don’t have too romanticized view of things. Doctors are usually just the most competitive premed jerks you knew :)

Wow....really Aconitase? I agree that the rise of Dr Google and ever-expanding administrative bureaucracy sucks, and I've got a reputation for being realistic about medicine and advising people against going into it...but you're being a bit harsh.

Doctors are greedy and petulant? Hate non-OHIP patients? Have you only worked with monsters? The vast majority of staff I've worked with have been extremely self-sacrificing. Their lives are perpetually on hold for their patients. I've also dealt with 5 non-OHIP patients in the last year, each within a different specialty, and I was SHOCKED by the quality of treatment the staff provided, and the amount of time they spent with them.

Yes medicine is hard and getting harder. Yes there is more BS and fewer benefits. But doctors are not the villains you portray. I feel bad for you, if that is the environment you were trained in.

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4 minutes ago, PhD2MD said:

Wow....really Aconitase? I agree that the rise of Dr Google and ever-expanding administrative bureaucracy sucks, and I've got a reputation for being realistic about medicine and advising people against going into it...but you're being a bit harsh.

Doctors are greedy and petulant? Hate non-OHIP patients? Have you only worked with monsters? The vast majority of staff I've worked with have been extremely self-sacrificing. Their lives are perpetually on hold for their patients. I've also dealt with 5 non-OHIP patients in the last year, each within a different specialty, and I was SHOCKED by the quality of treatment the staff provided, and the amount of time they spent with them.

Yes medicine is hard and getting harder. Yes there is more BS and fewer benefits. But doctors are not the villains you portray. I feel bad for you, if that is the environment you were trained in.

I don’t think it’s rhe environment I was trained in. I did not always think this way but it’s gotten very bad lately. 

 

How do you explain the OSA and COD? Are you on the FB groups and seen the infighting with the group. I am being very kind calling it kiddish behaviour - it’s much worse. They are literally tearing into each other over one thing. Money. 

 

In in terms of non-OHIP it might be where I’ve worked. They see on average 1-2 non-OHIPs a day per doctor. So they tend to be very upset about them. 

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Just now, Aconitase said:

I don’t think it’s rhe environment I was trained in. I did not always think this way but it’s gotten very bad lately. 

 

How do you explain the OSA and COD? Are you on the FB groups and seen the infighting with the group. I am being very kind calling it kiddish behaviour - it’s much worse. They are literally tearing into each other over one thing. Money. 

 

In in terms of non-OHIP it might be where I’ve worked. They see on average 1-2 non-OHIPs a day per doctor. So they tend to be very upset about them. 

I don't explain the COD and OSA by saying that my wonderful respirologist cares about nothing but dollar bills and is a terrible human being. That's a stretch WAY too far.
"Doctors" goes way beyond the small percentage of practicing physicians from higher-billing specialties that are fighting dirty to protect their income.

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2 minutes ago, PhD2MD said:

I don't explain the COD and OSA by saying that my wonderful respirologist cares about nothing but dollar bills and is a terrible human being. That's a stretch WAY too far.
"Doctors" goes way beyond the small percentage of practicing physicians from higher-billing specialties that are fighting dirty to protect their income.

It may be a stretch to paint everyone like that. But you must admit it’s disheartening to see the public infighting within the physician group about money. Really doesn’t paint us all in the best light overall

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Just now, Aconitase said:

It may be a stretch to paint everyone like that. But you must admit it’s disheartening to see the public infighting within the physician group about money. Really doesn’t paint us all in the best light overall

Yup, I agree that sucks. Just like it sucks that admin keeps growing and income keeps dropping. But I sure as hell don't agree that that fighting is representative. There are something like 30,000 doctors in the province, and the loud/aggressive ones are pretty obvious, and yet they make up a tiny percentage. You're painting the other 95% quietly hard working and extremely self-sacrificing doctors, who delayed gratification for decades, as evil. That's a little unfair.

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Just now, PhD2MD said:

Yup, I agree that sucks. Just like it sucks that admin keeps growing and income keeps dropping. But I sure as hell don't agree that that fighting is representative. There are something like 30,000 doctors in the province, and the loud/aggressive ones are pretty obvious, and yet they make up a tiny percentage. You're painting the other 95% quietly hard working and extremely self-sacrificing doctors, who delayed gratification for decades, as evil. That's a little unfair.

That’s a fair point. I guess my point is that if you think all doctors are nice friendly and get along and don’t care about money (which is what you think it’s like in med school) the real world is different 

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Just now, Aconitase said:

That’s a fair point. I guess my point is that if you think all doctors are nice friendly and get along and don’t care about money (which is what you think it’s like in med school) the real world is different 

and that is fair because you are right - and you already get the nice and friendly and care about money, and ha I have even run into the not friendly at all but don't seem to care about money either.

In other words medicine is the utopia of people with "perfect personalities". It is messy and complex because we are all messy and complex things. Those that expect it to be perfect will run into trouble - probably the same with anything else in life I suppose. 

I would agree with PhD2MD about this though - the majority really are hard working people that care about their patients and their profession. You have to keep that in mind when you run into one of the not so good ones!

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7 minutes ago, Aconitase said:

That’s a fair point. I guess my point is that if you think all doctors are nice friendly and get along and don’t care about money (which is what you think it’s like in med school) the real world is different 

If you think all _____ (insert any job here) are nice and friendly and get along and don't care about money....you'll be disappointed. People are people, even doctors. The fact that a tiny percentage out of 30,000 doctors in Ontario care about money enough to be aggressive about it online, just means that we're people too. In another sector, you'd probably see a larger proportion being aggressive.

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2 minutes ago, PhD2MD said:

If you think all _____ (insert any job here) are nice and friendly and get along and don't care about money....you'll be disappointed. People are people, even doctors. The fact that a tiny percentage out of 30,000 doctors care about money and are being aggressive about it just means that we're people too. In another sector, you'd probably see a larger proportion being aggressive.

Don’t disagree. I think the public nature of this is my biggest problem with why I find it demoralizing. Colleagues openly attacking colleagues. Just follow KG and COD Twitter or their news conferences. While it may be a small minority they are very vocal and very public 

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On 12/15/2018 at 10:36 AM, Aconitase said:

Don’t disagree. I think the public nature of this is my biggest problem with why I find it demoralizing. Colleagues openly attacking colleagues. Just follow KG and COD Twitter or their news conferences. While it may be a small minority they are very vocal and very public 

The best thing to do is to stop following them. I know nothing about whats going on apart from that they don't agree and theres a new specialists association. I haven't heard about the drama in a year. I don't even know what KG and COD stand for. 

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