Imagine you just got a new job, you will be a doctor working in the emergency department. You have never worked in an emergency department before so you are a little bit nervous but you know that those more experienced than you will guide you and teach you. It’s now 3 weeks into your new job, things are going all right, it’s not as great as you had expected, it’s busy, the hours are long and not everyone is nice to you, including your bosses. But you plod along, doing the best you can for your patients.
On one particular day you are working under a very pushy boss, who is pressuring you to see more and more patients, sometimes to the point of having 4 or 5 patients under your care at once. You don’t feel comfortable, you feel stressed, you don’t think you can do your job safely with this much pressure to see so many people in such a short time frame, but your boss keeps pushing.
One of your patients is getting admitted under the infectious diseases team for a particularly nasty infection. You have done everything for this patient, you have taken a history, examined them, taken bloods, ordered radiology and contacted the infectious diseases consultant who tells you to give the patient a dose of gentamicin, among other things. The patient is about to leave the emergency department and go to the ward, you are getting pressured by nurses to hurry up and chart the antibiotics, you are getting pressured by your boss to see two more patients one who is category 2 (must be seen within 10 minutes) and you still have 5 other patients under your care who need an assortment of other things.
You look up the dose of gentamicin, it’s given by weight. But you make a mistake; you chart the dose according to the patient’s actual weight and not their ideal weight. You don’t realise, you chart it among the patients other medications and they are sent to the ward, no longer under your care.
Hours later, as you are 5 minutes into seeing your 8th patient, you get pulled away by the infectious diseases consultant who has come down to see you. He pulls you away from the patient and takes you to the middle of the emergency department where doctors and nurses congregate but also in clear ear shot of the whole department, and starts ripping you to shreds for your mistake. The abuse continues for several minutes in front of the entire department. He leaves. After recovering from the shock you try to hold back the tears and make your way to the bathroom where you sit for 2 hours, crying. You are such an idiot! What a moron! You shouldn’t even be a doctor! What a waste of space! These are among some of the thoughts that go through your head.
Unfortunately this is not uncommon in our hospitals. It’s something that has been long tolerated in the medical profession for reasons I cannot understand. This verbal abuse and humiliation is something I have witnessed quite often. The abuser is usually a consultant or a boss, and what happens to them? Is there any disciplinary action for this abuse? No. A report isn’t filed; there is no human resources department, the new doctor is made to feel so worthless that they think they actually deserve it. In any other workplace something like this would not be tolerated. But for some unknown reasons, doctors treat other doctors (their juniors) abusively. Doctors are human beings; we make mistakes like anyone else. No harm came to that patient. When mistakes happen they should be a learning opportunity to prevent them from recurring. The only thing the doctor in the above scenario learnt was how hopeless and useless they were. It will only make them afraid to approach senior staff for help or to ask questions in fear of being abused, which is dangerous for patients. I will continue this topic of abuse in part 2.