If a medical trainee does not conform or chooses to challenge the ‘status quo’ they can be labelled a ‘trouble maker’. The GMC in their guidance ‘The Duties of a Doctor’ state we should respect each other’s diversities and individual skills. This on the whole does not happen. Doctor’s choose to ‘obey certain rules’ but not others. They know they should not have a personal relationship with a patient but then display undermining behaviour and bully colleagues/junior staff. I feel these behaviours are completely unacceptable and must improve to benefit doctor’s mental and physical health.
I am 38 years old and have dual membership of the GP and physician colleges. During my initial GP training things felt ‘fine’ as I thought the feeling of bullying/undermining behaviours were normal but when I returned ‘grown up’ to retrain I realised these behaviours were unacceptable. It lowers your confidence and risks making you physically/mentally unwell.
I am sure I would not have been successful with retraining if I had not been excellently supported by a few consultant colleagues. I also know I would have failed if I did not ‘put the head down and get on with it’. I quickly learnt to ‘do as I was told’. There is little or no mutual respect and the consultant trainer can be ‘god like’. I learnt if I had a different personality from my trainer this was not acceptable. One is encouraged to question things but if you do it can be the ‘nail in your coffin’. You must conform in this hierarchal training system. I have wanted to leave medicine many times due to these behaviours but it is my love for good patient care which motivates me.
I somehow wish the GMC could regulate these damaging behaviours better. I am not ‘fully sold’ on the concept of trainees improving ‘resilience’. This is obviously important but I feel this is a way out of not tackling the poor behaviours. I am of the strong opinion that most trainers have little self awareness. Courses do not alter these behaviours if one does not wish to change and these individuals attend the courses to ‘tick the box’. MSF is not accurate as one picks the staff they know will give them favourable feedback.
How do we fix this?
We can’t fix this. We can’t fix it given the personalities medicine attracts and what motivates why certain people enter medicine. However I think we can make improvements. We need to start at the grassroots and involve medical schools. This has already been talked about nationally. In an ideal world we would have ‘all rounders’ admitted to medical school and not necessarily the ‘bookworms’. This may seem harsh but there is a lot to being a successful medic. What the GMC could do is to incorporate self-awareness into training and appraisal. The tick box exercise of doing a Myers Briggs test is pointless as few have little interest in altering their behaviour. There needs to be robust systems in place to improve the NHS culture and try and remove the blame culture. I feel this is exceptionally difficult as it may be those who are open to change that welcome/embrace this. It tends to be those with lack of self awareness that are the ones who need to be targeted. It has been proven time and time again that good leaders can get good outcomes from their teams which will ultimately benefit patients. This can result in less burnout and sickness absence in the NHS.
I for one would like to think I will never make my juniors feel like I was made to feel. I am glad it is over for the ‘second time’ and there will be no ‘third time’. Hopefully in my lifetime I will see NHS culture improve? I feel I am in an informed position to make these comments as I have been trainee then trainer then trainee again. I ask us all to be mindful that every member of the multidisciplinary team are equally important.