Well the lesson you got was don’t say anything you push back against these people right they can ruin your career right you’re done right and and and no one will help you right that’s the thing they even know they know what is being done they know why it’s being done
Nobody’s going to help you so what do you learn from that you learn you know I’m either going to stick my neck out there and potentially lose my head right or I’m just going to shut up and keep trying to push right welcome back to Dear Healthcare it’s you all right we
Are back with Dr Elisha yagai thank you for being here thanks and we picked up last time or we left off last time on you transferring you needing to transfer schools because you were going to medical school in New Orleans right when the hurricane hit and all that aftermath
So let’s pick up there as you were describing that kind of process of needing to apply to transfer and how much of a headache that was and how you really were kind of left in this influx right there of just not knowing what to do and it being quite aggressive in some
Ways on both sides the students and the faculty in that position so let’s pick up there particularly the third- year medical students that was one of the hardest problems to solve because of because of the type of training you do in the third year so the school had to
Figure out how and where to continue clinical training right there wasn’t at least to my knowledge there was not a clear contingency plan on how to do that nothing had ever been developed for the scenario that went on cuz how long was it until like hospitals were back up and
Running even just for regular oh in New Orleans it was months other other places were functional you know okay um the the hospitals were running but the real issue was uh first there was no communication whatsoever right uh then eventually there was a little bit communication a little bit of
Communication but it was limited right and then began the process of oh we’ll have a plan for you next week next week next week next week uh a plan for you in terms of like where might what we going what are we going to do right how are
You going to continue training so we had been you know at that point we were more more than a month out right uh we had and and again like at that point I was sleeping you know on the on the floor of a friend’s apartment right were you back
In New Orleans at that point no no I was was okay yeah but you know and and uh and I was eating cereal because that’s all I could afford because I didn’t have any financial aid money so this was a real issue you know and I didn’t have
Any of my possessions because those were all stuck in New Orleans so from from the perspect from my perspective and that of many of my colleagues in the class we were in a really difficult situation yeah we were look we were looking for some kind of guidance leadership answers which largely were
Not forthcoming right uh and as as that situation deteriorated over time and as there kept being Miss deadlines and just things not happening and lack of communication Etc many of us got more and more disenchanted um and so began to say well I think we’re going to have to just fix
This no one is going to no one is going to save us so we’re going to have to fix this scenario ourselves and bear in mind while this was going on we again were watching the university make Provisions for various other types of students right how long was it would you say like
The start of this curve of people starting to make that jump of saying I need to go somewhere else it took place over several weeks initially in the initial stages everybody was 100% in rally around the institution right this is terrible we’re all in this well you
Were all put into this position because of the hurricane where you were all stranded deal with house stuff all yeah all all of these things were happening the issue so it was not like hey you know the school took a hit let’s get out of here right it was the school took a
Hit everything is chaos we get that but there was no again there had clearly been very little planning yeah there was no execution no in place and minimal communication right so and just to sort of trust us we’ll fix this at some juncture and at some at some point in
The beginning the no communication was because of those servers being down email communication but then became online again at the students fixed that actually so the students went yeah created a created a you know uh basically a chat group I think it was on Yahoo if I recall correctly at that
Point but that’s that’s how we were communicating with each other so students set this up and began to you know build in the administrators and kind of reach out to people and and get things going so communication began but then kind of after as this environment
Really began to sour over time uh then people started to look for alternatives to say okay I got to do something uh my education is being substantially disrupted here I don’t know what to do yeah so then then some people began to reach out and then uh you initial
Initially uh the schools that so people would reach out to different institutions usually wherever they were from right there was an initially favorable response from those ins from those institutions saying yeah we understand your situation right you can come and work with because we weren’t at the time we weren’t even thinking about
Transferring we were asking can I just wrot rotate with you so that I’m doing something just to be doing some clal can I just come in and do some clinical work so that I can just keep moving forward right okay and we can worry about what
It looks like later it wasn’t I want to transfer to you it was I just want to just not be sitting here doing nothing at all right is that unprecedented or does that happen sometimes within the medical school well there is there is preced for we going to rotate at another
Institution so for example like if you’re a fourth year medical student you you really want to do residency at some Hospital right you might try to set up an away rotation there oh where you go there and work with them for a month so that they get to know you so that’s not
Totally abnormal it’s not it’s not insane no it’s just not usually done during third year usually because you’re usually rotating at your home institution yeah so that was the initial thing and and so we went from favorable response yeah we could probably do this to Dead Silence to nope not going to do
It and eventually what happened actually was that one of the students got word back from the administration of one of the medical schools that had been will willing to take him to do a rotation with them saying sorry we’ve received word from your medical school to not
Accept you not again not to transfer just to rotate and do some get some clinical more clinical training right so with the intention of returning when it was back with the intention of returning when things were back right so they blocked that and when that happened that is when things began
To go south because all of a sudden we’re saying wait a minute we weren’t trying to leave we weren’t trying to ask for our money back we were just trying to find a place to go in a very unusual situation to keep training and you have
Gone interest oh and I I should add in that environment we were being told we could do this I forgot about that aspect of it we had even talked about it and they were told oh yeah go go find you know if a place will let you work with
Them then work with them their issue at the time this is what we were told right so we were being told publicly go seek this out privately those institutions at least from what they shared with us was they were being told by the very same people don’t take our
Students that burned the trust down right really really quickly and really quick question about like the financial piece because you had mentioned you’re not receiving financial aid during this time would that financial aid have been from the school itself it was that from elsewhere the money would come into the
School then the school was supposed to it to distribute it out to you right so it was loans and other things that you had taken right that medical student Deb is usually because you weren’t in a clinical setting right there no what had happened actually was they they often
They often messed up at least at this era in that school they often messed up your financial aid so our financial aid had not been distributed on time it should have been distributed before the hurricane hit oh it was not distributed on time so we were already late so it
Wasn’t even about the hurricane initially and then it was just because the infrastructure was all B once it all got right then it was like who knows when the money will show up right and actually in the end for many of us the reason we were able to make Anyan meet
Was because at that point FEMA had made payments to people in the area they just deposited money into your bank account okay not even student wise in general I was down to I forget what I had like maybe $50 or something like that was it
That was all I had uh and then FEMA F showed up and you know put some money in my bank account and that was how I was able to afford anything else at that point right so because I was living entirely off financial aid so and I
Think many other students were in a similar situation so that was the problem so the trust got broken because again it was public statement here go do this and then private statement were actually actively subverting you in the background and so then we were like well
If you’re not being honest with us about this what else are you not being honest with and then it was well then okay then then add to that well we have a plan well what is the plan we’ll tell you next week oh the next week comes we’ll
Tell you actually next week so the trust began to break down and then in that context we began to see okay you’ve handled your undergraduates you took care of your your pre-clinical students in medical school you took care of your you know fourth year St you take care of
Everybody but us in this third-year class we’re not taken care of and again in retrospect that was probably the heaviest lift in terms of getting something done but was to find those clinical SP to find those clinical spaces right but there was no honesty right that was really the problem it
Wasn’t hey this is a huge disaster it was the ya mentality rather than it being about you guys like making sure everybody’s taking care of clear communication really was about the communication right it and and I think that was that was the first problem right and it it went back I think I
Think from their perspective I think they felt this was a matter of institutional survival to some degree I think they thought that allowing people to leave in any context was going to lead to mass flight which is going to lead to essentially dissolution of at least that year possibly the institution
Right at least is going to lose all of its students or lose many of it students I don’t actually think that was true and I can say speaking from the perspective of both the students and all the conversations we were having on the side that wasn’t where anybody started right
That was where we ended because of the perception of dishonesty and subversion right on the part of the administrators that were responsible for that at that point in time that was the issue and how old were you then I was probably 25 maybe 24 25 yeah I mean had you felt
I feel like at that time in a lot of people’s lives that’s a time that you you often are starting to kind of feel some disillusionment with some authority figures in a way that you haven’t felt regardless of extenda circumstances had you maybe started to feel that at all
Prior to this was this really like glaring like opening that door toward like oh like I’m not I’m on the path but like it’s not the you know yellow brick road that I was told it was I we had already at least in that institution
We’d already had a little bit of that a little bit of that you know just to give you here here’s another example so I go to a lecture by the local one of the local I think he was a toxicologist if I recall correctly M and he spent his hour
With us trying to convince us that cigarettes actually were not harmful this is in medical school oh cigarettes were not harmful and why why was that an important turned out that he was a he was one of the docs that testified on behalf of the cigarette companies in the
Past yeah but this this doctor was a faculty member right in in the school and so we’re so we’re sitting there as I I think it second year in medical school right we’re sitting there saying well this you know kind of goes against oh I don’t know everything we’ve
Been taught everywhere else and all the scientific papers we can find and everything else you’re giving us like you’re giving us the industry lobbyist argument right you know what I mean it was like it was like a Thank You for Smoking moment right but we’re like but this is you’re
Not you’re not in Washington DC talking to a senator right you’re a professor of medicine at a medical school so there were experiences we had like that um that you know would at least raise your eyebrow that’s probably the way I describe it so there were you know there
Were elements of that there but this was I think the first big on on in the medical world institutional failure I think that that we saw and you know in retrospect again maybe in maybe institutional failure is too strong a word for the circumstances but and you
Guys were the ones paying the price for it or you were left figuring out where to go and then being told to go and then being told you can’t go yes that’s right basically just getting getting jerked out so how did you end up finding where you ended up transferring how did you
Find your way into that yeah the Well in that situ so what happened at that time actually was that um uh my my girlfriend was at UT Southwestern that time now my wife um and so I thought well you know maybe I’ll just try to go up there yeah and
And that’s Dallas that’s Dallas that’s right don’t know and I went through that iteration basically of going and talking to the administration and over time and we had some conversations and basically explaining at this point given everything that has gone on yeah I don’t want to be there anymore
Because I have lost confidence in the institution right so you were initially seeking to transfer you didn’t do this piece of like trying to find a clinical place no initially initially initially I had and other colleagues had but but became okay this is not about just a
Rotation anymore this is I don’t think these folks I think they have put the interest of the institution above the interest of the students that they’re allegedly serving right which is a kind of a common that’s an important part of your culture and your stance on a lot of
Things I mean that’s yeah this was the yeah it’s that it’s that problem that I think we see increasingly in American society right where the institution exists for the sake of its own perpetuation right right allegedly it serves a mission right but in reality it’s made Mission from its perspective
Is that it should keep going right no matter who gets sacrificed or what has to be done it should keep going there’s never a point at which it says well maybe I don’t maybe I’m either not fulfilling my mission right should we look our or maybe I shouldn’t even exist
If I can’t fulfill my mission right instead it’s just how do we keep these wheels turning yeah it’s that institutional inertia so it had that that feel so I went and have that conversation with them uh ultimately you know they with just to clarify with Southwest with Southwest yes so I had
The talk to the administrators there and then I and then while I was doing that some other students were talking to other institutions right and so some of us were able to get transfers yeah right out of uh out at that point and that is when the gloves really began to come off
So then other students saw that happening and said who felt very similarly yeah so they also began to have those same conversations and we getting some favorable responses yeah and then that’s when all that other stuff you know happened where people were having the transfers extended and
Then rescinded right um you know based on just phone calls that were going on in the back channels all from like people in your cohort like was it like a lot that were having issue significant number yeah yeah was a significant number of people uh because tan Drew
People in from around the country right and so when this happened people got scattered they of went back to the home Community uh you know and then there the the local medical school was willing to accept them right and at that we looked up the regulations so that the only
Thing you needed to have was an accepting institution so it wasn’t like you had to be cleared by the in you were leaving but what was really happening was the institution that was being left effectively did have to clear you and was calling and getting people’s transfers yeah like and forcing them to
Stay yeah that’s correct and so as you transfer to Southwestern were you able to start right away like and go in mid clinical relatively quickly yeah I started on a rotation with I forget how long it took it was it wasn’t very long it was a couple of weeks something like
That um and then I started on a rotation there right yeah and I when we were talking prior you mentioned off camera that I want on film for us for our listeners but um you mentioned a difference in culture and in Prestige at the institution you were leaving versus
The institution you went to can you speak to that a little bit yeah I mean so you know uh medical students tend to take rankings very seriously you know what they actually mean is a very different question that’s a whole different discussion in terms of what value they really have and how they’re
Determined but US News stands by them so we won’t get into that today okay another another there yeah it’s it’s there’s a lot of there’s a lot of stuff in that that is not really accurate but um but be that as it may so uh yeah Southwestern is a higher rated uh
Medical school in those in those rankings okay that’s not the same thing as in terms of what quality of Education whatever else is offered that’s very difficult actually to compare but in national ranking but in terms of national rankings right is a higher ranked place and then the culture was
Also very different and I would say Tan’s culture was much more overall much more collegial friendly uh and Southwestern’s culture was much more non-c collegial and unfriendly what do you mean by that like oh it was just much more abusive yeah yeah 100% in terms of like your load your workload
I’ll give you an example so I went into my obstetric rotation obstetrics at Southwest is a very wellknown very well respected residency uh they recruit very well and it’s a very high intensity place they have very high volumes yeah and I’m is like baby delivery baby
Delivery right yeah so I went into that uh that was my second rotation there I bear in mind I i’ the only thing i’ done before is I did I start up in Psychiatry at the Children’s Hospital which had a totally different system different computer system right so I’m going to OB
This is my first I don’t I’ve never been in this hospital I don’t know the computer system I don’t know I don’t know anything right there is no allowance made for that whatsoever in terms of in terms of how how we were treated bring you up to speed it was
Just expected like if you don’t I I would get chewed out for not knowing a paper thing that there was no way for me to know because I had never been there before right no training on that end there there was no there was no nothing
We just got thrown into it right which understand again right as a transfer we kind of got slung in the middle of the Year this is irregular we didn’t even start with orientation right what about for students that had been there the whole time were they having similar
Issues like being chewed out not from well yes people got chewed out but not in the same way because they at least knew what to do right and they’ve been there for a couple years already system right they were in that but you know it
Was like um there so for example in OB there was a resident room room there was a there was a room on the OB board right if if you were a medical student you couldn’t go in there unless there was a resident there oh like let’s say you
Weren’t doing anything at the moment you could not physically go into the room or sit in a chair because bre just a break room just a break room that’s there’s nothing magical going on in there it was literally a break room you could not go
In you had to sit uh in chairs along the along the wall and and appear to be reading an OB textbook that’s that’s what you could so you either were in a room doing something or you had be sitting on that chair reading to be reading you don’t have to read it but
You have to look like it this this is the case right so so I never forget one of the early ones I get we what we would do in there is go into baby deliveries or go into C-sections yeah these are the two things we would do in the C-section
As the medical student right you would stand there and hold the retractor what is a retractor a retractor is basically a device that’s meant to kind of open so if they make an incision they make a cut right to open up to open up the abdomen
Right and then going to open up the the the uterus or the wound get the baby up someone has to hold a metal device to just keep that open while they’re trying to work right so as a medical student you’d stand there and hold the retractor
Okay and a lot of times they’re they’re busy they’re doing whatever no one’s talking to you no one’s teaching you anything right you’re just you’re just standing there as a hand and you’re supposed to be learning I guess by osmosis who St right so by this time you
Know I was like I don’t think I I don’t think C-sections you know number one I’m not learning anything when I’m in them right number two I don’t think that this is a thing that I really want to do right uh in the long term so I don’t
Know that I’m gaining very much from standing there what I did want to do was be able to deliver a baby right so so I tell my senior resident I can I not go to C-sections can I just go to the actual uh you know vaginal deliveries
Right that are going on because I really do want to be able to do that and I need more exposure to that I need more of these that was that was my logic right you can critique it you can say that was wrong but that was my reasoning I tell
The senior resident this uh I go to sit down in my chair it’s it’s like 4 in the morning right and I’m sitting there trying to read my text 4:00 in the morning I fall asleep right I wake up in theair in the i w up in the
Chair in the hallway I fall asleep doing this I wake up the attending physician is is kicking my foot to wake me up this is really the case okay he’s kicking me in the foot to wake me up I wake up he takes me in the back room and chews me
Out because I have told my senior resident that I do not want to do any C-sections ever again and that like this is totally unacceptable right and I’m like well that wasn’t the conversation we had the conversation was if I have a choice between these two things I would
I would like to do the deliveries for the reasons that stated right right but it was very in other words it was a come in with guns blazing don’t ask any questions right guns are blazing right you have you by question down Authority on like very much yeah very very much
Was it more collaborative in Tain yeah and I didn’t do obstetrics there so I can’t but in general yes the F was a little bit more U was a little bit more collaborative in terms of working with your supervising positions right so there was there was that and then there
Was um there was an internal medicine uh rotation had so what the what the attending there would do his thing he seemed to enjoy humiliating the medical students like this was his thing he was known for this like this wasn’t just us yeah so like he had a fun hazing oh 100%
Right and so and the thing is this in in medicine like any any professional skill right the more you do it the better you get at it usually hopefully right and the more hopefully yeah it’s not not always true but it could be and it and it feels easier to you in
Other words right over time I would take you know just I if you’re trying to do basketball right start off you’re shooting you’re not very good right you shoot several thousand shots a day or whatever it is right eventually it’s really easy for you to make that shot
And then you look back at the 10-year-old who’s you 15 years ago right and they stink right you know and it’d be like going to them and being like why can’t you shoot right you know like I’m fantastic at this why aren’t you fantastic at it right yeah yeah that’s a
Good analogy honestly I’ve not thought about I mean medical school in that way but yeah for sure yeah you guys are learning new muscle memory you are right because so so the thing is that medicine prac medicine is rapid sequence for for for non-surgical specialist at least it’s rapid sequence pattern recognition
Right what it means is I have run through this this iteration right I’ve had X number of patients who have come in and told me this right so many times that I now know what the pattern is right I know that when you tell me this
Set of symptoms it odds are it’s this and if it’s not that it’s this second thing and if it’s not that it’s this third thing right and we’re going to work through this list based on highest statistical probability right may not articulate it in those terms but that’s
Actually what’s going on or what a flow chart basically within you right it’s a flowart you’ve internalized a flowchart right and you’ve internalized a set of rough probabilities right right yeah that you can do quickly as you could do it more exactly right so when you start
It’s like every time they come in right you have to start from zero and be like okay all right so they said they have chest pain all right now what causes chest pain again right here my list of things look at all the possibilities what’s most probable go yeah fast
Forward 15 years right if you tell me chest pain right yeah I I’m already ask okay I’m asking you a series of questions right rule this out rule that out check check check check che che che check we do all of that in 3 minutes right right but that would have taken me
An hour at the beginning right and maybe not even knowing which questions you need to ask cuz I was going to ask I was going to ask you a 100 questions right because I didn’t know how to Target my questions this is medical students are notorious for this right they take an
Hour to do an admission interview right that the attending can do in 5 minutes yeah right because of years of experience because of years of experience you know what to ask you know how to cut it down Qui right what parts of information are irrelevant you can
Filter those out and probably you know how to Circle back if there’s something that was Miss of a question that like could have been asked but was highly unprobable right to then when it’s like oh now there’s another piece of information or this didn’t work then you
Can quickly Circle back to like well I would have asked this but it was really low probability what about the know like yeah that makes sense you pull that out into this environment though enter and I think Academia may be a little worse for this but I couldn’t speak to that 100%
What you have is this weird dynamic right where you have very experienced people trying to teach people that have no experience right and and much much less knowledge and it’s a setup for abuse well and the people that are over you in these scenarios are they other
Than being your adviser when you’re in that setting like are they connected to the school regularly they’re faculty usually they’re faculty so they are teaching Persona they’re not theoretically yes theoretically yeah okay theoretically they’re teaching right but okay but Academia has a lot of personality types in it right right
There are people that are there because they want to do research they could not care less about teaching they’re just required to show up on the ward every now and then and teach people but really what they care about is the grant money they’re getting what’s going on in their
Right don’t care about teaching you clinically it’s irrelevant right for that matter they may not be great teachers right I mean a great researcher is not necessarily a great teacher and vice versa I mean they may be but they also may not be but in a lot of medical
Schools that’s irrelevant right you’re here as professor of blah blah blah you need to do X number of weeks of clinical teaching time on the wordss right and they’re there the whole time thinking about oh my project okay what’s going on with my test tubes right coach who also
Has to teach it’s it’s very much like that right and you care about one or the other but you know you don’t care as much about the other right and you may not be good yeah uh at what you’re doing so you have that and then you have other
People that I mean to some degree they like the power Dynamic right they like being the teacher they like uh being this the center of attention of the team right right they they enjoy that Vibe right they like the vibe of they’re not working with colleagues right they’re
Working with people that are inferior to them if not as humans they’re inferior them in terms of Professional Knowledge and skill all the time they’re always teaching people that know less than them they’re always working with people that know know less than them and have less experience right and they’re saying that
They like the there are people that enjoy that yeah they enjoy that Dynamic right because there’s a power Dynamic right that’s there is a power Dynamic and medical school is very hierarchical right right and if you want to achieve your goals right you need to please the
People that have the power to write your recommendations you know to give you grades right you need to keep these much push back I imagine very little right very little push back because pushing back can get you in serious trouble right right um so here again actually
Backing up a moment because you’d ask about to Lane iot this aspect also so there was a well-known senior faculty member at tane who had a notorious reputation for harassing the female the female medical students interesting including including women that were in my class right that had their own
Personal experience with this someone that in clinicals or like in a class clal yeah in clinical right so they would go in and there’d be there’ be all kinds of you know we can describe the hyink and things that he would get up to but he would get up to things that
Clearly were improper right made made these women very uncomfortable and they would go complain about it and not one thing would happen because he was a very high-profile person he had a very famous name he’s quite powerful within the specialty in the academic world so they
Did nothing to him until the year he was going to retire at which point then after the file was who knows how thick of complaints they finally decided to take action in the year that he had already said he was going to retire that is when action is finally taken we also
Incidentally I forgot that piece we also saw that go on in that institution right so we’re sitting here had hearing from uh female uh medical students about what their what their experiences are and how they’ve gone to report this and not one thing has happened yeah abuse not for
Being students but just for being females right exactly right but but that what I’m describing is that Dynamic right yeah this individual has power you don’t yeah right and and what the actual story that is was in circulation around this was that a resident a surgical
Resident at that time had tried to take this case forward yeah got drummed out of surgery that was this was story that we medical students were getting right and this was relatively recent right she tried to she tried to say something um This Guy’s super powerful right uh she
Got booted from the program or left the program but then tried to stick somewhere else and once again those back background calls go on right and all of a sudden nobody wants you anymore right and you’re not able to pursue your chosen specialty why because you dared to file a complaint against somebody
With more power which in 2022 sounds astronomically asinine but in this totally different story I mean not on what was happening but on how we treat it as a society how yeah yeah well I mean I think even you know obviously we knew it was wrong right of course but
The lesson there wasn’t a pathway there wasn’t a a way to be heard a way yeah well the lesson you got was don’t say anything you push back against these people right they can ruin your career right you’re done right and and and no one will help you right that’s the thing
They even know they know what is being done they know why it’s being done nobody’s going to help you so what do you learn from that you learn you know I’m either going to stick my neck out there and potentially lose my head right or I’m just going to shut up and keep
Trying to push right cuz someday I won’t have to deal with them someday I won have to deal with them right I’ll get out of this and I’ll finish my residency and then I can go somewhere else and I can work somewhere that makes me happy
Right but I just got to put up with this right that was the culture and probably to some degree still is right even if it’s that’s what you were feeling you know in a male seat of the same student seat though when you had transferred in
Those clinical areas and so to give you here again like another example so this this um this one doc what he would do is he’d come in every day he would ignore the residents he really didn’t have much to do with them at least not in front of
The medical students so we would as medical students at that time we were supposed to be on call every fourth night okay on call means you’re up all night going around with your resident to see patients okay you are in the hospital you’re in the hospital you’re
Running around doing this so this is every fourth night right which means you know you you uh over the course of a month you you have about week where you don’t sleep at all right you go you go the whole night without sleeping right
So so one week out of four effect I mean just imagine trying to do that every month right one week out of four you’re not sleeping this is pretty common in the medical profession because you would have stuff you need to be doing during the day to your safe exactly yeah so you
So You’ go so you’d go you’d come in you’d work all day yeah you would then work all night yeah and then You’ work the next day until about noon this is how it was done at that time right uh but here’s the thing so the normal
Policy in that institution was you come in you write your you you work all day you go all night and then you were supposed to submit something called a history and physical document what you were supposed to do was take one of the new admissions that came in from that
Evening right and then four days later on your next on call Cycle you were supposed to submit a written document that said here’s all the information I gleaned okay here’s my thoughts about possible diagnoses and which one I think is the most likely and what treatment we
Should do right so everywhere else all the other students for the most part they had four days to turn out this written report yeah we had to present it by 8: a.m. that morning after we had been on call all night when did the night strip start U I think it’s about
7:00 at night so you had from 7: a.m. I’m sorry maybe it was whatever it was about 12 hours approximately at night right and then you had to have this thing handed in by the time he showed up in the morning so you had to write it overnight right while you were supposed
To be doing while you’re supposed to be following your resident around and seeing patients right so two things happened the first thing is that our we start because we have to he’s required us to turn in this paper right yeah so we start saying okay residents well we
Can’t we need some time to write this we cannot follow you around all night the residents get super angry with us for not following them around so we meet with them and say we can’t was myself and another medical student we say look we can’t we can’t go with you we have to
Write these papers we’re being required by our attending physician to write these papers and we have to turn them in at 8 a.m. and you know this right and they’re responsible well that’s not our problem that’s your problem you need to talk to them but if you continue to do
This like we’re going to have to write you down on your evaluation right what so and would this attending physician be over these as well so like that’s their direct boss and they just still just be like whatever resp your this the response yeah wow that’s it I’m your
Boss and I want you to follow me around and even though so you see what I’m saying we’re but there was no backup from this attending physician to be like no guys I actually need them to have this paper in at eight we’re at the bottom of the the hierarchy again no
Communication cross and then you guys are screwed right yep so we’re making our residents mad by not following the culture at that place was you follow them around until they until they dismiss you you can’t go anywhere right and if you do your name is mud right if you do that
So we’re in a position of well but if we do that then we can’t finish our paper if we can’t do that then our attending will be mad right so what do we do we just got stuck in this Purgatory these two things so then then what would
Happen is then you’d go you’d hand in your you’d hand in your document he didn’t want you to just hand it in he wanted you to give it an oral presentation but before he would do the oral presentation he would take you on about two and a half hour walk around so
You’d walk around to see all these patients and during that process he would do a process that in medical parlament is called pimping which basically means I keep asking you questions so I’m asking you questions about all kinds of different aspects of the patient and their care and diagnoses
And what’s the differ while in the room with them or while while both while in the room while walking around whatever else right so like quizzing you yeah but it’s constant quizzing so imagine you’ve been up since 7 a.m. the previous day earlier than that right you’re sh up at
5: a.m. right to go in so you’ve been up since 500 a.m. the previous day it’s now 10:00 a.m. the next day right okay and you have somebody just blasting questions that you the whole time right and then at the end of that when you go through that whole process of walking
Around now he wants you to give an oral presentation of this multi-page paper that you just had to write right a few hours before though so it’s not very recently in your brain that’s fried at this point this is the is there any break in this night no no you just you
Just roll all the way through right wow and so and then the thing was that there are different styles of this right so some some doctors when they do this their goal is to teach you right meaning they’re asking you questions the point is not necessarily whether you get it
Right whether you get it wrong right it’s to be constantly seeing what you know give more and to help to some degree to help you learn a thought process right okay you don’t know the answer to this why don’t you know the answer to this well let’s explain what
Thought process would get you to the right answer like partly like helping instill that flowchart within you like for that that’s precisely and that’s if you’re going to use that technique not everybody does but if you’re going to use that technique that is how it should
Be used that should be the goal like for this stock the purp purpose was humiliation the point was to rub your nose in what you didn’t know and how much more he knew than you did really oh 100% yeah 100% that was the goal of the question asking process right so it
Would be I’m going to ask you questions right if you don’t know it I’m going to just humiliate you for not knowing the answer to whatever the question is right in front of the whole team and everybody else right I’m just gonna I’m just going
To tear you down for not KN this is happening in front of other people so whole team whole residents everybody else that’s there right so you’re just getting down for what you appear not to know um and so you know there was one um you know there there
Was one experience I remember having the the case was a guy that had come in with abdominal pain right and he had liver metastasis or something like that so you know I wrote up my paper on potential causes of liver metastases in this case right uh the thing about the thing about
This particular doc was that he really enjoyed Cardiology that was his thing he knew way more about Cardiology than any of us did at that point in time right so and most of the cases we had coming in a lot of them were hard cases so we
Learned very quickly if you do a heart case he’s going to just tear you to shreds because he knows so much more than you do about this so we learned the two of us learned we probably shouldn’t do heart cases because you know if you don’t want to just get blasted you got
To do something that’s a little bit out of his area of intense expertise so we would do this right so we pick side topics right yeah um and so you know I picked one that was was abdominal pain and I finish up my presentation he’s clearly very frustrated because there’s
Really nothing that he can go to town on right it’s a more limited topic which was intentional on my part right you’re being smart and how you to dance around we’re trying right he says uh so he says well you know tell me the differential diagnosis differential diagnosis means
What’s the give me a list of possible diagnoses okay that could cause this symptom okay so he says give me the differential diagnosis for abdominal pain right so I’m like okay so I start naming diagnosis right so I go on for about two minutes or so naming
Everything I can think of that could abominal pain I finish up and he’s like ridiculous you forgot hereditary spheros cytosis oh my gosh ridiculous right oh my gosh you know how could you How Could You Forget right you know and I’m like you know what I mean
And I’m like right I mean when you type in them to Google we now know that there are so many things that can this was I never forgotten that though to his credit I’ve never forgotten hereditary spherocytosis okay come up in your diagnoses for real though but it was so
Virtually never but it was uh I mean it was that this was the goal right and so there were lots of insults there was lots of tearing down like on a very personal like on a very personal level like insulting your intelligence insulting you as a person not just you
Need to know more right you’re an idiot right it’s like this kind of thing this was the dynamic so you know my my co-medical student right uh started taking so those papers right I would try to write my what my co-medical student started doing was cutting and pasting
Out of like medical pre-written medical journalist so look up a topic cut and paste and slap it into the paper and then read that right as my go the thing right he didn’t know that this was going on right so he’d be like oh that’s wonderful you know what a wonderful I’m
Right oh yeah I’m like well you you know that that was written by a medical professional right that wasn’t written by a medical student you don’t know this right okay so I’m I’m trying to write I’m trying to do it allegedly the right way I’m trying to write it myself right
You are just ripping me to shreds right well this is going so this is the dynamic right so I take that which kind of goes to what we’ve talked about before of like the type of person that ends up in medicine yes where it’s like you know needing to just check the bo
Like not just check the boxes but it’s an achievement thing like he’s like Accola this person who’s got all the right information whether they’ve learned it or not correct right they have learned a way around they’ve learned to achieve an outcome right they’ve learned a way whether they
Learned that information or not is irrelevant right they learned how to present the appearance of knowledge right right and I don’t I don’t fault them for that it was extremely high stress awful situation right but but but point that a flaw that’s what was going
On right your teaching them to to find a way to give you the outcome you say you want whether or not it has any actual effect on how good of a doctor they are or how knowledgeable they really are right yeah and you’re allowing you’re making no allowance for the fact that
This person by definition has less knowledge and expertise than you do yeah you are better doctor than them that’s why you’re teaching them right right the point is not you’re not it’s not a battle of equals right this is a battle of a clear power differential mentorship
For lack I mean except it’s not right it’s like a reverse so this was the you know this is the dynamic and and this was the problem so you you learn to produce the desired outcome rather than go through the process that might actually make you
Better at the job in the long run right so I take that Dynamic and I went to the I went to the to the clerkship director at that time and said hey this is the experience we’re having yeah like we’re getting just Torn to Pieces yeah what
We’re being asked to do is not comparable to what our colleagues our other medical being asked to do by their attendings we have we are being held to a different standard it was like you talked with your we knew it so I go present this and he says yeah
You know that’s true yeah we hear about this guy every every year every year we hear about yeah you he’s like that like okay and so what’s the what’s the plan nothing the plan was nothing the plan was yeah just suck it up like that’s yeah we know he’s like this he
Treats everybody like this and just deal with it like that’s the answer you’re you got the Short Straw that’s exactly that’s exactly what it was yeah so you know and then in that same Dynamic so I had actually about that particular rotation I’d written up like a letter
Outlining my stuff and I sent him the letter yeah and his response was I didn’t read your letter you know it’s too long you sent it to your attending physician no I sent it to the to the cler director I so I I documented the things and sent him a letter and his
Response was it was too long I didn’t read it just don’t care right so you you know just just deal with it right wow so yeah this was the so again right the vibe here is is put up with it up you’ll be gone soon we have an institution
Right we’re going to do what we’re going to do if it’s abusive it’s abusive you should just live with that right on this side of things you’ve talked you know about some of the pieces that happened in New Orleans and said like you have more compassion on the faculty side
Being an adult now on this other side but thinking about this situation from where you sit right now like hypothetically what do you think are the reasons that they wouldn’t just excuse this faculty member from their you know from their relationship with the university and instead find somebody
Better I think it’s uh one is that within medical education there is to this day still a normalization of an abusive Dynamic really I actually have much less empathy for those people yeah that I was dealing with a Southwestern than I do for the two-lane people because with two-lane people I can
Understand now as an older person with a family right the personal stress world is falling apart right now right and you’re not performing at your best but I can kind of of understand why that might have happened right in but but having since gone on to teach medical students
And residents myself I don’t think there was a good excuse for the behavior that I saw from either of those individuals or anybody else that was around them the way that it’s done it’s institutional culture right and medical education like I said has that it has that abusive
Element in it it has always had that abusive element at least in modern times right the word resident used to be because you lived at the hospital oh that’s where it came from you were resident because you used to live there and you lived there so that you could be
On call every other night so that you didn’t miss any interesting cases right that was how that was the dynamic right and so it shifted and they eventually shifted the work hours and they did these other types of things right to try to improve it but built into this this
Whole time is this sort of it’s this Vibe where people may treat you well yeah but if they don’t treat you well you just you just shut up and live with it if you know had another experience where there was there was an attending physician attending surgeon yeah you
Couldn’t speak to him as the medical student you were not allowed to talk to him if you had a question you had to ask the resident and if the resident deemed it worthy to be passed on to the attending position right yeah this is this is this is within this Century
Right is it like is it a portion of like do you ever graduate from this abusive position is it hazing and then it becomes Brotherhood ever or is it I think if you stay in the institution right yeah if you stay in the institution possibly I mean I I didn’t
Stay I’m just like from an outsid I’m like you know just thinking about this where I’m like there are so many instances of abuse in our culture that I think we’ve exposed over the last 10 years even that are some of that where we’re like yeah that was never okay like
But there was a Brotherhood that led people to be like no it’s fine we all did it we all went through those years like but there also has been a lot of abuse exposed in our culture in a lot of Industries where we’re all just like
Yeah that’s not okay yes and it’s never been okay and it shouldn’t and it didn’t it didn’t ever pan to something else either like why did we stay here so long I I think there there was there was some some element of a hazing and graduation into the fraternity right but but there
Also was an element that was just people abusing their power and I think they’re probably still is because they just had they had finally made it to the point where they had power they got to abuse and I will also say exactly that it’s ay it is a cycle of abuse thing right
Almost undoubtedly those people were abused going through their education and as soon as they got in a position where they could hand down a beating right they decided to do the same thing to the people below them who then and I would say it also becomes a self- selecting
Thing right because when you’re in an environment that is like that some personality types are like I’m out of here right yeah yeah I’m out I’m leaving as soon as I can it begins to self- select right for the people that can tolerate that environment who then who
Whether they like it or can tolerate it who then perpetuate it right because for them it’s like well it’s worth passing through all this so that I can you know put my name up in the stars or the other stars of this academic institution right
I want to be there too so you select out for the people that don’t like that and you select in for the people that like or tolerate it who then perpetuate it to the next Generation who then do the same thing right this process keeps going through the generations and then what it
Produces and the most pernicious part of it is it produces people that their best skill is hiding their weaknesses see what I’m saying that’s really interesting yeah and that’s the problem right medicine is rather than working on their weaknesses or or just beinging them or acknowledging them
Right so when when you’ve had when patients have an experience where for example the doctor gives them complete certainty on you know whatever this is and then they go somewhere else and that diagnosis was thoroughly wrong right right why did that happen yeah because for in many Cas well it maybe a
Knowledge deficit or whatever else right but even how did the knowledge deficit happen because going through the training the point of the training was to not be humiliated and exposed you see what I’m saying the the price of expertise is humiliation yeah you have to be bad at a thing before you’re good
At a thing but if you’re not allowed to be bad at a thing and this is this is the whole story of medicine and medical training you’re not allowed to be bad at it right because you’re being constantly judged and graded on these things so if you stink right well then you’re
Inferior right so your whole goal is to try to not appear to stink even if you do right so you just avoid things that make you uncomfortable you gloss over the things you don’t understand because if you ask a question then they know you’re stupid right you see what I’m
Saying which never gives you an opportunity to actually change or grow that’s the issue yeah right well that is our time but this has been I mean it’s so Illuminating honestly so that’s where I’d like to pick up next time is about where you went from there
Into your residency and how that kind of went but I mean I think that we’ll probably return to this topic about medical school at a later point of some of this piece of like some of that culture and how that shapes the type of person that ends up coming out of
Medical school into the actual medical field you know that’s our time today thanks for being with us again and we’ll pick up next time on your residency okay
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