The Elephant in the room: the (Toxic) culture of medicine

Thursday night, just before bed, I decided to take one more look at my Twitter and saw a notification where I was tagged in a young doctor’s tweet. He shared a publication that he and a medical student had worked on about Human Resources in Health. The tweet started “In light of today’s unfortunate statement by a senior doctor in regards to junior doctors…” (you can see the tweet here and read the study done.) Of course I saw this and was confused, what happened in the world of junior doctors? So I asked him.

I was sad to find out that a Senior House Officer (the same level I am at) was found dead by apparent suicide in Trinidad, and around the same time a senior doctor made some insensitive comments. In this article I will not discuss whether or not the two are related- the person claims it was in response to comments they saw made by junior doctors in regards to the work environment in medicine… No matter the circumstances the timing was unfortunate and the words left a bitter taste. These comments spoke about their “unpopular opinion” that if the environment you work in is “not conducive to your mental health… leave” and about the competitive nature of a particular field of medicine and it is “selective for the strongest” and “those willing to make the necessary sacrifices”.

Many persons are angry, so far persons have replied to the post expressing their disappointment, the Trinidad and Tobago Medical Association has put out a statement saying they condemn such remarks and the Medical Chief of Staff has reminded consultants that though their social media are their own, to be aware of what they post out to the public. One friend, involved in the relevant speciality, said something very insightful to me today in regards to what was said. She said that just because the field is competitive and you have to deal with long hours does not mean you get to be mean and negatively affect people’s mental health. She also echoed what many junior doctors have been saying for years, we (when we become more senior that is) continue to perpetuate the never ending cycle of abuse.

In the last two years we have had the treatment of junior doctors come into public eye more and more, since the pandemic this has only amplified. The public has been told about the unfair treatment, inadequate supervision, low renumeration, lack of protection specifically in regards to personal protective equipment and not being paid on time or in completion. Yet, there is not much we can say in terms of resolution and change. Either the stories are one day wonders, not acknowledged or rebutted. We have seen the representational body JMDA step up to the plate and create some solutions- but is it enough?

How can we tackle and break the cycle?

First we need to admit that we have a problem and one that requires solutions. Many other countries have research dedicated to accessing the culture of medicine and its impact on doctors- because you cannot know what you do not measure. While we seem to sweep it under the rug. It cannot be the norm that you suffer or “pay your dues” then turn around and continue the cycle. There is one friend who always says the same thing whenever we have discussions about the culture of medicine “the worst slave master is an ex slave”. The truth is many of us who complain about the system will turn around and be the same perpetrators we complain about, telling those annoying “back in my day” stories that we hate so much now. Too many of us think that this period of hazing is a rite of passage and neglect how much harder it makes an already difficult job.

We all have a role to play in improving the culture of medicine, those with power have the biggest roles, our consultants, heads of departments, administrators, senior medical officers, legislators and so on. It is difficult to advocate from a place of powerlessness when the fear of retribution is high. I want when we talk about those “back in my day” stories we think about our family, especially the younger ones. Would you want your younger siblings, nieces, nephews or even your children to go through the same hardships you endured when you’re in a position to create a better environment for them? I bet the answer is no.

It is no different for the junior doctors who come after you.

Usually I would give some tips on how we can improve, but that’s for a next time. I have made similar posts before and will continue to make them. What I want from talking about this, is for us to think about the individual and collective role we play as junior doctors, senior doctors, administrators, legislators and citizens of this country in the improvement of the health care environment for its staff.

I hope we open our eyes soon, because one day it might be too late.

My condolences go out to the loved ones of the SHO that passed, I cannot imagine how you must feel. For the doctors in the system, especially during covid 19, who are experiencing mental distress and burnout please seek help and take your days off. Here is a thread I found useful for mental health practitioners in Jamaica.

Samantha C. Johnson

Samantha C. Johnson