Breaking the Cycle of Abuse in Medicine

Research on the psychological abuse suffered by nurses, medical, students, and residents suggests that physicians are especially prone to be nasty to their less-powerful co-workers.  I talk about some of this research, and what Dan Denison and I saw years ago when we did an ethnography at a hospital in Michigan, in my post on Dr. Gooser and Asshole Poisoning in Hospitals. 

The great power that doctors have other others are one the forces that turns them into jerks, because as a long series of studies shows, it isn’t just a myth that power turns people into insensitive jerks.  This is especially true among surgeons, who are often the alpha dogs in hospitals.
A related reasons that so many doctors turn into jerks is that like members of all professions, they imitate their mentors — and if your mentors are assholes, you are in great danger of becoming just like them.   

BUT it doesn’t need to be that way. Look at this note that I got from a former surgical resident — and now  renowned surgeon — about how he and his peers fought the temptation to fall prey to asshole poisoning, and how it has had positive effects 20 years later.  This report suggests that it is possible to apply and enforce The No Asshole Rule, even against powerful structural forces and social pressures to act just like your demeaning superiors.

This is the exact email that he sent me.  I use it with his permission, with only his name is removed as he requested:

Thanks
and an Anecdote

I
just finished your book The No Asshole
Rule in about 4 hours. Thanks for writing it. Every page resonated with
my work experiences. I am a surgeon and have worked in academic medicine my
entire career. I trained at an "elite" training program at an Ivy
League teaching hospital. As you can imagine, my specialty has been a haven for
assholes and, even worse, sociopaths. My training program was better than most;
but, we still had our share of assholes. During my training, I witnessed
episodes of unbelievable mental cruelty on a daily basis. As residents, we met
every Friday for a few beers at a local bar after another arduous work week. We
kept a leather-bound journal book. The highlight of the happy hour was nominating
and electing the "Attending Asshole of the Week" or "AAOTW.”  Each aggrieved individual would recount their
episode with an attending that would merit their nomination as the “Asshole of
the Week.” The group voted and the “winner’s” name was entered into the journal
book. A brief synopsis of the "asshole incident" was also placed in
the journal. We had one attending who was such an asshole, he automatically won
if there was a tie. It didn’t matter if he was in the running that week or not.
The journal was passed on every year to the new Chief Residents. It was a
closely held secret among the residents. I understand they still have a
journal.

This was 20 years ago. It is possible to look at these sessions as "bitch"
sessions with no meaningful result. However, every one of my resident
colleagues learned from those sessions. We learned how destructive "asshole"
behavior was in our specialty. We vowed not to imitate the pathologic behavior
we encountered daily. 20 years later, we are now the program chairs and department
chairmen. We are spread across the country. I am proud to say that everybody
who was a part of that Friday group runs their training programs with an
unwritten "no asshole" rule.