toxic – Ena's worlds

“When you show up to those evaluation meetings, I want you to show up like a star athlete, wanting to improve in every way possible. We want you to become the best doctor there ever was.”

This was the response of an education specialist when asked how can residents cope with being constantly scrutinized and given “areas in need of improvement” at every assessment that occurs at least once a week.

Growth based mindset is a valuable asset in anyone, especially in young doctors who have so much to learn. HOWEVER, there comes a point where a resident becomes good enough to practice safely and competently according to practice guidelines. Beyond that point, it can be extremely demoralizing for residents to receive criticism on something that is not helpful for improving the quality of patient care in a measurable way. Specifically, receiving feedback for the sake of feedback, in a patient interaction where care was safely and competently delivered, can be exhausting for the learner. It can also impede their sense of mastery, contributing to burnout, anxiety, imposter syndrome, and demoralization. At the time of COVID-19 where residents are being redeployed into areas outside of their specialty in a particularly stressful environment does not make things any easier.

We see this outside of medicine as well. Social media bombards us with messages of “be the best you can be”, “achieve all that you can”, etc etc… While these messages can be motivating to a certain extent, it can also feel like a lot of pressure in this world that is already so competitive and stressful.

You ARE enough.

Did you get up today and go to work, even if you didn’t want to? Did you do what you could to finish the work that was needed within a reasonable time frame within the minimum required standards? Were you reasonably kind to others and didn’t hurt anyone, including yourself?

GREAT! In some days, even doing these things can be extremely difficult, so great job!

As a society, it is time we re-evaluate this “growth based mindset”. Growth is great, but so is happiness, satisfaction, and gratitude for who we are today. Striking the right balance between these essential aspects of life should be the focus, not endless “growth and expansion” at the expense of one’s wellbeing.

Again, you ARE enough.

Culture of incompetence is a phrase that us, as resident doctors, came up to describe certain hospitals that have a culture that encourages a passive form of incompetence by discouraging productive change.

This does not mean that they encourage residents to make mistakes or to be incompetent in a general sense. Rather, it means that we are encouraged, either directly or indirectly, to abide by unspoken rules that are prohibitive of increased efficiency or innovative approaches to patient care. To give an example that I had mentioned in my previous posts, I had once worked in a hospital where working fast to speed up patient care was seen as putting pressure on the team and being a bad learner. Other residents had similar experiences in this hospital, where they were asked to adjust to the team’s pace, even when it was clear that there were areas of improvement needed to make the team more efficient. The hospital had set up an unspoken rule that it was happy with the status quo, despite the fact that it was no longer serving the giant and ever growing population of patients, resulting in months or even year long backlogs of patients to see, and patients waiting in the emergency department for days just waiting for a bed to become available in one of the inpatient units.

How does a culture of incompetence form? I believe that it starts from a seed of “leaders” that believe that what they are doing is near perfect, if not perfect, and that there is no room for improvement. Any attempts at productive change is seen as stirring up trouble or even being a bad learner. This kind of culture in turn produces an environment where those who agree with this worldview are the ones who decide to stay after their mandatory rotation ends, and the saga continues.

This kind of workplace culture can cause traumatic moral injury in young and motivated learners, possibly making them lose that spark that keeps them wanting to innovate and improve. Perhaps the reason why healthcare has seen so few innovative changes in the past many years is because this culture is pervasive in medicine. As residents, we get placed in a lottery system that inevitably lands us at a hospital with such a culture at some point during our training. While I wish I could say that most of us come out of the experience with our eagerness and dreams of a better future intact, it often marks the beginnings of becoming a bitter and burnt out physician.

I noticed this change in myself more recently when I pulled out a garnet bracelet from my jewelry drawer for work today. One of my daily rituals as a witch includes picking out a gemstone to support me at work and to set intentions for the day. Garnet, besides from being a protective stone, also encourages vitality, leadership, and positive growth. Since being burned by this culture of incompetence and many months afterwards, I was afraid to wear this to work in case it would push me to stand out more than a resident “should”, attracting negative attention and criticism. Today, for the first time in almost a year, I took out this bracelet for me to wear to work, feeling finally ready to return to my old self again.

If you feel that a productive and growth-oriented behavior that is appreciated by patients or clients is being met with resistance and even animosity in a new environment, I implore you to take a pause and to evaluate the environment before changing yourself. If you could find a way to hold onto that spark inside of you to ignite torches of positive change, a day will come when you are free to light up the world as you are meant to do.

Stay strong, my friends. Better days are just around the corner.

Tag Archives: toxic

Toxicity of “be the best” culture

Culture of incompetence