Contempt for the newbies

Reading this article, I was reminded of an impression that I've been developing as I spend year after year in medical training. Health care places enormous value on an individual's cumulative experience, and appropriately so. However, I often see that value expressed as disdain, even outright contempt, for inexperienced individuals -- i.e., people who are simply in an earlier stage of their training. I can't even count the number of times I've seen a student, intern, or junior member of a team publicly excoriated, not for incompetence, not for doing anything wrong, but simply for their lack of experience.

Case in point: a while back I was a few days into a new rotation, trying to operate in a system I'd never worked in before. I was trying to get a patient's visit wrapped up expeditiously, and made a mistake filling out a new lab form. A senior nurse walked up to me in the hall with the form, and in front of waiting patients flicked my nametag and half-shouted "you don't know anything!" in my face.

Now, I don't think that this person was actually questioning my clinical judgement or my ability to make reasonable choices about appropriate lab tests. We're all trying to do our best for our patients. And frankly, health care is very, very hard, and we all feel insecure about our own abilities from time to time (daily, even). But I'm frequently shocked by how often this comes out as what seems like little more than hazing of the junior personnel, simply because they're junior. I guess this is much on my mind these days because with every year's turnover I become more responsible for teaching -- and modeling behavior for -- junior members of the team.

Of course, I've been lucky -- the worse things that have happened to me during my training so far have been trivial compared to things that are routinely inflicted on trainees other places. But still, I'd like to think that there's value in consciously striving not to perpetuate these behaviors.