Dear members of the medical community,
I am writing to share my concern regarding a series of unusual and troubling cases affecting medical professionals across the country. It manifests as a selective form of hemineglect in otherwise neurologically intact individuals. Despite functioning at a very high level in most aspects of their jobs, affected individuals are most commonly physicians. They appear unable, in certain instances, to perceive the presence of junior members of their health care teams. Notably, other components of the physical exam are likely to be normal, and focal neurological deficits are very rarely present. Thus, affected individuals are at risk of going unrecognized unless they are evaluated under specific circumstances that are likely to elicit signs of neglect. Medical students pose the greatest challenge to affected individuals, and their presence is most likely to be neglected by these individuals as a result.
Such neglect impacts multiple forms of sensory input, including classic hemineglect which is failure to perceive items in one portion of the visual field, as well as compromised auditory perception. Signs and symptoms include looking directly at the junior members of the health care team but refusing to acknowledge their existence, ignoring their comments or questions and on occasion, ambulating in a peculiar manner that forces the junior member to avoid being struck or trampled. This leads not only to uncomfortable social interactions in the presence of patients, but also confers a heightened risk of health care-associated injuries if the student or junior member is unable to adequately dodge the affected person.
The etiology appears to be multifactorial. Prolonged time spent in the hospital increases the likelihood that a person will develop symptoms suggesting an iatrogenic cause. Risk factors include participation in a rigorous residency programs, assignment to particular specialty services and grandiose self-perceptions of work ethic. Severity is positively correlated with time elapsed since last vacation although further studies are warranted to establish the exact causality. Past and present experiences with supportive mentors, reasonable workplace expectations and a culture of teaching and respect for personal obligations often are negatively correlated with this disorder.
Notably, prolonged exposure to affected individuals increases the likelihood that junior members of the health care team will develop a similar syndrome as their training progresses. Medical students working alongside residents and senior physicians look to them for education regarding medical practice and professionalism. Thus, these students are likely to emulate their residents’ and attending physicians’ behaviors without realizing that this behavioral pattern represents an illness rather than normality. As such, it is imperative that we address this pattern immediately in order to heal symptomatic individuals and prevent future cases.
I have great hope that this affliction has the ability to be not only cured, but also prevented. At the core of this problem is the inability to perceive those who are neglected; thus, a team approach is required for recognition of pathology. Healing cannot occur in isolation.
Efforts to prevent further cases should include rigorous and candid education of new residents as they are at elevated risk and may not be aware of the early signs and symptoms. In addition, senior physicians will benefit learning the etiology as well as signs and symptoms of this unique hemineglect so that they can better confer protection and recognize early-onset symptoms.
Some senior staff members may be chronic sufferers and unaware of their own conditions. They represent unique challenges but are worthy of treatment nonetheless. Medical students, while often able to identify affected individuals, are notably deficient in recognizing when they become symptomatic. Prevention in this population will require ongoing discussions, exercises in resilience and opportunities to discuss the experiences of interacting with afflicted colleagues.
I look forward to opening dialogue and inviting expert opinions so that we can collaborate to tackle this worrisome problem together in the medical community.
–A Concerned Student