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“Welcome to Medicine”

You don’t deserve abuse because you’re a medical student.

You don’t have to “tough it out” because you’re a medical student.

You don’t have to sit in silence and painfully nod along with an attending’s racist, misogynistic lectures because you’re their medical student. You don’t need to pick the skin off your cuticles to stop yourself from replying. You don’t need to learn how to hide your grimaces behind your mask because you know you’ll have to listen to them attack your identity for the next several weeks.

My first interaction with my new attending immediately set off alarm bells in my head: when I introduced myself, he commented on what a difficult name I had and asked twice if he could call me “Abby.” Throughout the day, he would go on to flippantly joke about mental illness, insist COVID-19 was a liberal political ploy, scoff openly at the message of the Black Lives Matter movement and call every female in the office (including patients as well as myself) inappropriate pet names like “baby girl” and “little lady.”

As he casually spouted countless racist or sexist views, I held my tongue and hid my discomfort. He was a white male attending in a suburban clinic and worked exclusively with other white male attendings; it didn’t appear he had ever been challenged about his views or his behavior. As a woman of color and a student, I certainly wasn’t going to speak up myself. This rotation was 1:1 with the attending and without other medical students, interns or residents to validate my concern, I convinced myself I would just have to make it through the next two months.

From just one day in the clinic, I had compiled a list of 13 bullet points that outlined the most flagrantly inappropriate comments and actions from my attending. But I still didn’t trust my experience — was I overreacting? Was I being too sensitive? Was I going to ruin this attending’s life by voicing my concerns? As “just a med student,” did I even deserve the right to feel uncomfortable?

When I tentatively mentioned to colleagues and mentors the litany of offensive, problematic statements my attending physician had said during the first two days of my rotation, a common response was, “welcome to medicine.” That struck a nerve. I didn’t want to accept that statement as fact, I didn’t want to accept this environment as inevitable, and I didn’t feel that we, as the next generation of physicians, should have to. More than my own discomfort, it was the frustrating complacency of that “welcome to medicine” statement that finally convinced me to reach out to my school about the attending.

I wasn’t alone in my hesitancy to bring my concerns to my administration. The 2019 graduation questionnaire by the American Association of Medical Colleges (AAMC) noted that though 40.1% of graduating medical students experienced mistreatment during their time in medical school, only 23.2% of those students reported their experience. Students cited fear of retaliation, doubt that an event was important enough to report and the belief that nothing would be done about the situation as reasons for not reporting.

These were all thoughts that ran through my head; at the bottom of the hierarchy of medical education, we don’t trust ourselves enough to believe that what feels wrong might actually be wrong. Most insidiously, a 2018 study found that one of the leading reasons medical students don’t report mistreatment during their clinical years is the perception that mistreatment is a normal part of medical education, a rite of passage if you will — “Welcome to medicine.”

When I came forward, I realized I was lucky because I had the most supportive medical school administration I could have hoped for. When I tentatively asked, “Is this really that bad?” they replied with a resounding “YES!” making it clear that they were on my side. They took me seriously and removed me from that rotation the minute they heard my concerns. I felt like my safety was their highest priority and I’m grateful for that.

While my medical school acted swiftly in my defense, I later learned that other medical professionals were less supportive. After I left my rotation, I heard from students working in the same office that the other attending physicians were whispering about “that poor medical student” who “did the right thing” by leaving the clinic. Those physicians discussed amongst themselves how that attending had been becoming increasingly problematic, how his conspiracy theories were getting increasingly incredulous and he was becoming increasingly irreverent towards patients and students. They had known before my name had ever even shown up in the office inbox that this attending was a questionable teacher and provider, but never brought their concerns to the attending himself or the schools who subjected their students to him.

I struggled with pangs of betrayal and loneliness: these physicians had nodded to me in public and had gossiped about “that poor medical student” in private. While I was fielding microaggressions one-on-one across a desk, berating myself to get a grip, fighting against my own instincts, they had known all along that I was going to struggle and left me to flounder anyways. Those white male physicians, who held the most power in that clinic and would face few consequences by speaking up about a sexist and racist colleague, did nothing.

It genuinely baffled me that they could have these discussions about how inappropriate this attending was and still smile at me walking beside him every morning. I can’t help but wonder: perhaps they were so complacent because they didn’t see this as an anomaly in medicine. Perhaps they thought it was something students needed to get used to. Perhaps they too thought, “Welcome to medicine.”

I didn’t learn much medicine the first week of my rotation, but I learned something else: I don’t want to subscribe to the culture of medicine that makes students believe they have to tough it out. Medicine isn’t an old boys’ club anymore. If we can’t expect attendings to speak up on our behalf, then we will have to advocate for ourselves. I don’t mean to say that there aren’t thoughtful, supportive attendings that continue to fight for us — there are, and I’ve had the privilege of working with many of them.

This experience has shown me, however disappointing the thought may be, that I can’t necessarily count on that. But the old guard is not the future of medicine — we are. Even as medical students, when we see things that we believe are wrong — whether that is sexist and racist comments from attendings, overly harsh treatment of trainees or impolite comments about patients — we have both the opportunity and the responsibility to act on them by bringing them up to the administration that oversees medical education. And when we eventually find ourselves in those positions of power as senior residents, attendings or medical school faculty, we must remember what it felt like to be at the bottom of the hierarchy and speak up for those below us. We can work towards a better system than, “Welcome to medicine.”

Image credit: Best Shoes (CC BY 2.0) by gm.esthermax

Apshara Ravichandran Apshara Ravichandran (3 Posts)

Contributing Writer

Saint Louis University School of Medicine

Apshara Ravichandran is a third-year medical student at Saint Louis University School of Medicine in St. Louis, MO. In 2018, she graduated from Williams College with a Bachelor of Arts in anthropology and chemistry. She enjoys reading, running, and going to the local dog park in her free time. After graduating medical school, Apshara would like to pursue a career in a pediatric specialty or child psychiatry.