How many times have you heard “it’s a sign of weakness?” This clever jab of an insult comes mostly from the surgery camp based on my experiences. This saying and a dollar will buy you a 20 oz. Coke, and here’s why.
Weakness Is A Product of the Creator
Weakness is nothing more than the opinion of the accuser. They think you are weak by participating in some action that they deem exemplifies weakness in you. However, to a “normal” person, your actions are seen as very common. Weakness never comes into the equation.
It is the training (or more accurately, brainwashing) that has led these people to feel this way. Molds are cast early in training, and to deviate from that mold is a “sign of weakness” in itself. That is what they would have you to believe.
The Inbreeding of Inaccurate Thoughts
These abnormal schools of thought are inbred within the various specialties of medicine. As the medical student is taught that taking time off is a “sign of weakness”, he begins to believe that this is in fact the case. As his training continues into residency, this misconception is further hammered into his head by frequent reminders from upper-level staff.
By the time he reaches attending status, he is a super-breeder of misinformation. Years of brainwashing has taken its toll, and he himself believes that false information is true. The process then goes full-circle, as the attending inseminates lower-level residents who in turn inseminate their juniors.
It’s an orgy of falsities.
Weakness In Action
Many of you may be wondering what all of the hoopla is about. Here’s a list of frequently cited “weak” actions on the part of residents and medical students:
- Working less than 80 hours per week
- Taking more than 2 days per month off
- Wanting to eat at least once during the day
- Being sleep deprived and showing it at work
- Putting your family before your work
- Taking a full Saturday off instead of rounding until noon
- Calling into work sick
If you take a close look at all of the above “weak” actions, you’ll see that they really don’t show any weakness whatsoever.
Dehydration and Rotations
While on my internal medicine rotation, we had a resident who was obviously sick and should have stayed at home. Every 3 or 4 hours he would receive a liter of fluids through a hep lock that he kept wrapped up in gauze. Wouldn’t any normal person stay home under these same conditions? I questioned him on why he wasn’t at home in the bed where he should have been. His reply? It’s a sign of weakness to stay home when you’re sick.
If this isn’t evidence of the mind conditioning that takes place during the medical training process, I challenge you to find what is.
The True Weak
Although any physician in any specialty is capable of spreading this false message through mind conditioning processes, surgeons are most likely the ones with the greatest amount of skill in this arena.
I’m here to set the record straight:
- It’s not a sign of weakness to work less than 80 hours per week. This is known as efficiency and budgeting your time wisely.
- It’s not a sign of weakness to take more than 2 days off per month. This is known as being human and having a life.
- It’s not a sign of weakness to want to eat three meals per day, on time. This is known as sustenance.
- It’s not a sign of weakness to show sleep deprivation at work. Sleep is known as a basic requirement for life.
- It’s not a sign of weakness to put your family before your work. This is known as being a good husband/wife/father/mother.
- It’s not a sign of weakness to want a full Saturday off every week. This is known as rest.
- It’s not a sign of weakness to call in sick to work. This is known as calling in sick to work.
The only true “sign of weakness” is when you actually buy what the man is selling. Resisting the purchase and going against the grain shows that you are strong, courageous, and looking after what’s most important in your life.
Your statements are true, a job in medicine should be just like any other job. But realistically, is it possible to take those Saturdays off, spend time with the kids, get rest, in a job like medicine? What are the possible repercussions as a resident for having self-respect?
Great post. It’s all so true. On one of my rotations one of my interns was so sleep deprived that he was literally hallucinating. We actually had a “nice” attending who told him to go home at like 10 am once she realized what was happening. He literally refused to sign out all day long and stayed and tried to work. I ended up bailing around 4 pm and he was still there and the attending was going to force him out of the hospital. Unbelievable. Why anyone would do that to themselves is beyond me. I guess the brainwashing was truly entrenched in this dude very early on in intern year.
UBCRedFox – If there was work to be done and you didn’t show up, I’m pretty sure you would get in trouble. I may have not made this clear in my post, but the point I was trying to make was that I don’t want you guys to feel like it’s a sign of weakness if you request time off.
There are some specialties that will allow you to have weekends off during residency (such as pathology or maybe dermatology), but the more rigorous specialties such as surgery generally do not afford this luxury.
The Lone Coyote – That’s a perfect example of the type of behavior that I’m addressing in this post. That kind of stuff needs to stop along with conditioning medical students and residents to believe that it’s weak if they left the hospital.
Great post. As a third year medical student, I quickly hit the wall of guilt many attendings will try to lay on you for wanting a life. On my first rotation, my attending explained it to my like this: “Medicine is a very demanding mistress.” This man works 70+ hours per week, rarely sees his family, and has never left the country to travel. He told me: “If you want a forty hour a week job, you shouldn’t be in medicine.”
Also, I was recently ill with a 102 degree fever and bedridden for a week. I had a note from my physician stating that I was ill. Of course, I panicked, thinking, “How can I miss so many days? Should I just go in?” I stayed home, but felt ridiculously guilty and had to eat a lot of shit from my clerkship director.
The attitudes that prevail in medical training are completely ridiculous. I am sure residency will be a blast.
great points. i hate this saying, but i guess i have to use it. “when i was a resident” there i was a pgy-2 in the ER at one of our community hospitals. i was in the ER doing a consult. as i got to sit down, i see DR. H. “what are you doing here?” i ask. he say, “i got called to see a patient.” i thought, i’m there resident why are you here. but, that was how he was, always helping out. before he left he said to me something that sticks, “if you need me call, IT IS NOT A SIGN OF WEAKNESS.” i, like others, had this driven into my head. don’t call, get it done.
all of these are great points:
* Working less than 80 hours per week
>>it is important that you put in enough time to get the job done. i think the hour number is irrelevant. i take 10 calls a month (2-3/week). in the winter, life is good, not much trauma. ~10 hr days and every forth weekend. in the summer, let’s just say i hate trampolines, jungle gyms, motorized scooters, and children riding in the back of trucks. longer hours, of course, but as a team we share the load. like a good WWE tag team.
* Taking more than 2 days per month off
>>This is a requirement. you need to reset.
* Wanting to eat at least once during the day
>>another requirement, 3 meals. what i do when we are in long cases (10-12 hr) is make my residents take a midway through. potty break, sustenance, hydration. then i take a break. makes these cases more doable.
* Being sleep deprived and showing it at work
>>not cool, we actually have a comfy couch that many residents sleep on in the office when they want a cat nap. (we do have a call room). if it is really bad, we seen them home.
* Putting your family before your work
>>if you don’t take care of your family, how good a physician are you going to be?
* Taking a full Saturday off instead of rounding until noon
>>ahh, this is a medicine thing. you know how ortho rounds. LGFD (looks good from door)
in the end a healthy resident and physician is better than a battered one. but, there is no weakness in ortho, ever our women bench over 200lbs. (smiley face) just jokes.
Thanks for the comments guys.
TPG – The system makes you feel like you’ll be ridiculed and/or looked down upon if you take days off work sick. It’s really a ridiculous state of affairs at the moment. That attending is pretty close to the mark on his 40 hour per week comment. I think it can be done with some specialties, but those are few and far between.
Puryear – Haha, love the comment on the women in ortho. I’ve noticed that Ortho typically attracts the “meatier” people from both sexes. It must have something to do with the saws and drills.
It does sound like your program takes better care of residents than most. If only all programs would do this, we might end some of the abuse and indentured servitude that occurs all to frequently today.
For example on my surgery rotation as I student, my very first case lasted around 14 hours and I was in there straight through without any offer of a break. Being my first day, I didn’t have the balls to ask for a break at the time. I did grow a pair by the end of the rotation, though. =)
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I’m an anesthesia resident and was in the SICU recently where call is q3 for 30 hours straight. I was sick for a week but still showed up for call. However, the night before one of my calls I got really sick, lost my voice, had a fever, and could not get out of bed. I called in sick and felt really guilty, but I literally was not able to walk down the stairs let alone do a 30 hour call taking care of 20 critically ill patients by myself. Of course, I was reported to my program director by the surgical attending in the SICU because I was not a “team player.” UNBELIEVABLE! This is the stuff that makes me want to quit medicine altogether…as physicians, we can take care of sick people and are supposed to be compassionate and understanding, but when we are sick we are looked at as weak, unprofessional, selfish, etc. Something has got to change.
hi nice site.
Man,
I almost collapsed from neuroleptic shock reading what you wrote because they are so to the point! Medical school is the biggest waste of my four years. It’s almost worst than prison. However, you did highlight some very good points that I coincidentally took from this whole nightmarish ordeal in your “letter to medicine.” I hope more people would see this truth and be man/woman enough to say so. I’ve been saying it for the past two years now in my wards and have been belittle and looked down upon as the “weaker” and “dumber” medical student. Thanks to medicine, I’ve learnt patience and humility that would make such envious commentators even more green with jealousy when I drive around town in my new luxe car going to my luxe house.
Goodbye med school. Goodbye hell.
- J
As the medical student is taught that taking time off is a “sign of weaknessâ€, he begins to believe that this is in fact the case.
I love this site. I have been married to a Neurologist for 31 years. Went through Med School and Residency married. I was the laundry and cook bitch. But what did I know, I was in love. I still love the crazy geek, but I still get ‘must be nice’ when I take a day off work to catch up on housework, etc., LOL I wondered where the attitude came from–thanks for sharing. Those of us in medicine know what you are sacrificing. Save some time for yourself, and IT IS NOT A SIGN OF WEAKNESS. You should be the leading lady (man) in your own life (borrowed from a movie line). By the way, I am a nurse, and I LOVE medical students. They listen to me and we take care of people together–the way it is supposed to be.
Haha…Thanks Hoover.
Now I know where my mom got this from. Yes, she’s a doctor. I always needed to “toughen up” and stop being so “weak.” “Life is hard.” “Nothing easy is worthwhile.” I never missed a day of school for being sick. In my mom’s eyes I was never sick…because I didn’t know what it meant to be sick. She had “seen real sickness.”
She went to medical school in the 70s. I heard they were worse then.
I think she has post-traumatic stress disorder or something. It’s not cute.
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You know I’m just wondering if those attending physicians forget that they ever complained too. Weak Bitches. lol.
I was an engineer once. I guess I came here just to prove doctors aren’t really smarter than us normal people. I proved that, but now I’m stuck forever.
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Sometimes I feel like such an outcast for wanting simple human needs and basic respect and care. I was so sick, for so long and my program didn’t give a shit. http://erdoctor.blogspot.com/2008/12/in-sickness-and-in-health.html
I am a 4th yr and I truly believe that medicine sux! Even though I plan to do a residency, I try to stay away from the ‘brainwashing’ these bastards try to do. “Thats a sign of weakness” or “medicine is for saving lives”, ” see more patients earn less money and dont take days off!”. “Its an honor to be in medicine”
BULL FUCKING SHIT!
I have already given up 5 yrs up my life for studying medicine, even though I dont regret it, its attitudes like what Howard mentions that makes me sick! The PATIENT should be honored that I spent over 10 yrs of my life to help his miserable self, not the other way around. Treatment is a choice, they can always eat herbs at home and not see a doctor. Go Howard Go!
Me again, its NOT WEAK to want more time, its NOT WEAK to be tired, it NOT WEAK to want more money. Medicine as a science I love, but as I delve more and more into the politics of it (not by choice) the more I hate it. I am so sick of fellow med students and residents who believe the BS of working longer hours will make you learn more. These people are brainwashed, workaholics with no more brains then a monkey. How many classmates have we all had who looked like bufoons and couldn’t even have a normal conversation with anyone and cranked out A after A? They had no clue how to boil water and got the highest Step scores?
Thank you Howard for echoing my sentiments. I am not nearly as good a writer as you. I have a tiny blog someplace where I was ranting at the world. Please continue and make us all happier!
I’m now an attending. This article brings back some memories. I saw some of this mentality while I was a student, then a resident. However,even then I felt like I didn’t need to let anybody play games with me. Maybe it’s just my personality, but I had no qualms about saying NO to the bullies. I’ll just share a few incidents to illustrate the point.
1. My medical school had a written policy that all medical students, regardless of the rotation site, were to be off for Labor Day. I was less than surprised to find that the chief resident on my medicine rotation scheduled me to be on call with her on Labor Day. After all, the unwritten rule was that since residents have a lot of say on student evaluations, if the residents did anything unfair, students would simply complain amongst themselves and say nothing. But I had already made plans for Labor Day (mostly to finish residency applications) so I wasn’t about to give up that time. I told her that a memo had gone out indicating that we have that day off, and she was quite insistent that it did not apply since this was an away rotation. She told me I’d be there with her on call on Labor Day. As far as I was concerned, it would be zero in July in Miami before I’d spend an unpaid holiday playing misery loves company with her. Giving her a look that expressed that sentiment (I’ve been told that I speak paragraphs without ever opening my mouth), I informed her that no, I would NOT be there with her on Labor Day, because we have it off regardless of whether it was an away rotation. I told her I’d bring her a copy of the memo the following day. I did but she wouldn’t look at it, insisting it didn’t apply to me. The suck-up med student on the rotation with me piped up to say that he’d be there if she needed him; he didn’t care about having the day off. I made a call to the dean’s office to double-check that the memo was still in effect; they said it was. I didn’t go to medical school to be a medical student. I went to complete a residency so that I could spend a career as a physician. For months I had planned on having that one block of time on Labor Day to tie up loose ends on my ERAS stuff, and I’ll be darned if I was going to let her attempt at a power trip interfere with time off that I was promised. It seems that the dean’s office got a little concerned by my phone call. The dean’s office called the clerkship director at the away site, who in turn had a little conversation with the chief resident. The resentment coming from her was unmistakable as she told me that I would indeed not be on call with her on Labor Day. She was positively fuming. I’m sure she wanted to make the rest of the rotation miserable for me. However, I was a good student. I did my work, had good rapport with the other residents, as well as the attendings and patients, and (perhaps importantly) another resident on the team voiced surprise but support that I stood up to the bully. The attendings liked my work and gave me good marks. I know there is always a power dynamic at work that has to be considered when you’re the student, but there will be less bullying when you develop a backbone and stand up for yourself.
2.During residency, I encountered a bully on a surgery rotation. ACGME says that the rotation has to give you an average of one day off per week. I knew the surgery program abused its residents and most of them did not get this time off, but I didn’t plan to be shortchanged. So when the chief resident gave us our schedules which (of course) were missing any indication of when our time off would occur, I brought it to his attention. The other residents just about gasped. Did I care that he was gonna get mad? Nope. Not at all. I knew the ACGME policy and it was going to be enforced whether he liked it or not. I would work hard every day I was there, but I was going to have my recovery time too. That was not negotiable.
So I asked him if he planned to indicate when our days off would be, or if he’d like us to discuss among ourselves and do that part of the scheduling ourselves. The poor surgery residents looked like they were about to have a heart attack because the chief started huffing and puffing, and he told me that Saturdays would be my day off because I could leave right after rounds. I told him that if I had to come in for rounds, then it wasn’t a day off. A day off is a day when I don’t have to be there at all. A day with just rounds is a short day, but that’s not a day off. I wanted to know when my four days off would be (yes, I was that blunt because I asked nicely at first and it got me nowhere). Suffice it to say that I got my four days (guess he didn’t want me to complain to the ACGME) but only because I put my foot down about it.
3.Perhaps the most ridiculous (and most dangerous) bullying incident occurred when I was a third year med student. Sleep deprivation, stress, and exposure to God knows what germs combined to give me an episode of pneumonia complicated by an asthma attack. It was so bad that the physician who treated me wanted to admit me because my pulse ox kept dropping, even after a reasonable period of treatment and observation. I didn’t want to get admitted because I just didn’t want to be in the hospital. Despite my continuing symptoms and low pulse ox, they were kind and let me leave without making me sign out AMA.(If you leave AMA, insurance doesn’t pay for your care.) But they wrote in BIG letters on my discharge papers to stay home until further notice. I can’t blame them for writing that. After repeated nebs, steroids, supplementary oxygen, etc. I still couldn’t walk five feet without getting really short of breath and desatting to about 92%. For a nonsmoking woman in her 20′s with no other medical history, that’s not so good. I was out for five days. When I came back, I was on a whole slew of medicines; some had to be taken every 4 hours, some every 6 hours, and some every 8 hours. The FIRST day I was back, the resident wanted me to do overnight call. (Anticipating this, the doctor who cleared me to come back to the rotation had already written a note saying that I was not to take overnight call for another 2-3 days.) I informed the resident of this, who got kind of mad but he didn’t (couldn’t) push the issue. He did, however, get mad again when I pulled him aside and mentioned that, while I knew the timing wouldn’t be exact, I had several different meds I needed to take throughout the day. I wouldn’t just take off without saying anything, but I needed him to be aware that my doctors hadn’t given me prescriptions that were taken only once or twice a day. He snorted and looked like I had done something to displease him. Lo and behold, I knew he’d do his best to make sure I’d end up retracting on a long case. No problem. I decided I’d retract, wait for an obvious lull in things, and then mention that I needed to step out for a minute to take the meds. He acted like he couldn’t believe I had the gall to do this when I politely made my request. I scrubbed out, took my meds, came back re-scrubbed, and continued retracting like nothing happened. Afterwards, he made a snide remark about my leaving to take the meds and made a comment about whether it was really “necessary”. I thought about a cousin of mine who died of an asthma exacerbation and thought it would be really stupid to risk a relapse (or even death) just to keep this knucklehead happy. So I told him it was very necessary because I liked being able to breathe, and the meds helped keep the symptoms under control. He didn’t say anything stupid to me for the rest of the day. Actually, he had very little to say to me the rest of the rotation. I didn’t care; I wasnt there to make friends with him or to lick his boots. I did my time and went on to the next rotation.
I ended up in emergency medicine. I enjoy the days that I take care of somebody who needed my help. I don’t enjoy the politics of medicine so much, but I’m not ready to totally leave medicine. I could easily see myself working on a secondary career in something else, though, just in case medicine becomes intolerable. I don’t bully students or residents, and I don’t tolerate people around me doing it either. I encourage them to stand up for themselves, because nobody else is going to do it. Many are afraid to speak up, but I remind them that they are the only ones who will advocate for their interests.
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