Verbal Abuse and Its Impact on Mental Health During HO Training: Learning to be Compassionate to Oneself

It is no news that junior doctors are stigmatized early in their practice by their senior doctors. Dealing with verbal abuse, discrimination, and unfairness certainly take a toll not only on one’s physical wellbeing, but also on one’s mental state.

 It is important for doctors to be compassionate towards each other and be strong to be able to  survive in the real world. Striving for a better work life balance and a stress-free job is like winning the lottery for some doctors who may be suffering in silence. Why should you adhere to such a toxic work environment? This is not the end of your career, rather it is just the beginning. Your skills are assets that can be put to good use in various non-clinical industries. 

You only live life once, so live it to the fullest doing what you love. Dr. A shares the unforgettable ordeal he faced during his houseman years in a local hospital. He completed his housemanship in 2020 and had been posted to a local hospital. He describes his housemanship experience in 2 words: “extremely horrible”. He felt that the  system is riddled with toxicity, bullying, and racial discrimination. He recollects his worst experience which happened in the pediatric ward. The senior doctor spoke very harshly to him and accused him of being rude and incompetent. To add salt to the wound, his colleagues were no better. They seemed to have adapted to the dog-eat-dog environment of the housemanship training and took part in seriously unprofessional and cut throat behavior.

Verbal abuse can seriously impact a doctor’s mental health. Dr. A considers the comments made to him mild compared to his colleagues who were called “prostitutes, cheap, and easy”. Language like that would definitely have an impact on a person’s mental health. Regardless of the severity of the abuse that he was subjected to, Dr. A’s mental health was greatly affected. He went through episodes of depression along with severe weight loss and a loss of motivation. It made him question his decision of becoming a doctor in Malaysia. 

He was not alone in this struggle as in recent years many have come forward sharing similar stories. It is truly baffling that doctors who work so hard to make it through medical school have to undergo such a tough trial to prove their competency. The very people who help patients on a daily basis turned around to show a completely different side of themselves to their colleagues. It was a betrayal at the least and a nightmare at the worst.

Dr. A, now a senior himself undergoing postgraduate training recalls that the experience did get better with time. He credits his survival to being “thick skinned” and taking life “one day at a time”. There is a big jump between medical school and clinical practice. It’s unfair that the transition is made more difficult by a toxic work environment.

After talking with Dr. Juliet Matthew who is a psychologist at a private clinic and also teaches university-level psychology, we saw common themes that kept appearing throughout the interview which were: 1)the generational differences in coping with the hardships of being a houseman, 2) the lack of effective communication, and 3) the lack of a strong support system amongst doctors. 

GENERATIONAL DIFFERENCES

To address the generational differences – in the eyes of a Senior MO, the younger generation is viewed as being naive and “strawberry-like”. Simply put, they are seen as a generation that is soft and easily upset. To better understand the deeper meaning behind this point, we need to grasp the fact that the younger generation was brought up very differently to the generations  preceding them. 

When talking about MO’s that have been trained in our parents’ generation, becoming a doctor was seen as moving up in the hierarchy of societal standing and the ability to provide for one’s family. The emphasis was on improving generational wealth and status as opposed to seeking happiness as a priority. This is not to say that doctors didn’t enjoy their jobs, but that there was more than one intention and motive to those that chose the field then. Hence, going through verbal abuse by senior staff was seen as a rite of passage and considered a norm. 

LACK OF COMMUNICATION

When looking at the newer generation, people tend to speak up because they value their own intrinsic happiness more than a job title or the sacrifice to get one. It’s a generation that believes that if they are happy, they will be fulfilled by their jobs, and their future will be taken care of. However, many housemen do not wish to speak up as they fear being marginalized by their MO’s.

Dr Juliet comments that, “Unfortunately in Malaysia, this is not yet a possibility as people are not yet mature enough to accept criticism and will view talk-back as a counter attack.” This implies that communication training for all senior and junior staff in any hospital is vital to understand that constructive criticism is not an attack on their egos, but instead, an opportunity to figure out how to improve their performance. 

A lot of the times when housemen are yelled at, the reason they feel unheard and marginalized is because they have been attacked for their extrinsic qualities outside the scope of the skills they possess as a doctor. Many see this as an attack on their personality which would cause them to react emotionally rather than logically. This is the case for many of the housemen that Dr Juliet counsels. Dr Juliet proposed that training in  effective communication could alleviate this level of verbal abuse, but how long will it take Malaysia to adapt to these changes? 

A CRUMBLING SUPPORT SYSTEM

Lastly, a lot of housemen don’t have the support system that they need. Many feel that their own friends in the housemanship training would judge them based on the verbal abuse they receive. They feel ashamed and feel as though they are inferior to their peers. 

Dr Juliet commented  that many housemen feel as though the rest of the department also looks down on them, so they don’t have someone to go to. Unfortunately, if they have an issue, they are referred to the psychiatry department and not to a counselor. There’s a stigma that would be imposed on them as being “ a psychiatric patient”, and so they refrain from seeking help.

KEY TAKEAWAYS

It appears that both Dr. A and Dr Juliet had different takes/responses to the questions we posed to them. Having completed his Housemanship at a local hospital, Dr A expressed that his experience was “very horrible.” In addition, the Malaysian system was described as “poor” and “not conducive” for youngsters to gain an insight into the world of medicine. Dr A further highlighted the maltreatment from his seniors and stated that the environment is “better in Sabah and Sarawak” along with pointing out the worsening environment in tertiary hospitals. On the other hand, Dr Juliet, who was posted to Sabah, provided a balanced outlook on her time as a Houseman. Her experience as a Houseman had both, “bad” and “great” moments. Contrary to Dr A, Dr Juliet is a proponent of the HO training as it provided her with a rich experience. 

Furthermore, both the doctor and the psychologist shed light upon pivotal turning points during their Housemanship. Dr A stated that being posted to the pediatric department, his abilities were frequently undermined through the use of derogatory language which consequently established a “toxic environment” along with “back biting”. Resonating with Dr A’s experience, Dr Juliet explained how the multicultural environment led to the development of a language barrier which was “humiliating.” The direct consequence of defamatory words hence impacted Dr Juliet’s and Dr A’s mental health to a certain extent. 

Providing  insight on how their journey impacted their mental health, Dr A emphasized that the lack of guidance led him to “hate the medical profession.” Further comments revealed that Dr A “regrets” his decision to enter the world of medicine and would advise people against it. Moreover, Dr A elucidated on how he felt depressed and became increasingly reserved. However, his mental health saw an improvement with experience and seniority. As housemen occupy the lowest hierarchical tier of the food chain, they in turn suffer in silence as they are unable to challenge the authority of their seniors. Dr Juliet  shares that she was “conditioned” to comply with the seniors as they were more experienced and therefore, that “they knew better.” Hence both the doctors were able to provide congruent perspectives on the impact of their housemanship journey on their mental health. 

In addition, our interviewees provided an insiders’ look into some of the unpleasant words they were subjected to. Dr A recalls being labeled as “incompetent” and “not fit to be a doctor” even when displaying the utmost respect towards his superiors. His colleagues on the other hand were harassed by being labeled as “cheap”, “easy” and even as “prostitutes.” Dr Juliet states that her experience with verbal abuse was much “milder” compared to Dr A and describes Dr. A’s verbal abuse experiences as “personal attacks.”

In order to cope with the hardships of Housemanship, our interviewees provided details on their recuperative mechanisms. “Take it a day at a time” states Dr A, encouraging future junior doctors to “not dwell on the past” as it can’t be changed. Moreover, Dr A advocates junior doctors to develop a thick skin – explaining that it was an acute learning process for him. Dr Juliet believes in fostering tenacious friendships with fellow junior doctors and being transparent with them. The subsequent method enabled Dr Juliet to not feel “singled out”. Those methods proved to be effective coping mechanisms to overcome the trials of Housemanship. 

The housemanship experience can be a grueling one causing enormous exhaustion to a doctor. Under these circumstances, a doctor is expected to be kind to their patients but what about their own personal wellbeing? 

It’s the dream of every doctor to be able to provide solace to patients in their time of greatest need. It is a profession where compassion walks along every step of the way. However, knowing how to take care of yourself is also a very crucial part of the journey. As we can see from the stories of these doctors, being resilient also entails kindness towards oneself.

This article was written  by Harini Srinivasan, Pratam Merchant, Atharva Raje, Shivani Thisinayagam and Shalini Parthiban of the International Medical University (IMU), Bukit Jalil, Kuala Lumpur.

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