Orientation Or Disorientation?

Orientation Or Disorientation?


By:  The Generation Y Surgeon (@GenYSurgeon)


I recently graduated and transitioned into my fellowship. As most physicians know, part of transitioning to a new hospital is enduring the necessary mandatories and introductory sessions; however, as a small percentage of a large number of incoming physicians, I was grouped with the interns for orientation. This was painful for a number of reasons.  However, what made me buck was much more subtle.


“It’s Our Policy”…

When I showed up for orientation on the second day, one of the admit staff at the sign-in asked me where my badge was. Understanding how painful it is to replace a hospital ID badge when you haven’t memorized your employee number, my heart sank. How could I have lost that thing already?! So I looked down to my right hip, the place where it had sat for 5 years while I operated and rounded and….it was right there. The admin proceeded to tsk-tsk and point to her left shoulder. “It’s our policy..” she snapped in a sing-sing voice. Did she just scold me as if I were a child? Keep in mind that I was in the OR until after 8pm only days prior, had packed up and moved an entire apartment and was still answering calls about patients still admitted at my residency hospital. Lets just say that the response she received was not as benign as she would’ve hoped. And then I realized she didn’t know I wasn’t an intern…


Show Some Respect

I usually don’t snap at administrative staff; however, this interaction really struck a nerve.  What bothered me wasn’t that particular interaction as much as knowing that woman thought it was her right to speak to me like that. She wrongly assumed I was an intern and spoke at me disrespectfully as if I weren’t a physician at all. I am always respectful of the ancillary staff in hospitals, regardless of their positions. Without the techs, transport, cleaning staff, office staff, managers and administrative staff the hospitals where we work simply wouldn’t run. I will point out, however, that without physicians the hospital would be worthless and without residents (future attending physicians) the hospital would very soon be worthless.* And as such, providers should be treated respectfully, even in their earliest years.


The Interns Should Be Treated Like Adults…

Had this particular woman realized that I was in fact a board eligible surgeon, not an intern, I’m positive she would not have spoken to me in that way. I’m also positive that she had spoken to every other intern in that manner because she truly thinks they are beneath her. This make me angry for interns and for physicans in general. Let’s not forget that, by the time we entered residency, many of us were nearly one quarter of a million dollars into educational debt, 4 years of schooling beyond our bachelor’s degrees and already real, really tired. By the time we enter residency we have demonstrated commitment beyond our years and devotion to a noble profession. Interns should be treated like professionals, not children, because guess what…they’ve earned it.


…Even Though They Don’t Act Like It Sometimes

Now back to my real-life scenario. Thoroughly irritated, I looked around and much to my dismay, the interns were acting just like I had been treated. The room reeked of immaturity and bad behavior, all the markings of a group 10 years their juniors. The orientation had been set up much like college/university orientation and the new physicians were certainly acting the role. I wonder why the interns act like that, and whether it’s universal and what exactly happened during residency that pushes most people over the hump and into maturity. Would a different environment lead to different behaviors in these residents? Would they be treated differently by the admin staff?  Maybe all twenty-somethings are like that in every field.  If so, I guess I’m not as disappointed.


Don’t Accept It & Help Repair It

It’s important to think about what sort of environment we first expose our residents to because this first impression may have more profound effects than we realize. There are entire bodies of literature in business and management fields which outline how to create and model professional behaviors. Outside of Medicine, this is a huge deal and yet for some reason (probably because we are too busy and too tired!) physicians have let this aspect of the workplace slip. We would all agree that we have learned by modeling our seniors and conforming to the workplace norms, but what kind of norm have we set for the interns during their orientation? Should they expect to be treated disrespectfully? Should they accept that they are considered inferior to the ancillary staff during their entire first year? No, they shouldn’t. And neither should we.


Evolve Or Die

You may be wondering why I’m bothering to write about this issue on a blog about business models and innovation, and I’ll remind you that healthcare is in fact a business…and we are part of it. Don’t like it?  Well, guess what, denial of what it really is just got us managed by other people.  (Thanks a lot, dinosaurs, for that one.) The question is how to effectively take care of people in the current climate of Medicine and NOT to deny its realities or hope your denial and beliefs will somehow change it.  Evolve, people, or die.


And This Is Part Of That Business

Part of the business is building and maintaining an environment where the physicians can feel comfortable and empowered, and in this environment respectful communication is key. Somehow we have forgotten the importance of mutual respect and effective communication and our culture has shifted to the point where our incoming physicians are treated like scum. This is not how we should be ushering our interns into the hospital.


Where Can You Look For More Information?

As I mentioned before, there are entire bodies of literature on how to build effective workplace environments and how to communicate effectively. One free resource that I frequently use is called MindTools. I receive regular emails which outline different aspects of personal and professional growth, culture change, and common obstacles as well as some how-to guides for improving your workplace. I will challenge you to make small changes in how you model professional behaviors to the hospital staff and your mentees. With small, individual changes hopefully we will be able to change the maladaptive cultures that plague our field.


Disagree?  Have a different idea?  Let me know beneath.




*FYI:  Although I am writing specifically about physicians and residents, in spirit I mean to include all other providers…NPs, PAs, prehospital staff, etc.