¶ Defining Medical Bullying
What exactly is bullying ?
It's taking those subjective things for the purpose of tearing someone apart and not building them back up .
You don't say nothing , this is going to continue or it's going to get worse . If you say something , it's going to get worse , but you might get your respect . Talk us through that , yo .
I think you should always say something . I'm going to give an example . I had a friend who was an ENT surgeon . She was from Puerto Rico and they started making some comment about her being Mexican and at first she kind of went with it . That followed her all five years . She hated it . Damn , come on , little Mexican ENT . Ha ha ha .
And she's like um , and that's a common thing .
People will joke around someone being Puerto Rican versus Mexican versus yeah .
Exactly , and it was a slight . So that's an example of when you don't address it . You should never not address it .
All right , what's good everyone . Welcome to another episode of Docs . Outside the Box , it's your boy , dr Nii . Listen , we got a special guest in the building , or virtually we got Dr Letitia Bilbreu . What's good how you doing Welcome to the show .
Thank you , thank you for having me , thank you .
Thank you for having me . So everyone . Dr Bill Brew is an orthopedic surgeon badass , but she's also decided to get some additional training and she is specializing primarily in hand . What's the whole full thing ? I know you , I say hand surgery , but like , how do you like officially say it ? I say hand and upper extremity because I do fingertip to shoulder .
So , yeah , so for all those trauma patients on 4th of July when they like hold on to the M80s too long , she's your woman , she's the one who's going to take care of you when it goes boof . Right . But that's a , that's a crazy , crazy job , very busy job . I work with surgeons , just like you , on a , I pretty much say , on a daily basis .
¶ Dr. Bilbreu: Hand Surgery Specialist Introduction
But also you handle just common , you know orthopedic hand issues on a daily basis . So it's not just trauma , it's a whole bunch of different things . So for the med students listening , for the residents listening and they don't know what hand surgery is , go ahead and let them know what you do hand surgery is .
Go ahead and let them know what you do , absolutely so , like I said , fingertip to shoulder , the non-trauma stuff is going to be your everyday things carpal tunnel , trigger fingers , any kind of tendonitis .
I do a lot of sports related injuries too , for those wrist sprains , finger sprains , going all the way to trauma , from the basic wrist fractures all the way to the complex elbow dislocations , and then I also dabble , of course , in microsurgery .
So I'm the person that , if you know somebody cuts the nerves to the hand , I'm going to be putting nerves back together . Or comes in with a fingertip that's been cut off or a gunshot wound to the hand or , like you said , firecrackers to the hand . I'll be the one reconstructing the upper extremity .
Yo , she a unicorn . Y'all , I'm telling you , we are blessed to have you on this show , dr . Bill Bruce Thank you , thank you , thank you so much . So in a second I'm gonna let you do more of an intro of yourself . But , like , I want to get the audience like , really like , listening to why we are here today .
So , listen , like you know , right now we're recording this late in March , which means that everybody is matching and at least right now , tomorrow or Friday , people will find out exactly what residencies they're going to be going to . Right , they found that they matched earlier in the week and then they're going to be finding out exactly where they're going to .
And if you haven't matched and you're listening to this , I feel for you . But listen , you still going to make it . But you're going to see this all through social media .
People are going to be excited , people are going to be disappointed and people are just going to be just excited to be moving on to the next stage of their training , right , going into residency , which is a big deal . You get the MD or you get the DO after your name and you're practicing .
You know , learning how to be a doctor in essence , right , which is a big jump from med school . But you know , one of the things that we rarely talk about on this show , but you actually see a lot of on social media . Hella on Reddit is bullying in residency , and this is something that you know .
We see it on social media , but we don't really get a chance to like talk about like , how do we like identify it ? How do we get through it ? So let's talk about that . That's what we're gonna talk about in this episode is , like , what happens , you know , when all the glitz and the naivete goes away and you find out
¶ Match Week and Residency Bullying Statistics
that you're being pushed around in residency . How do you handle that ? Right , and Dr Bill Brewer is our expert on this . Who's going to talk about this ? But before we jump into that , y'all , let's talk about some quick stats . I got some notes and I feel like an old man . I got to make my screen bigger .
But here's some quick stats on bullying in medical training . Studies show that up to 48% of residents experience some type of mistreatment during training . Right , that's a big deal . Almost close to half of all residents in training experience this . Right . There's definitely gender differences .
Female residents report experiencing significantly more bullying than their male counterparts . Right , if you're an international medical grad , I didn't even think about this . If your primary language isn't English , oh yeah , you about to get bullied .
You likely are going to get bullied on this right and here are some of the consequences of all of that right Of being bullied . You likely are going to get bullied on this right and here are some of the consequences of all of that right Of being bullied .
Some of the consequences are residents are reporting feelings of burnout we talk about 57% due to being bullied Worse in performance , 39% due to being bullied , and also depression . And you know folks in medicine we got a suicide issue right . Know folks in medicine .
We got a suicide issue right , so this .
This is a big deal , Dr Bilbrue . This is a big deal . So the way , how , man , we can go in so many different directions with this , but , in your opinion , like what exactly is ?
bullying . Did you experience bullying in your training at all ? Yeah , so I think . I think we
¶ Handling Day One Bullying Experiences
all know what bullying is . It's taking those subjective things for the purpose of tearing someone apart and not building them back up right the person that is doing the bullying . They want to make the other person feel small , inferior , less than they want them to doubt themselves . And did I experience bullying ?
Absolutely , you know , day one and I think that comes with you know , you mentioned those stats and I think if we were to focus again on the women . And then you know , for me , I was Iic surgery training program in the state at the time and my first day it was a general surgery and I remember the chief resident was like , oh , leticia Latoya .
My last name was Roe at the time Roe , you better not give me no trouble , girlfriend and like this exaggerated urban . And I was so confused because I'm like wait .
How do you respond ?
Right , and people are laughing , and I've never been ashamed of my name , like I still spell my name fully out . So I was like , oh , he's making fun of me , like he's making fun of , like , the fact that I have a very ethnic name , right , and you know , I was coming from Atlanta where at Morehouse , half of the class is named Isha , you know .
So you know . It's very common for you and stuff , yeah , so I like , it took me literally minutes into the conversation to be like what was that ? He's making fun of me . So how do you handle that ?
Like you know , I always tell my mentees you don't have , unless you like I'm super quick now , but I've had 15 years to gather that quickness you , you always just take the time and pause , never come back initially , even if you have the mouth and and that vernacular with the four letter words to jump back . I always say just pause and digest it .
Right , and that could even mean for a day or two , understanding that you're not using that information to be like man , I got a terrible name or you know , whatever . The negative information is always negative . It doesn't reflect on you but reflects on what caused that person to say that .
And I realize it's because he had never worked with a Black female intern ever . Right , like this was his first . Sorry , there was one more before me , but this was like his first experience in his chief role and so understanding that dynamic helped me to shift the reason why the bullying was happening .
And that's just on a peer-to-peer and it's very intimidating when you're an intern and you're a chief and you you're like , how do I convey to this chief that he doesn't have to get intimidated by my name , that I'm not going to sit here and curse him out anytime he tells me hey , go check on patient so and so , um , and and it took months to build that
relationship , to develop it , to disarm the person right . So a lot of times you have to disarm the bully .
okay so , okay so , because I , because I get what you're saying right , because , yeah , maybe you should pause , right , but like , how do you ? Here's the question that I got for you , and I think what you're saying makes a lot of sense . So , how do you get your , your people that you're you're training , or your , your mentees ? How do you get them ?
Because there's two ways that you can handle this . Right , there's a pause , and then you let it go , and then there's a pause , and then should I address it in a day or so ? These are two ways in which these are going to happen and the consequences are completely different . Right , you don't say nothing , this is going to continue or it's going to get worse .
If you say something , it's going to get worse , but you might get your respect . Talk us through that , yo .
So I think you should always say something , and I'm going to give an example . So , as I was an intern , I had a friend who was an ENT surgeon . She was from Puerto Rico and they started making some comment about her being Mexican and at first she kind of went with it . That followed her all five years
¶ Building Your Support Village
. She hated it , damn , she hated it . All right , come on , little Mexican ENT , ha ha ha . And she's like um .
And that's a common thing . People will confuse or joke around someone being Puerto Rican versus Mexican . Exactly Versus yeah .
And it's like it was a slight no-transcript , so like if you're at phase 15 , like me , I got you from the moment you say something , I got something right back for you , right ? But ?
you're an attending , though .
You're board certified .
You know you good , so you could come back and be like but when you , but when you're an intern and chief .
It's different . So you that's that's where you do need to pause , because you have to strategize . This is just as essential a skill set as learning how to suture . Especially if you're being bullied for something that you know .
Most likely this may follow me in my career , whether it's you having a certain name , a certain build , a certain gender , a certain sexual identity . You have to build that skill set of how do I deal with these bullies .
And that could be when you take that time to go home and talk to your village , talk to your parents , talk to your friends , talk to your family , say , hey , I had this situation , gather the opinions on how to address it , coalesce them together and then come up with a plan Right .
So for me it wasn't going back to him and saying , yeah , my name is Letitia . I told him , hey , I'm really proud of my name . By the way , my mother named me . I'm from England . We're from Jamaican heritage . We tend to carry a lot of last names . I know where to say your last name's Greek . Can you tell me how to pronounce Chakalakalakalis ?
And then so I'm a jokester . So I was like no-transcript .
Especially in a male dominated field like yours .
Even if you report it up , people are going to be like oh , you can't handle this Exactly , she can't handle the heat . I've been in that situation , yeah it's tough my hair and was like yo , your hair stinks and I'm calling my and I'm like that's yo , that's a macroaggression , right . So I'm calling my program director .
Hey , this attending just how he was like , well , what you using to wash your hair ? That's laughing . I'm like , oh , that's the support that I get , but again because they're not equipped to .
He's not equipped to handle that .
He don't know what to do , even had somebody have to have that be an issue because he's never had a resident with locks , he's never had an attending comment on a resident's hair . So he and that's what I'm saying Know your village . He was not .
And you still got to push through , though . Despite that , though , right .
Despite that .
You know , these changes may occur in five years , but during those five years I got to get through . I got to get through it . This is my second year . You know like , oh my , this is my real year .
And you know to teach the individuals that are listening so you can learn from wisdom and not trial and error like myself . You really have to identify who your village is . You have to identify who your sponsors and your mentors are who will understand your plight .
They don't have to have the same background , gender , religion , identity as you , but they need to have the ability just to listen first , to be like let me just hear what you're saying , I don't have a solution yet , but let me hear you out Right Cause again , it's just strategizing when you're dealing with these bullies .
Now I got a question for you , let me . Let me start by saying okay , so what I have down as bullying and medical training is harassment , right , intimidation , correct , excessive workloads , yeah , right . So like , why am I always how come I never got a golden weekend and , like you know , in nine months , right .
Or are you like , why am I always on call X , Y and Z , right ? Every holiday I'm on call . Come on , you'll stop playing Um verbal abuse , um being excluded .
I don't talk to that person , you know , we not you know , hey , I'm going to talk to this person , to talk to that person , to talk to the person who I got an issue , who I'm trying to intimidate , right , right . But here's one thing you talk about strategizing . What is the difference between constructive criticism , right . What if they like ?
What if , for example , from the standpoint of how they're correcting you ? Right ?
Yeah .
What is ? How do you differentiate between yo ? This person is just being constructive , like they hit me at a point where , yeah , they might be right versus yo
¶ Differentiating Criticism from Harassment
you . You straight up mistreating me Like let's talk , right , take us through that .
I think that this is the . So your residency is meant to train you how to be a better physician , whatever that may be . So if you keep that as the grand scope of things , anything outside of your training ie commenting on your hair , commenting on what you do for fun on the weekends that ain't got nothing to do with my training .
The second thing is I tell people focus on the objective , and sometimes you have to help the attendings to focus on the objectives . I'll use an example , and I love this one .
I was like a third year or fourth year and I was doing a hip replacement where really the attending was just watching and they're helping to retract and at the end , hey , how did I do ? I think you were awkward , sir . I think you operate awkwardly . I think it's just awkward . So then I think you operate awkwardly , I think you , it's just awkward .
So then I had to break down . What was my surgical time ? Was it appropriate for this ? Yes , okay . Tourniquet time appropriate ? Yes . Was there excessive blood loss ? No . Were the components in the right place ? No . So when I finished going through all the objective things that are used right place no .
So when I finished going through all the objective things that are used . I said so . Can you help me ? I'm trying to what is awkward , uh well , uh stutter . So for the medical students , the residents , the fellows you want to focus on , the objective of is what they're saying having an effect on how you are operating ?
Damn , I like the bill , bro , Yo she cooking .
Oh snap .
I love this . Listen , this is what happened .
Y'all learned from wisdom and not my trial and error . I had to do these things .
I love this . Okay , but yeah , when you Because it's going to happen . This is going to happen because people , you know , there's going to be times where you're going to get a bad report or a bad review and you're like I don't understand this . Come on Right .
And , as you know , like residency really is based on what somebody , how someone , thinks you're doing , and as much as ACGME has shifted to try and have really specific guidelines . I always tell my mentees you keep your own look at me book . After every surgery you need to find your chief or your attending and you go through hey , what was my time like ?
What was my blood loss ? Like , how well did I fix whatever you're trying to fix , what did you think of my technique ? Even if you have to form your own scale and then you have to keep that as a log so that they're not just turning around and saying , well , yeah , I don't know , I just think he's okay .
Well , how can you say you think I'm okay when for the last six weeks , every time I meet with you at the end of the week or on a biweekly basis and we go through things , you said I'm doing good and you , oh look , you signed it right here .
I'm so serious , like , especially when you're in a position where you feel like I'm being harassed here , cause it can be so low key that you don't know if it's harassment or if it's a personality thing or if , like man , maybe I really am struggling . Go back to the objective data .