Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine Western University of Health Sciences,
St, Pomona, CA

Are You Intimidating?

The podiatry school year is in session! This past weekend, we at Western University had our campus-wide convocation, which consisted of the nine colleges of the university marking the commencement of the 2010 academic year. For me, this event marked the first time I felt “older’ (a relative term, of course)--I realized that when the arriving class of 2014 completes medical school, it will have been 11 years since I graduated from medical school. I can only imagine how this comparison might feel to those of you who have been in practice for many more years than I have. It’s a novel situation for me instructing our future podiatric leaders--and I realized as I spoke with them that my position of authority may be quite intimidating. I’d like to take a moment and consider where “intimidation” fits in to our professional lives.

In Nature, as in Medical Training

Intimidation stems from one basic concept: the power differential. This idea is most simply exemplified in the animal kingdom. When two gorillas are competing for a mate, they will show off against each other with raised arms, puffed out chests, and standing to full height in a dominance display. The dominant gorilla is the one that successfully creates a power differential in the mind of the other, thus intimidating him and getting the girl. In other cases, this power differential is not perceived but actual. Consider the gazelle that keeps a justifiably safe distance from the hungry lion. Intimidation exists by the very nature of the relationship between these two animals.

Is it Real?

The same is true in medicine – there is both a real and perceived power differential. Real in the sense that those of us in positions of authority (teachers, chief residents, attendings, directors, etc.) have the ability to significantly affect the futures of those that work and train under us. This is especially true in podiatry, a relatively small network where our trainers often know others in power positions and may directly affect our future prospects.

Is it all in your Mind?

There’s also a perceived power differential – and with this one I have a problem. My problem? Thank you for asking! My problem is in the abuse of this perceived power difference. Now, I know a certain hierarchy must exist. If I’m training a resident in the OR, it’s mandatory that they do what I say and adhere to the power differential for everyone’s safety and good patient outcomes. As Cartman from South Park says, “They must respect my authoritah.”

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Power is Abused

But when this power differential is abused, nothing good comes out of it. We’re all familiar with the nurse-doctor relationship. Historically doctors have abused this power differential, creating an “us vs. them” relationship which is only now starting to slowly break down. I learned early in my training that nurses were a gold mine of educational opportunities (still are) and should be considered part of the healthcare team rather than as “subordinates.”

This power differential exists in spades, when you look at the attending-student and attending-resident relationships. I can’t count the number of times I was abused as a student and resident, only to keep my mouth shut because I was intimidated by my attending. I fell right into the power differential trap. I’ve also seen it since. How many of us have, for example, referred to “the student” forgetting that person actually has a name. When we do this we’re reinforcing an unnecessary power differential.

Be the Solution, Not the Pollution

This problem in medical training has improved much over the past years, but it still has a long way to go.

Here are my suggestions to avoid abusing the power differential.

Look at yourself first. When you deal with those below you in the hierarchy are you purposely intimidating? Are you abusive? Think hard. We all know who you are.
If you said ‘yes’ to the first question then stop it.If you were abused by your trainers, your parent, or someone else, then take steps to move beyond it without taking out your insecurities on someone else. Use your real power to stop the cycle dead in its tracks
Remember the Goal. The goal is not to boost your ego. The goal is to train residents to become effective, responsible and confident doctors. A combination of stern authority where a situation requires gravity and collegiality where appropriate, will work much better toward reaching that goal than constant intimidation.
Remember the golden rule. Do unto others as would have them do unto you. Do you want someone to berate you when you make a mistake? Do you like it when someone yells at you? Would you like to be “pimped” and derided if you don’t know the answer? If not then don’t do it to anyone else.
Realize mistakes are where we learn. Understand that when your resident or student doesn’t know something it indicates a deficiency which is simply an opportunity to teach. Ignorance and mistakes should never be hidden. If your resident knows everything then they don’t need your residency. Teach others that you don’t know all the answers, and show them how you find the answers. Help them understand we learn more from our mistakes than our errors.
Foster an environment of emotional safety. As the one with the power (real or perceived) you have the opportunity to set the stage for an open atmosphere in which ignorance is combated with kind education and there are no negative repercussions for mistakes. There should be no such thing as punitive learning.
Break the barriers of hierarchy. Get to know your underlings. Call them by name. Learn who they are. Above all, be approachable.
Care.

The superiors I’ve trained and worked under have been blessings to my career. This handful of individuals appear to effortlessly embody all of these traits – they’re true humanists. Their power and influence as teachers and mentors are infinitely superior due to their appropriate constructive use of the power differential. How do you use your power differential?

What do you think?