Trainees as Agents of Change: Using Your Voice as a Medical Student.

Abstract

To the Editor: I was in the emergency department (ED) when I overheard my preceptor talking about a transgender patient. “Hairiest woman I ever saw!” He laughed. “Apparently it’s a woman, but let me tell you, there’s not much ‘woman’ there.” Every medical student has heard an attending physician say something inappropriate or discriminatory. When that happens, do you say something? When? How? The hierarchical nature of medicine makes it notoriously difficult for trainees to speak up, although the benefits are numerous. 1 In my case, partly from the shock of it and partly from my own cowardice, I said nothing. Later, I walked home in tears, disillusioned with medicine, and more so, disillusioned with myself. Moral distress is a well-documented side effect of remaining silent and I was experiencing it firsthand. The next morning, I wrote an email to the preceptor using a framework I had learned in my third-year orientation, which in part relies on assuming good intentions. “I think you were trying to give the patient excellent care and communicate the situation clearly,” I wrote. Well, maybe that was stretching it. “I would be happy to talk to you about ... preferred pronouns (which can sometimes be a confusing topic).” Was I being too deferential, I wondered. Diplomatic to the point of obtuseness? These were hard questions that I needed to answer before I sent the message. I decided that I was being diplomatic because my goal was revolution, not retribution. Sure, I was speaking up partly from the moral imperative to say something (better late than never!), but mostly, I hoped that I could change this provider’s future behavior. And to do that, I would call out the noble core that I truly believe drives most physicians. Not only did the provider respond to my email but he also set up a meeting with the head of the ED and the nurse manager to discuss what I had heard and ways to ensure a welcoming environment for all patients in the ED. This incident taught me that once you get over the formidable hump of actually speaking up, it is important to consider your goals. To trainees, I would say this: By appealing to the empathy and nobility inherent in medicine, you can make a difference.