There is a culture to medicine that I alluded to in my previous post about how everyone in the hospital is your boss. In essence, medicine is a profession like no other where “scutwork,” “malignancy” and “bad-mouthing” colleagues is standard practice. In the academic world this continues on in full force even after becoming an attending. In the private medical world it still exists. There is always a “Chief” or “Chair” of the department or division in which you practice. Most professions have hierarchy or levels of the ladder on which people sit. In medicine, I submit that the personalities are very strong due to the history of malignant medicine.

I have never seen such a profession where co-workers harbored such hatred towards each other. I have witnesses this at all levels of the medical spectrum from student to resident to attending. In the surgical field it is more predominant that in other fields of medicine but it exists in all realms of medicine. I have come to the conclusion that there are only a few reasons why doctors are so mean to each other.

First, I believe that many people are unhappy in their choice of career. Thus, when they see others doing better than they are or enjoying life more than they are, they do whatever they can to keep those people down. This is what I call the crab theory of medicine — that one crab won’t let another escape and will drag him down, causing both to die. Another reason for malignancy is that many physicians are really not mature individuals with many life experiences to give them perspective for their work. For most doctors, being a doctor, resident, or medical student is the first and only job they have ever had. Things get a little hazy when you do not have different perspective.

The “God complex” also still lingers in the medical profession. This is the notion that the doctor thinks he is the healer and can do and say (yell) anything he wants. Perhaps the most compelling reason that explains why doctors can be maligant is that medicine is a demanding field in terms of hours and energy and sacrifice. Proper coping mechanisms are difficult to develop when your environment is filled with similar people suffering the same affliction. It could be argued that in medicine there is no room for error and thus this stress causes doctors to behave badly.

Despite the malignant medicine practiced today, things have gotten better over the years. As the profession progresses like other industries, the medical environment will be healthier for all of us doctors. Some of us cannot wait.