I first heard the term “hidden curriculum” mentioned in my first year of clinical training at medical school. The majority of first year medical students are extremely excited to finally be at medical school, after years of planning and work, exams and interiews. They are keen to meet patients and idealistic about what the life of a doctor is like.
We were warned that as we progressed through medical school and into the clinical workplace, we would see doctors who were cynical, disengaged from their patients, who didn’t appear to “care” as much any more, and whose practice might be somewhat ethically questionable.We were warned that if we were not careful, we’d end up like them. Some authors go further than that and warn that if we are not resistant to this erosion of ethical values we put ourselves at risk of repeating the atrocities of the Nazi regime. These changes are not what medical school aims to teach, but things that people pick up along the way, learning from the examples set by more senior doctors, and so it gets called the “hidden” curriculum.
As I’ve gone through medical school I have seen friends of mine become more cynical. Some seem to see patients as a chore. I know of people who seem to think that being a doctor makes you superior to other people, or that being a particular kind of doctor makes you superior to other kinds of doctors as well as everyone else.
Medical culture has lots of insidious norms, some of which I’ve written about before – the idea that you’re a bad doctor if you’re happy to go home at the end of the day, or if you’re not willing to work hours and hours of unpaid overtime. That if your priority in life is to be happy, you can’t have a career as a surgeon. That “patients” are a class of people and are somehow different from us, or that patient is problem to be solved rather than a person asking for help.
That doctors somehow never get ill.
I don’t think any of you will be surprised to learn that throughout my medical career I’ve put considerable effort into trying NOT to become indoctrinated (‘scuse the pun) into medical culture. I’ve tried not to become cynical, and to continue to treat my patients as people, and to be open about my health affecting my ability to work, and to resist when people try to tell me that being a doctor means making all these compromises that I’m not willing to make.
I will be writing more about specific parts of medical culture that I find troubling, but for now I’m going to leave it at that. I would really like to hear of other people’s experiences of workplace culture, and medical culture, any problems you’ve come across, and any solutions or ways of coping that you’ve come up with.