‘I can tell you from experience that the surest way up the ladder is to listen carefully and follow my orders. You may be confused at times and other times unsure but remember… I will never ask you to do anything that I wouldn’t do myself.’
This is from the final scene of the brilliant film Nightcrawler, with Louis Bloom (played by Jake Gyllenhaal) welcoming the interns for his newly formed news company. If you watch it in isolation, listen to the words he chooses for this one moment, you’d think it was a fine example of a boss aiming to encourage, inspire and support his new colleagues. Words that say ‘I have been where you are, I will help you succeed and I will ask nothing more of you than I ask of myself.’ Words we should aspire to match maybe? But watch the clip and listen closely to the music, listen to when it drops out to allow us to focus on the final words spoken:
‘I will never ask you to do anything that I wouldn’t do myself.’
Now I won’t spoil the film for those of you who haven’t seen it but what might sound like a source of comfort for the interns, has a completely different meaning from the perspective of the audience. Knowing what Louis has done to get to this point, what he has been prepared to do to succeed, leaves us feeling horrified for the new employees. They have no idea of who he is, what he is capable of. It is a spine tingling, stomach churning finish to the film.
But what has any of this to do with Medicine?
It’s that time of the year when we induct new staff in to our Emergency Departments, GP Surgeries, Wards and Operating Theatres around the UK. Some are starting on specialist training programmes, a few are starting their careers as doctors, all of them will be looking to their senior colleagues for guidance and support. What are we going to say? Sadly I suspect many will hear, ‘I won’t ask you to do anything I wouldn’t do.’
Now, it might not be said exactly like that but it will be implied. For instance:
‘We were lucky to get any formal training in my day.’
‘He’s off sick? I remember having to take a break from the ward round to vomit!’
‘I stay until the work is done, that’s what doctors do.’
‘Why do you need a break? I’m not taking one.’
Regardless of the specific example spoken to them, the subtext is clear:
‘If I coped with it, did it or still do, I expect you to as well.’
Unfortunately the reality is that what many of us went through in the past, or still choose to do in the present, is far from healthy or appropriate. Excessive hours at work, sleep deprivation and skipping meals were a feature of many of my years in training. Belittling comments, hierarchical intimidation and bullying are all things I have experienced as I tried to do my job too. Worryingly, for most of my career I accepted all of this as ‘just how things are’ and continued the cycle of abuse in turn as I moved up the power structure.
The attitude of ‘I won’t ask you to do anything I wouldn’t do’ has led to the perpetuation of some of our most ingrained and unhelpful behaviours such as rudeness, bullying and discrimination as well as poor beliefs with regards to working hours, training and self care. Just because ‘I do it’, ‘I put up with it’ or ‘I survived it’ doesn’t make something right or even acceptable. Through our behaviours, both active and passive, we allow this perspective to continue, maintaining the status quo within our culture.
So what’s the alternative? Well, imagine if we took the same approach to medical treatment as we do to our working culture. What if we insisted our juniors not only worked and behaved like we used to but also carried out the treatments we used to… just because ‘that’s what we did.’? Imagine how different, how ‘backward’, our clinical practice would be today. We need to realise that many of the attitudes and behaviours of our past are as outdated as the treatments we used to use.
So, does that mean us old folk can never talk about the past, never share stories of our long hours, imposing bosses or inadequate supervision? Of course it doesn’t, these stories are a valuable part of our profession’s history, part of who we were then that shapes who we are now BUT we need to avoid using them as some twisted standard setting exercise or a chance to undermine the problems our junior colleagues are facing, like some medical version of Monty Python’s Four Yorkshiremen Sketch.
Instead we can use them as way markers, a chance to illustrate how and why we need to keep moving our culture forward, never settling for the belief that our present is the best that we can be. Or perhaps as an illustration, an opportunity to get alongside a distressed comrade with a story that shows empathy for their situation, allowing them to feel safe to explore the difficulties we may have had to face alone. There is power in these stories, let’s make sure we use it well.
I think, ‘I will never ask you to do anything I wouldn’t do myself’ is a pretty shitty expectation to set our junior colleagues. No, I expect so much more of them. I expect them to question everything I do and why I do it so that they can learn from my mistakes. I expect them to achieve more than I ever managed and to be better than I ever was. And as they do this I will support them as best I can, cheering them on enthusiastically as they put my past to the sword, because it is only through each new generation reaching further than the one before that we can truly move forward.
The future is bright, and it is our job to help them shine.