In the hospital, there is always some tension across the rungs of the hierarchy. Some gaps are decades apart. Some are only a few years apart, such as between senior residents and junior residents. On the one hand, one hears a steady stream of complaints pointed upward from those who are dissatisfied with the status quo and want to improve how we work and deliver care.
“I can’t understand why they are ignoring this problem!”
“Why can’t they understand that the current system is unfair and unsustainable?”
“Do they care about our well-being at all?”
Over the last four years, in looking upward at the decisions made by others, I have also felt this impulse more times than I can recall.
On the other hand, just as often, one also hears comments from the top directed downward about how things used to be much worse and how perhaps people should learn to be more grateful.
“When I was an intern, we used to work so much more.”
“When I used to cover that service, we looked after twice as many patients.”
“When I was training, we used to have much less support than we do now.”
Looking back, I have said these words, too.
The reality is that we all, at some point, experience both sides of this dynamic. In our various roles, we are sometimes at the bottom of the ladder and sometimes at the top. As we rise or fall in the hierarchy or take on different responsibilities, we may find ourselves on the other side of the same issue.
Having heard and been on both sides now, I think I understand where this tension comes from. Both sides do not necessarily understand the needs of the other and cast each other as extreme. Therefore, these issues become highly polarized.
Going forward, all of us, across all stages of the hierarchy, need to do better.
First, when we feel the impulse to complain or label something unjust, we cannot prematurely jump to conclusions. In these situations, I have found it helpful to be reminded of the bigger picture. Is there even a small chance that I am being unreasonable and need to change how I am looking at the issue? Do not be quick to infer negative intentions or character traits upon others based on what we perceive on the surface. In my experience, even those we assume to be totally in disagreement with us are generally not that different from us.
At the same time, we all need to recognize that, more often than not, complaints do stem from a valid cause. Complaining is often the language of progress. It is also a testament to the environment of safety and openness that exists. It is a sign that they are engaged and committed to always furthering progress. The reason why things have gotten better over time is that people throughout history have decided to actively address problems they perceived. If everyone were to be just grateful all the time, how would we figure out where to go from here?
Working conditions may have gotten much better than they were in the past. But the system can always strive to become safer, more efficient, and more humane.
We may have more support and resources around the hospital than we did before. But we can always find a way to do more for each patient.
We need to heed these voices.
The adversarial nature across the rungs of hierarchy is deeply ingrained in many hospital work environments. It unnecessarily takes up our time and energy and decreases our workplace satisfaction. But ultimately, we have to strive to remember that both groups want the same thing — to continue to make progress for ourselves and our patients.
Have you helped instigate change where you work? How did you go about doing so? Let us know in the comments.
Jason Han, MD is a thoracic surgeon and was a 2018–2019 Doximity Author. He tweets at @JasonHanMD.
Illustration by April Brust
