Moral Injury, The Sequel | AMA 24

There was a lot left unsaid in my first video on "burnout" and moral injury, so now I gotta get some of it off my chest.
zdoggmd.com/mor...

[@LaSmoocherina]

Love this! Today was crazy at work. We had a 16 year old vocational CNA student on my unit and she passed out. (A super awesome tech caught her) It was hard to get her to come around. When she finally did, she had tears s streaming from embarrassment. I held her chin up (mostly because I didn’t want her to look down and pass out again). And I wiped her tears and said, “you have nothing to be embarrassed about. Sometimes in healthcare, we get sick or dizzy or nauseous or we cry, but that’s the part of us that’s human. It’s the same thing that allows you to have compassion. You can be a robot and have no compassion and never get faint at the sight of blood, but being human is way better. You did nothing wrong here.” She just nodded and we got her instructors. But my techs thanked me so much for what I said to her. Other people were like, “well, this isn’t the job for her!” I said, “not true. I had a strong gag reflex for about 3 years and definitely when pregnant, but that almost never happens to me now. We don’t give up on 16 yr olds that want to care for people.”

[@sarahcrain8083]

Good for you. Two weeks ago my husband had shoulder surgery. He was the last patient on his surgeon's schedule. The damage took 3 hours to repair. I woke up that morning feeling pretty bad. By the time we arrived to the hospital, I was full blown sick. Spending most of my time in the restroom, with my rear on the toilet and my head in a trashcan. By the time my husband made it to the holding area. I didn't think there was anything left to exit my body. Sitting there and without warning 😂 it erupted like a 🌋 from both ends. The nurses that had to be overwhelmed and on the brink of exhaustion, were so sweet to come to.my rescue. Grabbing cleaning supplies and scrubs for me to change into. I was so embarrassed. One of the nurses told me not to be embarrassed. Since I lived just a few minutes from the hospital, I could run home and shower. It was going to be a long evening. It would probably make me feel better. It was 8PM when the surgeon came out to talk to me. He apologized for me having to return to the hospital. It was standard procedure for a loved one or care taker to be present for outpatient surgery. He felt bad hearing how sick I had been and having to return. It turned out that I could have stayed home. While surgery had gone well, my husband was being admitted due to breathing issues. Just as I had advised could be the case with his sleep apnea issues. Had he realized how sick I was earlier in the day, he would have planned to admit my husband. Instead of making me suffer it out in the waiting room. Monday the surgeon was pleased to find my husband doing so well. The surgeon even acknowledged that I looked like a entirely different person. As he turned to my husband asking if he realized just how sick I was the day of his surgery. For the surgeon to tell us, that when he gets married. He hoped the sickness and in health part would work as well as it had for us. 🤒😷🤕

[@rebeccaabel4589]

You are compassionate nurse and coworker as a pct l have seen the emotional detrimental effects this job or calling does to all healthcare workers. We are humans physicians nurses respiratory techs Physician assistants etc we need to support each other.

[@sharonjohnson2965]

Beautiful

[@vettejakes]

Whew chile... as a nurse working the battle field for 37 years, ( worked in various in patient settings )you’ve said what I’ve felt all that time in 4 minutes. Daily I have to remind myself why I chose to be a nurse. Times have changed so much. My saying is that it’s gone from healthcare to health business and I did not go to business school.

[@saritastreng2673]

Sad.

[@annie123e]

"So they don't put in the work and passion that proves to their mentors that this is a frickin' calling." I'm just beginning my 4th year but I have already heard attendings tell residents that divorce is to be expected and they have no business making time for their spouse. I've watched residents work 12 hour days, 12 days in a row, with a wife and infant at home before getting the "golden weekend" that is expected in every other field. How is this just? We shouldn't have to personally suffer through burnout before we get the right to say that this system is inhumane! Work hard, yes. But I reserve the right to fight for my health and my relationships outside of medicine before (not after) they are broken. This system isn't designed for education, it's designed to profit from the cheap labor of residents.

[@JohnnyLodge2]

I am a new attending. Residency is difficult. It’s not the slavery it is made out to be by some. We had 50+ residents. More than half were married when they started residency. Just less than half were parents. We had only one divorce (an unhealthy relationship with a toxic resident) but multiple marriages and child births. I am a teaching attending at a large academic center now and there hasn’t been any melodrama among medicine residents. I was a chief resident last year and the sense of entitlement was real. Yes, the hospital has you as an indentured servant and they will always pressure PDs to increase the amount of labor they can get out of you. That’s something you push back against. But too many people complain about every little thing like being asked to work. You’re doing the self fulfilling prophecy that was mentioned. Please remember that residency is transient. You put in the work for a few years and then it gets significantly better. This isn’t just true in medicine but pretty much all fields of employment. Even drug kingpins start out working crazy hours for low wages.

[@laurap4415]

So right.

[@kathygaddy4039]

I know this is about docs, but I am a second career nurse. I got into this thinking I was going to change things. But now I believe in the "Starfish Theory" which is if I can help one person then I am doing the best I can. It is unsatisfactory on so many levels, but that, plus being on of your followers (doc's aren't exactly known for compassion) keeps me going. But I see those people every day, uncaring nurses, docs that give me the orders "I want" without knowing the patient. Come on I'm a f**king nurse, I'm calling you in the middle of the night because my patient is in pain, vomiting, freaking out, I don't want to call you, and yes I probably know what you are going to order, but I'm not a freaking doctor. Burn out also happens when a doctor says "and you are calling me at one o'clock over constipation?" and you have to explain 3 calls and 3 interventions were done during the day but the patient is still bloated, painful, and vomiting feces smelling stool. I want to say WTF all I want is an order for an NGT that should have been ordered 12 hours ago. So it is not just the system it is also the healthcare team.

[@lisademartini1]

thank you for caring about your patients.

[@doug5203]

ZDogg, I have to firmly disagree with your last point. Burnout does not just start when you are an attending physician. The medical education system is broken. From huge examinations that determine the very fields you are able to enter prior to even seeing patients, to monthly examinations that require extended amounts of time to prepare for, with quantifiable impact on residency placement, there is a reason students are less engaged while on the floors. That coupled with medical legislation, EMRs that require residents to treat the computer and exclude student learners, subjective grading systems and literature reviews that are almost never relevant to the information tested on exams, is there any wonder why students this generation are more jaded than prior? There is no longer the space for them that there once was in the age of paper charts and verbal orders. Now add that to what you have stated. These students know they have the monumental hurdle of residency facing them and hear from their mentors how broken the system is. They have already lost hope. What may have called them to medicine gets hit by reality in those four years of graduate education and beyond, and it shows in the residency choices these students are making; they want a future with better hours, less paperwork, more patient interaction. Giving up your 20s and 30s is only worth it if the system takes care of you on the other side, and that bitterness can start as early as medical education.

[@1220975]

Yes! 4th year med student here, and you hit the nail on the head. Grading during 3rd year absolutely sucked. Performance evaluations are entirely subjective, so we feel the need to study our brains out for the one factor we can somewhat control - the shelf exam. Every minute I was running social work errands for the residents, I was thinking about how my time would have been used better by studying. During surgery we were at the hospital from 4AM to 5PM, and then we had to go home and study a couple more hours. There is extreme maladaptive perfectionism in medical school, and the root cause is the medical education system.

[@half-wallhockey]

There has to be a maladaptive perfectionism in medical school. You have to try to be as perfect as you can be for the future patients you treat. Work your ass off, but don't lose the thread of humanity for your colleagues and patients. That's how you become the best doctor you can.

[@mattfarajz]

The entire medical education paradigm is broken. Residency programs evaluate students by initially reducing them to a USMLE Step 1 score, and as a result from the very beginning, medical students are incentivized to spend as little time as possible studying in the classroom, seeing patients, and working in the hospital. Very early on in med school you learn that your time is best spent in front of the computer grinding away doing multiple choice questions and flash cards. The students who do best on these tests get the best residencies, and the students who may have better interpersonal skills or aptitude for clinical interactions fall by the wayside. The system is maladaptive and self selecting for creating residents who want to get back to their own lives and do their own thing, and medical schools train students to minimize patient contact in favor of studying.

[@bobbidenton694]

Doug this video was a complete turn about from his original that actually “ Felt” for us in the medical field... he’s a total sell out and a hypocrite... he lost complete respect from me...

[@robertwynkoop7112]

As ZDogg points out, "burnout" or moral injury is the final common path resulting from exposure to the system. Like radiation, the more exposed you are, the more injury you sustain. But yes the system is broken. We as currently practicing providers bear responsibility for letting things become as they now exist. I really do empathize with your current situation. I am not sure that I could make it through medical school and residency today, knowing what I know now. Your points are very well taken, but USMLE and subjective grading which heavily influenced the ability to enter the residency of our choice existed to a great degree even in the 90's.... but these are only symptoms (both my issues and your issues) of the ill health of the ENTIRE system-- education, residency and practice. We need to advocate for investing in PEOPLE, not EMR and technology, chasing the almighty dollar. The patient should profit from interaction, not the system I'm a 20+ year ER doc. There must be more TIME for the students, residents and the doctor patient relationship to develop. There should be enough providers generated through education and residency that we could all be capped at 8 to 10 patient encounters per day! Patients are more complex, living longer with more problems, on more medicines, and also have as many complex social issues as ever. I simply cant see a fully dressed, wheelchair bound 80 yo man with leg pain in the room, and provide him with an ear (listening), an exam, and thoughts on what may be occurring and what to do about it (test and educate), then treat, as well as arrange follow up and then document the entire interaction for the almighty customer (insurance company) IN 15 MINUTES. And if I don't do this and score well on Press Ganey (a statistical joke) and produce large numbers daily, I am labeled as a bad doc, a problem. The Medical Industrial complex is the problem, and it will take revolution to change it. Revolution starts with each of us taking responsibility, educating ourselves, our colleagues, our patients and our politicians. I've been inspired to start a new job.... it'll be full time too! Please feel free to reply further. I'd love to talk more about this with you.

[@laurasmith4510]

LOVE your stuff! Thank you for your voice. Yes AND on what you've said on moral injury: I'm a chaplain in a 1,100 bed teaching hospital that's a Trauma 1 Center, Transplant Center, with 12 ICU's. Nurses have my heart. What they do for 12 hours seems impossible. I'm seeing a LOT of "burnout" caused by moral injury. I'm working hard with Nurse Managers to provide better support for all caregivers (docs, techs, etc), although focus is often nurses. We're finding that the cause of moral injury is so complicated. Everything you've said and this too: Pt acuity is crazy high--people who 10 years ago would not have even survived to get to the hospital. The patients are often younger, which really tugs on the heart strings--people who have young children, expecting many more years of life. Families can now basically live in the ICU room. All of this results in caregivers becoming closer and more attached to patients and families--not in an unhealthy boundary crossing way, just reality of the situation. Add to that the fact that our technology CAN do things that many of us are not sure we SHOULD do to people. A culture that seems to promise miracles and is death avoidant, creating totally unrealistic patients and families. (One of my personal soap boxes: News flash folks: WE ALL DIE.) MD's who have their own culture of wanting to "cure," their own pressure of insurance, numbers, statistics, etc. Not throwing docs under the bus here, just recognizing all the pressure they are under as well. I work a lot with our Palliative Care service, so I echo Dr. Suri's thoughts on the inability to have difficult conversations, which results in unrealistic expectations, etc. (She's amazing!! Everything she said and wrote!) All of this often results in the medical team taking care of basically a corpse, and nurses are on the front line of that, dealing with family hope, but knowing the inevitable outcome. Add the old school nurse culture of compartmentalizing, just internalizing and moving to next patient, etc. We can do better!

[@nduval]

First time I'm going to have to disagree with the ZDogg. Since healthcare systems bought most of the private practices and therefor 'own' most of the healthcare providers, there is a hefty imbalance of power. For us to make change we need to crawl, hat in hand, to administration. Example. . . . doctor burning out. . .. asks for a scribe in order to spend more time with his patients. Administrator, under pressure from the board then says doctor can have scribe only if he sees 3 more patients per day. Negating the purpose for the scribe to begin with, ie extra time we hope to use for patients now spent generating profit. Provider doesn't get to make that call, . . . . administrator does. They win because they have the power. We will see patients whether they get us the scribe or not. We have a moral obligation and they know that. No control over our own fate,. . . . the match that lights the fuse of burnout.

[@yellowrose0910]

YES! Administrators have no morals to be injured. They sit in their offices or lie in their beds; able to eat or pee or poop when they want; safe from being shat or pissed on, from being punched or grabbed or berated, balancing patient and staff lives with greed for profits. They are the PROBLEM, as is anyone that simps them!

[@bigdavid1001]

I don't think current attendings understand the massive debt medical students/residents are being forced to sign/delay paying. It was a nice deal 15-20 years ago but now its a crappy pool to wade through after finished. From a fellow IM compatriate.

[@goldilocksbears1713]

“Healthcare is a tribe!” Unless your a resident/fellow.

[@robertdean3569]

3,200% increase in administrators from roughly 1978-2013. Who pays for that increased overhead? The answer is not hard, by law only one person can generate that revenue. You want to solve the problems with the high cost of healthcare, address this, the third party and the other hidden cost (PBM's, GPO's, device companies, inefficient delivery models...).

[@soulsaver1664]

As a Patient Advocate and advisor to the CMA, my moral injury is doubled. I am still a patient, but I have full awareness of the system and where it’s at. You are correct about the admins, but it’s the politicians and policy creators who need a hardy kick in the shin. However, when I mentor medical students I tell them to not forget about their heart and to always bring it along. Here’s a recent quote of mine the CMA (Canadian Medical Association if you are unaware) used: “My hope for the next wave of health care providers is to have more time and psychological safety in the workplace so that they can stay grounded in the true purpose of the profession: their oath and commitment to authentically listen, partner with patients and support patient-oriented health outcomes.“ - Elke Hutton, CMA Patient Voice Member

[@PH-xw1ri]

ZDogg - when you went through med school, the tests were way easier and you weren't 500K in unforgivable debt. Don't shit on an entire generation. Signed, Resident doc

[@robertwynkoop7112]

While I agree that medical school and training must be different (and more expensive) than in the past--- more drugs to know about, mores testing and analysis of the Bayesian benefits of the test (maybe a good thing), more imaging, new diagnoses etc, BUT you don't have to deal with 110 hour weeks, berating by senior residents/staff, more patients without medical care access, higher rates of trauma, tobacco use, drug and other self inflicted injuries, less knowledge-- more rope to hang yourself with etc.-- your experiences are different but no more difficult than ours. Additionally, we practicing physicians must bear responsibility for the current state of affairs, something you will have in your own future. However, unless we all come together to change the system for the betterment of ourselves and our patients, we will fail all the future patients and providers.

[@jupitercyclops6521]

A bit off topic, but a question I've had for some time; is an "inflated ego" or "ego itis" a prerequisite, for med school or is that taught in the graduate program? It would be hard not to have an ego getting through all that curriculum, and who would want a dr making life/quality of life altering decisions who isnt confident in themselves and their abilities. But sometimes with some of yall, it goes beyond annoying to the point of being counter productive & even dangerous.

[@johnlee7691]

Damn. That rant about how to enter medical school at 2:43 is excellent advice to students!

[@lenak9993]

Hmmm it sounds like you backed down from the original message. Made it sound soft. I was inspired but now I see it will not happen.

[@tony5180]

there was some victim blaming here. sad to see the about face.

[@StitchingSpinster]

As one of many I'm sure who've been on the receiving end of "those entitled little pieces of sh!t", thank you. I will respect you Doc with as much respect as you give me.

[@semao7034]

Being a sheep and perpetuating a clearly broken system was never my calling.

[@tiaregraves1116]

AMEN! As a nursing administrator working in risk management, I too become a second victim! Thanks for that truth, tell 'em ZDoggMD!

[@far06c]

I am a big fan of yours and our world needs you to be the voice for healthcare. However, I strongly disagree with your position regarding students and residents. Never before has medical school been so expensive and useless when it comes to actually TEACHING the students. Medical students are purchasing a medical degree and teaching themselves everything. The current resident climate is such the hospitals treat them like NURSE PRACTITIONERS. The hospitals care more about making the dollar than educating the residents. You are actually part of the older generation of physicians and it seems like you have a hard time understanding the younger generation. Please take more time and energy to listen to the younger physicians and let them share with you their troubles so that maybe you will have a better understanding and so you won't be so dismissive with their issues.

[@yellowrose0910]

Remember he wants us to feel sorry for those poor morally-injured Administrators. They're doing nothing wrong according to him. He's blaming it all on us.

[@countesscalypso]

Entitlement. I’m a nurse, and yes today is me being an Rn one year. One of the residents complained about a perfectserve message (nurse to dr communication), saying it was “all day long”. My response “welcome to the next 40 years of your life”. The look on his face I can’t describe. This resident started with me, so he listens to me. I said “your nurse is your eyes, don’t be mad when your eyes see something. “

[@MayonnaiseJane]

IT Helpdesk is getting moral injury too. We're the frontline between IT Bureaucrats and the Doctors who have to use the system. Firstly, we're the literal face of the EHR so we catch sour attitude from a lot of callers who just want someone to vent their frustration on. Secondly, yes we would love to "just send someone" so you can get back to your work, but the Administration won't give us enough people to do that. So now have to make you wait because the Wristband printer at the ED Triage intake desk won't print wristbands, the Anesthesiologists computer in an Active OR with a patient on the table has gone on the fritz, we have four lab computers offline in Pathology and one in Phlebotomy and, the Pharmacy Robot refuses to fill any Q 3 hours orders, but ONLY the Q 3 hours orders and no one can figure out why, and the Pyxis on E8 won't let ANYONE take out controlled substances, and all of that trumps your one individual WOW, so will you PLEASE troubleshoot with me for 10 minutes over the phone so I can fix it and get you on your merry way, because otherwise going to have to wait for all that stuff to get fixed before the on-site tech gets to you. Yes, I feel like shit that I'm having to run you through all this when you're trying to get patients their meds, but it's the best I can do with what I've got.

[@albertyamoah8827]

Why did you walk back the message from the first video? This may have killed any possibility of Health 3.0.

[@apespc9886]

4th year medical student here - this really resonated with me and inspired me. Thank you!!!

[@christinezehnle7552]

Nurse for 28 years. I give 100% from 7 to 7. Dont work extra, dont think about work when I m not there. I am just as dedicated...but I aint burnt out. Of course its a business, kind of naive to think otherwise IMO. I mean for christ sake I get paid to do it, right. An d I do it very well. I am of service to my coworkers, therapuetic with patients but done at the end of my shift. My profession has given me the opportinity to make a good living, sleep well morally and be a member of an elite segment of the American labor force.

[@robertwynkoop7112]

I can't believe your YT category is 'comedy" This is about as far from funny as it gets..... As a 20+ year ER doc, I've had extensive moral injury, to the point where I can no longer practice. I am dedicating myself to helping with change, for the betterment of our patients, future providers and ourselves as providers. We must catalyze change in the Medical Industrial complex through education, interaction and sharing with our patients and our colleagues. WE are the ones called to take histories, do physical examinations, test, diagnose, treat our patients. There however has bee a huge gap in healthcare interactions and that is EDUCATION--- what we think is going on with a patient, why, and what to do about it. It is because we do not have TIME.... I have about 8 minutes to do H&P, diagnose, treat and educate and arrange followup (very important in acute care medicine)! We spend more time at the barbershop or the auto shop than we do with our patients. We must invest and support in PEOPLE to increase access, provide time, and fulfill OUR ideals of what it means to be a doctor..... Right on ZDogg! I've been in the trenches with you, and you have inspired me to get to work again!

[@MrGeek2112]

Thanks for calling out OUR responsibility, as residents, fellows, and attendings. I have to say, in academic medicine, that SO MUCH DEPENDS on the program/training director and associate directors. If they institute a culture of high but fair expectations, honest but supportive critique and responsiveness to abusers of the system, and crucially the delicate balance of autonomy and support for the interns on those first night float shifts, residency programs will graduate specialists with experience, resilience and the grit to handle whatever comes their way. I have to say I so appreciate the high demands of my residency coupled with supportive supervision. E.g. covering the entire hospital on my first night float month, which were tempered with the availability of expert backup on call, including the department chief. Our attendings answered the phone awake, alert and never asked for harder work than they gave every day on rounds and after. When I became an attending I only got upset once when a fellow came on board and immediately started lazing out, leaving at 2pm and a lot of work for the night float to do. Having been that night float doc a few years before, I was incensed. Our training director understood completely. After some work on rectifying and remediation, and more problems the training committee discontinued their fellowship. We didn't trade them to another program, passing it on. Sometimes it becomes clear that a given career or work setting isn't a match for a person.

[@peterterry7918]

As someone who struggles with this, I agreed with the first rant but felt that it was a little imbalanced. This helps balance things more. I don't like getting into comment critiques on little things or issues that don't apply to some but not all people. I really think that these rants should be considered "conversation starters" because no You Tube rant will be enough to cover all scenarios. I believe it is only in the back and forth of a respectful but honest conversation (with the people locally that we work and have earned influence with), that we can find the proper balanced position to help us move forward without leaving the good things behind IN OUR SITUATION WHERE WE ARE. Change starts locally and I need relief where I live more than pwning someone in the comment section. I support your right to critique in this forum, this is just where I am at. While your style is much different than my own, much respect and appreciation for you and what you do for us front line medical folk! No hate mail, just gratitude! Let the Conversation continue!

[@looking4leasuretime]

I like listening to you, as I am waiting for the last of my left brain cancer and then hopefully what treatment I get to start tomorrow or Wed. Thank-you for your clear information.

[@letmegeton09]

It’s not entitlement it’s self worth and respect. When did doctors become referred to as providers? We are doctors. HCAPS scores don’t determine if you are a good doctor but that’s what the corporate world uses to assess a good doc vs bad? Ungrateful patients, family members, who when you walk in and stay on their phone and expect you to wait? Or patients curse at docs because they can? We are expected to take the moral high ground and ignore the verbal insults? Who will stand up for us? Protect us? Having docs discharge before a certain time for “numbers.” Medicine is filled w ungrateful people in one of the most noble professions, yet docs shouldn’t get burned out? There needs to be a handbook on how to be a good patient! Physicians need to take the field of medicine back and not let it be run by Corporations. Goodbye ‘human kindness’ cause that is the worst Corp ever.

[@genehobbs1825]

It hurts everyone... and we are all responsible for correcting what we can

[@Shinybadguy]

I take responsibility for myself and my own struggle with PTSD after decades in critical/emergency care settings. Sorry but hospital administrators that are responsible for protecting and perpetuating a broken system aren't going to get any sympathy from me. They seem to enjoy collecting the big bucks while pushing meat through the grinder and there is no sign at all that anything will change...Ever.

[@Acerola211]

I'm not a clinician, but on the last point - how are you supposed to take care of your patients if you don't take care of yourself? It sounds like the previous generation contributed to the messed up system by setting up a toxic work culture. Why would you want the new generation to follow it? I mean, toxic work culture does so much damage to the individual and their families in general, I don't think that encouraging it anywhere - including in healthcare - is a good idea. Do you really want to put your energy into maintaining a messed up system, instead of into figuring out a better system?

[@Skrutfilen]

Hey man, what do you mean with this general entitledment of next generation of phycisians?

[@sharonjohnson2965]

As an older RT, I have the skills to see my patients and colleagues as PEOPLE.... The younger generation does not. They know lots and definitely catch on faster to the new stuff. We need all of us.

[@AntheaBurson]

Yes! My clinical supervisors are on "our side." I would absolutely not want their job! Some residents are absolutely wonderful, others are so entitled it is painful to consider calling them, because they don't even listen, just tell you this is not an emergency (as if I should wait and let it escelate to that?! Not on my shift!) Our policies /protocol have notification parameters, so sometimes even when I don't really believe I "need" to I will be calling. Especially when it is in your orders!

[@pedinurse1]

Some of them feel that they are hurting their staff and are forced to be legalistic and commit very unfair acts towards their staff. However, is anyone ever going to stand up to this crap?????

[@toldt]

I like you ZDogg, but you sound like an administrator didn't like your last video and told you to change your tune (and you did).

[@tomwright9904]

Doctors are some of the most resilient people.... I'm not so sure about that. My suspicion is that moral injury risk could in part be modelled in terms of personality type using the big 5 model. I would suspect that neuroticism is the main predictor of burnout. However, I suspect that conscienciousness is actually *maladaptive* for moral injury, as is agreeableness. Agreeableness and conscienciousness can both make people good at their job (as indeed can neuroticism - you get results like "the best surgeons are those who are most obsessed with their mistakes") but they probably incline people towards burnout. Long term versus short term resilience.

[@lauramahnken5549]

Damn straight! Work your passion, earn your stripes... And try, try, try to maintain a healthy self-care routine. Always easier said than done but you have to put out the effort. We cannot care for our patients, maintain our families and ourselves without trying to balance in a healthy way. Walking into the medical field already thinking that it's going to beat you down means you will never rise up.

[@Richard-wz9uh]

Agreed on the medical student/resident entitlement thing. I’m graduating from residency this year and I can not tell you how exhausting it is to constantly hear whining from classmates about how unfair residency is. Y’all! We literally signed a contract to work hard so that we can hone our skills and be the best doctors possible. To all the residents out there: Man/woman up and don’t view yourself as a victim. We are anything but victims. We are the top 1%. We chose this. Work hard and reap the benefits. Work hard so that we can take the best possible care of our patients.

[@allisonhigginbotham4182]

Richard I love it! Totally agree!

[@tomwright9904]

I think the big resiliency factor is going to lie *outside* the individual, i.e. being assertive, complaining, being judgmental, coming to conclusions, feeling accepted by a group. That's a different form of resilience.

[@alesia365]

Dont feel gulity dawg...You have to flip over a few tables to shake the place up a bit. This is your calling.

[@katybrennan8222]

They are stuck between a rock and a hard place. :(

[@PurpleIrishSweater]

KEEP PREACHING THIS!!! I need solution oriented people!!!

[@teresaboze69]

ZDoggMD Must have found the Buddhists. CONGRATULATIONS! As Paul McCartney's daughter, Stella, stamped on a tee-shirt from her clothing line, "About fucking time" upon the occasion of her father's induction into the rock and Roll Hall of Fame.

[@rebekahgutierrez2554]

Preach!

[@securemindsetofficial]

Sir would you be open to talk on my podcast on this topic?

[@ChristinaDBP]

👏🏻self-fulfilling prophecy👏🏻 🙌🏻🙌🏻🙌🏻 yaaas!

[@montanacrone8984]

Nailed it.

[@soonny002]

Mentors telling their mentees that the system is broken, in most contexts, really isn't good mentoring. It just sounds like the mentor whinging to their students and expecting some kind of psychological reward by doing that. (What, you want a cookie?) If mentors want to complain, they gripe up the food chain, NOT DOWN. Here's the thing: No system is completely perfect, but no system is completely broken (otherwise it wouldn't run at all). Depending on what you're looking for, you can find it. Look for flaws and you'll find a ton of it. But what's the point of looking for flaws if you don't intend to improve things? It's just an excuse not to work hard. And likewise, look for hidden gems in the system and you too can find it. And here's a clue, the hidden gems are usually embedded in people. You don't like the system? Well, get involved and be a part of the solution.

[@kyhaverkamp8773]

Speak it! On day 1, medical schools need to invest in teaching students to cope with stress and dedicate time to practicing meditation and other self-care techniques.

[@knosis]

Yeaa. My medical school is doing this. I have had so many mindful moments lol

[@alexsandraAPRN]

Well said!

[@betsybrown7757]

This was good!

[@christinezehnle7552]

Nope, I find a way to live with less. And wine lol

[@alesia365]

its working

[@ronnie2115]

We have the same issues in EMS. Medics are so cynical and pissy that when a student rides with us they are already sick of the system before they even have a chance to work in the system. It's a systemic issue.

[@witchHunterRN]

It's a bloody, f*****, cycle. Really.

[@primrosed2338]

I'm curious if you would like to address Surprise Medical Billing/Balance Billing legislation and the push against it from lobbyists of Private Equity-Physician Staffing Groups. Throwing it out there.

[@joesamprerer]

Moral injury, good topic. The way it's presented here makes this guy look a bit unstable.

[@Saknika]

I really liked the last point, but probably not for the reason you're expecting. It was like a wake-up call that if you prepare someone with a negative thought, you're not doing them a favor. I've absolutely thought I was helping someone by letting them know what a shit-show a certain activity was going to be and complaining about the difficulty of something, without thinking about how that will impact the person who has never done the activity before. Makes me really consider my word choice from here forward. I'll need to rephrase that yeah, that activity can be difficult but you won't know how you fair until you try it; or something similar. Perhaps it is similar for those who are putting these thoughts in students' minds: they think they're offering fair warning, but really setting them up to fail. Good intentions gone wrong. I hope that people really do listen to your last statement and take time to consider it before reacting, because it's going to be unpopular opinion but it's not incorrect. I can also clearly identify clients I dealt with in the student clinic when I was in school to be an LMT that I was a-okay with handling until someone else told me what a nightmare they were, then I dreaded it. Someone else's opinion really colored the experience for me, but then more often than not I had no issues with the client when I actually got in there. So yup, can see both sides of it, and I think if folks stop and really think about it, they will too.

[@bckids09]

Please study and do one of these for teachers, if you can. I have shared this and the other vid re: teaching. It's so similar. Find someone to partner with- I'm in, if you want.

[@jeffreytimmons5582]

They don’t care about crap!!

[@dianamarie1652]

Ok you go from one extreme to another? What the hell!!! How about giving done true advice here! You can not assume everyone goes through the same emotions and shit! We are all different and handle things different! Work in long term care with 25 residents and 2 aides that don’t give a shit, have family members yelling at you cuz mom or dad didn’t get to bed on time!!!! Have residents falling, sick, dying!!!!!! Every other day!!!!

[@therebel1375]

I wont burn out I'll burn the system >:)

[@allisonhigginbotham4182]

The Rebel great outlook I love it! 😂😂

[@primrosed2338]

I'm joining you! Rawr!

[@palinopsia]

Who's profiting the most from the system? They are to blame.

[@wizzkablooie2731]

Blaming people just adds to the problem. He has already said what the problem in the country's healthcare is- money. So to fix the system we need to rearrange the spending/cost of healthcare ;)

[@treelineractual1671]

I’m so glad I have a degree in Communications and didn’t go into healthcare, y’all stress me out

[@poodlemama1914]

I loved your first video...this one seems like pandering to administrators. It feels like you were “spoken to” and now you’re back peddling. So sad!

[@TuroVJ]

tell me why i thought the exact same thing!!!

[@lisademartini1]

ok - now i gotta pretend that i didn't just see this....very disappointing. You're asking us to feel sorry for the administrators?!? ...not one word about the patients taking all the real blows. Go look at my channel - that is my daughter being taken down by the healthcare industry during a hospital stay...it is all pure drug induced liver evisceration - terrifying and horrific i cant believe that was even possible in America. Those videos can be aligned by the length of her hair and at the end when she looks like she is recovering from the hospital induced evisceration, it was just because i was able to stop all the drugs for a couple of days (she was YOUNG her body wanted to LIVE so it would immediately rebound) - but then the hospital just euthanized her in front of my face...and when i say euthanize I am quoting a depty attorney general's summation during a nursing board hearing...THIS MADNESS HAS TO STOP - IF YOU GUYS HATE IT TO THE POINT OF HATING YOURSELVES, THEN JUST STOP IT ALREADY. YOU GUYS HAVE THE POWER TO STOP THIS AND BECOME HEROES....when i was trying to save my daughter's life i went to those administrators begging for help - THEY ARE NOT SUFFERING FROM MORAL INJURY - THEY ARE COUNTING THEIR MONEY ...you don't see administrators taking their own lives, do you? do you? I'd really like to know if a single one has taken their own life. My advice is to FORGIVE YOURSELVES AND START STANDING UP FOR YOUR PATIENTS NOW!!! and i think part of that is working a normal work day so good job new graduates for fighting for that! why do doctors or nurses work 12 hour to 36 hour shifts? who on earth could do a good job with those hours? it's ridiculous.

[@melaniescharrer7190]

Wow, way to shit on residents. Clearly we aren't working hard enough for you. Unsubscribe.

[@joygernautm6641]

Haha! Truth! The look on new nurses face When I tell them I worked 2400 + hours a year in my first five years as a nurse as a casual with no benefits and no set hours haha!! You have to earn your right to bitch haha

[@aeroslimatic]

Perfect topic to talk about money in vaccines.

[@emmalynne7851]

Preach!