Finding tolerance for differences and seeming inadequacies of others has rarely been a problem for me. In high school, my year was the first year that my school developed a “tolerance” course to help young students broaden their perspectives and develop a greater appreciation for others. However, my schedule did not fit with the rest of my class, and when I inquired with the principal about the mandatory nature of the course, he told me, “I doubt this is a course that you need.” He was referring to my leadership in a student organization that my best friend and I founded, the Free Thinkers Society, a weekly, after school student and teacher discussion group whose purpose was to eliminate intolerance and miscommunication. The organization was very successful at my school (reaching well over a hundred students during my three years as co-leader), and several chapters were started in schools throughout the country. Nonetheless, tolerance requires many applications; not all are as straightforward as they seemed earlier in life.
As my medical training progresses, I am beginning to suspect the extent to which we, as medical students and individuals, can change in personality, attitudes, and personal approaches during the course of medical school. The process of medical training can be difficult, and there is a degree of machismo espoused by older generations of physicians: if you cannot succeed in the face of adversity, then this is not the right profession for you. This, in many respects, is true: doctors who cannot handle the stresses of the profession or the training abandon it for other pursuits. This attitude, however, runs contrary to one potential defining characteristic of many members of my generation of future physicians: an objectivist “rational self-interest,” manifested in the desire for guaranteed lifestyle amenities and a tendency to complain about the antiquated and unreasonable demands and expectations of our forebears. Accordingly, this stage of medical training (the second year) seems to be quite difficult for many of my classmates, and I have noticed a steady decline in congeniality, patience, and tolerance. This is a time when many medical students may begin seeking professional help for depression and anxiety, but they are the wise ones where others may prefer to deny self-awareness. Those of us who feel a little more grounded might consider these options: should we condemn our classmates who tend toward a high frequency of bitter complaints, or should we avoid condoning the unreasonable expectations of our flawed mentors by remaining silent or by joining in the expression of discontent?
I have never liked the mantra “I am intolerant of intolerance.” While the sentiment is honorable, I question whether there is much to gain from condemning individuals who are displaying their instability and vulnerability to persistent stress. Nonetheless, it is difficult to suppress my distaste for their tactics: tendencies toward aggression and self-righteousness, ad hominem slander, being unacceptably unsociable, and taking out one’s stress on others. Usually, the best I can do is to avoid expressing my disgust, but that doesn’t change my compulsion to judge my colleagues for their unacceptable behavior. In doing so, I think I am neither exacerbating nor fixing the problem. Ironically, I have no trouble shedding the natural tendency toward being judgmental in the care of patients: they are my charges, and I can best help them when I set aside personal biases and beliefs to understand them fully. However, are my colleagues my concern? This, I believe, is one of the most significant problems within the medical profession: we, as physicians, are unwilling to take responsibility for the inadequacies and improper behavior of our colleagues. We are generally unwilling to correct them, punish them, or engage them in a prolonged dialogue with the intention to bring about positive change. Is it appropriate to judge one another and offer useful criticism, or should physicians remain independent entities? At this time, considering the “sink or swim together” nature of the medical profession within the context of larger health care changes, I think the answer is a resounding “yes,” we must learn to take responsibility for our fellow physicians. Instead of merely giving an excuse such as “Oh, he’s a bad physician” (or “She’s going to be a bad physician”), it is important to find ways to encourage a proper code of conduct. Being judgmental and discriminatory does not necessitate negative sentiment and condemnation: if we can learn to focus on improvement and teamwork, then we might have a chance to avoid letting many young physicians grow callous, bitter, and needlessly rebellious.