Keegan Guidolin is a General Surgery resident at the University of Toronto
Han Yan is a Neurosurgery resident at the University of Toronto
Much attention has been paid of late to the phenomenon of social echo chambers – situations in which people’s beliefs are amplified and repeated in a closed system as no dissenting opinion originates from within the group. Echo chambers on social networking platforms such as Facebook and Twitter were identified as a factor contributing to the outcome of the 2017 US Presidential Election. We believe that social echo chambers exist in the real (non-digital) world as well, within social groups whose members may interact outside the group in general, but who discuss particular subjects only within the group. Examples include religious communities, political clubs, and even artistic groups. We believe that the surgical community forms such a social echo chamber and that its effects are strong and far-reaching.
Our most senior staff physicians and surgeons often recount the “good old days” when they were truly resident physicians, living in the hospital. They espouse the virtues of operating or working for over 24 uninterrupted hours and managing acutely ill patients into the night post-call. They may balk at modern duty-hour restrictions, vacation time, and academic half-days that give current residents respite from hospital duties. Discussions with like-minded peers only reinforces the opinions already held by these staff, and in turn these (often not so) private opinions affect the way staff interact with their residents. Only within such a social echo chamber could the words, “I can’t believe they let you go home after a thirty-hour shift; you have it so easy,” be uttered. Only in a situation in which contrary opinion is seldom, if ever, expressed could it be thought acceptable to ask a resident who has just become a new father, “Why do you need to take time off? What are you going to do? Watch your wife breastfeed?” Words of well-intentioned praise can be just as suspect: “Thanks for skipping your protected teaching time to help me in clinic.” Or the wilfully ignorant statement on the eve of a resident’s academic half-day, “See you on rounds tomorrow morning.” When certain staff talk about the positive attributes of residents, they rarely comment upon their personality, knowledge, clinical decision making, or surgical skill, but rather compliment that they “never complain” or that they’re a “hard worker”.
We discussed these examples, which we had heard, with a (self-described) “junior” surgical staff doctor, who revealed that their perception of the culture of surgery was quite different. They too were exposed to similar old-fashioned opinions from senior staff throughout their training. Yet as a cohort their colleagues determined that they would act differently. This mentor expressed surprise to hear that these opinions were still being aired and wondered how their more senior colleagues could continue to hold such views. We believe that it’s possible that the generation of staff surgeons who have entered independent practice in recent years have created a social echo chamber of their own, a foil of the older generation, which holds opposing values. How then can both of these groups exist in such close proximity, with members of different groups often sharing the same office or administrative assistant? The social echo chamber effect may be an explanation. Such views – like political and religious ones – are strongly-held; disagreement makes everyone feel awkward and threatens to sour critical relationships. Instead of discussing their differing opinions and engaging each other, members of these two groups tend to avoid the topic and dismiss contrary opinion. Just as in the social media echo chambers experienced in recent years, those expressing an opinion contrary to that held by the group are labelled in such a way as to dismiss their opinion without consideration.
In the US Presidential Election, contrary opinions were dismissed as “fake news”; among senior surgical staff, juniors are dismissed as “whiners”. In anti-vaxxer groups, supporters of vaccination are dismissed as “pharma shills”; among junior surgical staff, seniors are dismissed as “dinosaurs”. These are the labels used to dismiss unpopular opinion, and to prevent engaging directly with the contrary argument. This is how the social echo chamber isolates us.
Physician (resident and staff) wellness has ben in the news recently, and with good reason: more and more physicians are dying by suicide or falling victim to drug or alcohol abuse in an attempt to manage the stresses and expectations (real or perceived) of the job. A recent systematic review and meta-analysis estimated the prevalence of depression or depressive symptoms among resident physicians to be 28.8%, much higher than the average in the general population of 16.6%. Could the social echo chambers within our profession contribute to this crisis? Would it not be better to communicate than to dismiss contrary opinion? We believe that the importance of bravely casting ourselves as the contrarian within our professional echo chambers cannot be overstated. One can never know when one’s words may change a mind. We need a profession that tolerates dissenting opinions and allows ideas to grow and evolve.
While it is very disconcerting to me to hear of the continuing disparagement of resident-juniors in this fashion, I also recognize that this is far from a new phenomenon. I was well aware of it right from the start of my junior internship more than 50 years ago. From the examples in this blog and the increasing occurrence of burnout, depression and suicide within the profession, I conclude that there is even less support for the coming generation of physicians than there was then. I am disappointed and sorry for this situation. The authors’ conclusion about social echo chambers may well be correct both in social media and in the real – non-digital – world.
As I read these blogs, I hear so many echoes of universal care and compassion in the writings of these “junior” contributors, and feel encouraged to see these attitudes, which relate to the fundamental reasons for the work of the profession, expressed so clearly and sincerely. I am truly sorry if their “seniors” don’t exhibit similar attitudes toward them in their work.
I agree fully with concluding sentence of the blog: the profession does need to have an open forum where there is respect for all members, openness to hearing dissenting opinions, and discussion leading to resolution where applicable.