Although I was born during my father’s surgical residency at Madigan Army Base in Tacoma, Washington, I spent the entirety of my childhood growing up in South Carolina. I call myself what many in the South refer to as a “Bitter Southerner,” someone who takes pride in the taste of well-made shrimp and grits and gets nostalgic about the smell of the salty Lowcountry marshes, while simultaneously feeling ashamed by much of the South’s sordid history. Still, I hold dear many of the South’s ways of saying things. Yes, there’s “Bless your heart,” “Y’all,” and my personal favorite, “All y’all.” But also, so much more.
It was during my own surgical residency in Tennessee that I first heard the adage, “You catch more flies with honey than vinegar,” from my program director, Dr. John Tarpley. For those who know Dr. Tarpley, this is one of many such “Tarpisms,” and speaks volumes of his approach to both his professional and personal relationships. Dr. Tarpley is quick to smile, has a hearty laugh, and is generous in his interpretation of conflict, choosing to always assume the best of people. And it is his philosophy- and one that he has imparted to generations of Vanderbilt trainees- that a desired outcome is much more likely if approached with kindness rather than bitterness, hard work over entitlement.
During his 2020 AAS Presidential Address, Dr. Karl Bilimoria discussed the results of a large survey of general surgery residents about mistreatment and burnout, which was administered during the 2018 ABSITE exam.1 Dr. Bilimoria and his team found that 31.9% of residents reported experiencing gender discrimination, 16.6% racial discrimination, and 30.3% verbal or physical abuse (or both). Weekly burnout symptoms were reported by 38.5% of residents, and 4.5% reported suicidal thoughts in the past year. Not surprisingly, residents experiencing discrimination or abuse were markedly more likely to have symptoms of burnout or suicidal thoughts. Sadly, mistreatment came from patients and patient’s families, as well as from attending surgeons. In discussing these findings, Dr. Bilimoria ultimately circled back to the same theme as Dr. Tarpley. He encouraged his audience to, “First, interpret things in their best, most generous way.” He spoke about how when we are intentional about not making assumptions, we become aware of the good and honest intentions of others. Our first impression can often be wrong, and the implications of a snap judgment lasting.
We all have experienced countless frustrations in the operating room, the hospital, and the clinic, many of which are out of our control or jurisdiction- especially for junior faculty and residents. It is tempting- and certainly stereotype reinforcing- to throw a fit when the instruments are contaminated or the case is delayed. Yet, perhaps we are failing to realize that the tray is contaminated because it is the medical student’s first day in the operating room, and he is terrified and flustered. Or that the circulating nurse called out sick today because his mother is critically ill, resulting in a last-minute change in case assignment and unexpected delay. All too often, we do not know the whole story, and ultimately when we do, it can be quite humbling. “It is a mighty thin board that has only one side,” as they say around here.
So, as we all work towards our own professional and personal goals, may we do so with generosity and kindness. Be slow to blame and quick to forgive. Or put more plainly by my late grandmother, a retired South Carolina schoolteacher, “Hush your mouth, and quit being ugly.”
1 Hu YY, Ellis RJ, Hewitt DB, et al. Discrimination, Abuse, Harassment, and Burnout in Surgical Residency Training. N Engl J Med. 2019;381(18):1741‐1752. doi:10.1056/NEJMsa1903759