By Eve Purdy (@purdy_eve)
Every resident has one, or more likely a few, moments that they wish they could take back. Sometimes they relate to patient care but more often they relate to interactions with our colleagues. My most recent came in the form of an ugly rant about the term “pimping” directed at an unsuspecting, and very well meaning staff emergency physician.
I was on call on my final day of a two-month cardiac critical care rotation. I was in the emergency department finishing my third consult in two hours, completing orders for those patients being admitted, and had to race up to the unit to care for four sick patients, two of whom needed new lines. I had just been paged three times, twice for ward issues and one wrong number. A staff from my home emergency medicine program happened to see me in the department. He came over and asked, “Hey, do you want to get pimped right now?” He had a an interesting ankle x-ray he wanted to teach me about. Instead of politely declining, or better yet taking ten seconds to learn, I launched into a full-on rant about my distaste for the term “pimping” in medical education. While I maintain that the premise of this rant is entirely legitimate (discussion saved for a future post), I do recognize that the reason the phrase irked me beyond belief in that moment and the way in which my message was forcefully delivered represented a bit of a breaking point. Someone who was trying to be nice ended up on the receiving end of my stress and frustration. It was counterproductive on all fronts. It was not me. Walking out of the department towards the critical care unit I felt awful. I thought about the interaction for days after.
We all have moments that we wish we could take back. Unfortunately, that is just not possible. We can reflect on what led to behaviour we are not proud of and seek to change mitigating factors. We can work to develop techniques to help to recognize and more effectively manage stressful situations. We certainly must seek to make these unfortunate moments as rare as possible.
The anthropologic lens of Pierre Bourdieu’s theory of capital and habitus can help us to understand why such moments have the potential to be especially damaging for trainees. It can also help residents think about how they can mitigate the dangers of such moments through optimizing their usual existence.
A full overview to Bourdieu’s theory is beyond the scope of this article. Check out this video for a quick introduction. Essentially, individuals exist in a variety of different social groups. Their position in those social groups depends largely on the capital that they have. Capital can be economic (resources one has access to), social (relationships one has and relationships one maintains), and cultural (the way one speaks, the way one dresses, values etc). All three types of capital contribute to overall symbolic capital, and related positioning in a community.
As residents we are learning to practice medicine but we are also accruing – and sometimes losing – capital in all forms. Cultivating and maintaining relationships (building social capital) is essential to our success. Moments like the one I described above threaten social capital. Fortunately, the staff physician involved knows me well. He knows that this was out of the ordinary. I have built up enough social capital in my department for this to be a small debit from a full account. I didn’t end up in the red, especially after reaching out to discuss the situation the next day, but I could have. Had this been an interaction with someone I had not previously met, or someone I did not have as much social capital with, it could have been devastating to my reputation and positioning in their world. I could become known as “Eve, that rude emergency medicine resident.” Word travels fast in the hospital and ultimately it could affect my ability to do my job well.
There is no excuse for being rude or behaving poorly. We have to own those moments, apologize, grow, learn, and move on. However, maximizing capital in all forms in our normal day-to-day existence can protect against the potential disastrous consequences of an anomalous interaction. Basically, the more capital you have, the less likely the type of situation I described above is to sink you. Residents, who are early in the process of generating capital in the hospital and who are interacting with many different groups with whom they have little background, are particularly vulnerable to the negative consequences of one-off interactions. Mindfulness of this reality as learners, and empathy for this circumstance as colleagues, might go a long way.
Since reading Bourdieu, I find myself reflecting on the wide varieties of capital transacted in the hospital and their relative importance to different groups. It is quite fun to observe and think about. Give it a go and share your thoughts about capital below!