In a Hospital Hierarchy, Speaking Up Is Hard to Do

From The New York Times
By BARRON H. LERNER, M.D.

Doctors in training sometimes confront situations in which they worry that their supervising physicians are making mistakes or bending the truth. Yet even though such acts can jeopardize patients, the inclination and ability of young doctors to speak up is hampered by the hierarchies in teaching hospitals....

This new division of labor established hierarchies. On the top were the senior physicians who made rounds on the wards once or twice daily. Next were the overworked residents, who essentially lived in the hospital while training. Last were the medical students, who spent the most time with patients but were most assuredly at the bottom of the heap.

Although some senior physicians welcomed feedback from their juniors, others disdained it, either overtly or through intimidation. And students were all too easily intimidated. In a 1993 article in The New England Journal of Medicine, a Harvard medical student reported that although her resident routinely made derisive remarks about her patients on rounds, the rest of the team laughed nervously rather than confront her....

The student whose resident seemingly lied to the attending physician about the blood test did not speak up either. The resident was a good doctor, she said, and so she had given him the benefit of the doubt. And, she added sheepishly, both the resident and the attending physician would be grading her.

Jane Goodall - With a Founding Mother in the Field of Primatology

By John Noble Wilford - From The New York Times:

“There’s the alpha male,” she said, immediately sizing up the cast of characters.

A zoo official said the alpha was a 16-year-old named Hank. He was stretched out like an overfed potentate, relaxing at the base of a tree from his duties as a propagator of the species. Not far away on a tree branch, a 7-year-old male named Kipper kept a worshipful eye on Hank, his role model.

“Young males pick out an older male — it doesn’t have to be the alpha — and follow him around and study everything he does or doesn’t do,” Dr. Goodall explained. “It’s part of their separation from Mom.”

Chimpanzees: Almost Human, and Sometimes Smarter

From The New York Times:

Chimps display a remarkable range of behavior and talent. They make and use simple tools, hunt in groups and engage in aggressive, violent acts. They are social creatures that appear to be capable of empathy, altruism, self-awareness, cooperation in problem solving and learning through example and experience. Chimps even outperform humans in some memory tasks....

Jane Goodall, a young English woman working in Africa in the 1960s, began changing perceptions. At first, experts disputed her reports of chimps’ using tools and social behavior. The experts especially objected to her references to chimp culture. Just humans, they insisted, had “culture.”

“Jane suffered early rejection by the establishment,” Richard Wrangham, a Harvard anthropologist, said. “Now, the people who say chimpanzees don’t have emotions and culture are the ones rejected.”