Season 1: Episode 2 – Medical School Part II: Abuse of Many Kinds

Dear Healthcare It’s You: Episode 2

Elisha Yaghmai

Well, the lesson you got was…

Jo O’Hanlon

Don't say anything.

Elisha Yaghmai

You push back against these people, right? They can ruin your career!

Jo O’Hanlon

Right.

Elisha Yaghmai

You're done, right?

Jo O’Hanlon

Yeah, yeah.

Elisha Yaghmai

And no one will help you, right?

Jo O’Hanlon

Right! Yeah.

Elisha Yaghmai

They know what is being done. They know why it's being done. Nobody's gonna help you, right?

Jo O’Hanlon

Right.

Elisha Yaghmai

So, what do you learn from that? You learn, you know, I'm either gonna stick my neck out there and potentially lose my head…

Jo O’Hanlon

Right.

Elisha Yaghmai

Or I'm just gonna shut up and keep trying to push.

Jo O’Hanlon

Right.

Jo O’Hanlon

Welcome back to Dear Healthcare, It's you.

Jo O’Hanlon

All right, we are back with Dr. Elisha Yagmai. Thank you for being here. And we picked up last time, or we left off last time on you transferring. You needing to transfer schools because you were going to medical school in New Orleans right when the hurricane hit and all that aftermath. So, let's pick up there as you were describing that kind of process of needing to apply to transfer, and how much of a headache that was, and how you really were kind of left in this influx right then of just not knowing what to do, and it being quite aggressive in some ways on both sides the students and the faculty in that position. So, let's pick up there.

Elisha Yaghmai

Particularly the third-year medical students. That was one of the hardest problems to solve because of the type of training you do in the third year. So, the school had to figure out how and where to continue clinical training.

Jo O’Hanlon

Right.

Elisha Yaghmai

There wasn't, at least to my knowledge, there was not a clear contingency plan on how to do that. Nothing had ever been developed for the scenario that went on.

Jo O’Hanlon

Because how long was it until like hospitals were back up and running, even just for regular?

Elisha Yaghmai

Oh, in New Orleans it was months.

Jo O’Hanlon

Okay, yeah.

Elisha Yaghmai

Other places were functional, you know.

Jo O’Hanlon

Okay.

Elisha Yaghmai

The hospitals were running. But the real issue was, first there was no communication. whatsoever, then eventually there was a little bit of communication, a little bit of communication, but it was limited. And then began the process of, oh, we'll have a plan for you next week, next week, next week, next week.

Jo O’Hanlon

A plan for you in terms of like where they might be placing you again for clinical…

Elisha Yaghmai

What are we going to do, right? How are you going to continue training?

Jo O’Hanlon

Okay.

Elisha Yaghmai

So, we had been, you know, at that point, we were more than a month out, right? And again, I think at that point I was sleeping, you know, on the floor of a friend’s apartment.

Jo O’Hanlon

Yeah. Were you back in New Orleans at that point?

Elisha Yaghmai

No, No I wasn’t I was in Texas.

Jo O’Hanlon

Still? Okay. Yeah.

Elisha Yaghmai

But you know, and I was eating cereal because that's all I could afford because I didn't have any financial aid money. So, this was a real issue. You know and I didn't have any of my possessions because those were all stuck in New Orleans.

Jo O’Hanlon

Right, Yeah.

Elisha Yaghmai

So, from the perspective - from my perspective and that of many of my colleagues in the class we were in a really difficult situation. We were looking for some kind of guidance leadership answers which largely were not forthcoming.

Jo O’Hanlon

Right.

Elisha Yaghmai

And as that situation deteriorated over time and as there kept being missed deadlines and just things not happening and lack of communication, etc., many of us got more and more disenchanted.

Jo O’Hanlon

Right.

Elisha Yaghmai

And so began to say, "Well, I think we're going to have to just fix this." And no one is going to... No one is going to... save us. So we're gonna have to fix this scenario ourselves. And bear in mind while this was going on. We were again, we're watching the university make provisions for these other types of students, right?

Jo O’Hanlon

These other students, yeah. How long was it would you say like the start of this curve of people starting to make that jump of saying I need to go somewhere?

Elisha Yaghmai

It took place over several weeks initially in the initial stages everybody was a hundred percent in rally around the institution, right?

Jo O’Hanlon

Right.

Elisha Yaghmai

This is terrible. We're all in this.

Jo O’Hanlon

Well, and you were all put into this position because of the hurricane where you were all stranded and dealing with house stuff.

Elisha Yaghmai

That’s right. All of these things were happening. The issue, so it was not like, hey, you know, the school took a hit, let's get out of here.

Jo O’Hanlon

Right.

Elisha Yaghmai

It was the school took a hit, everything is chaos, we get that. But there was no, again. There had clearly been very little planning. There was no execution and minimal communication.

Jo O’Hanlon

Right.

Elisha Yaghmai

And just a sort of trust us will fix this at some juncture.

Jo O’Hanlon

And at some point - in the beginning, the no communication was because of those servers being down.

Elisha Yaghmai

Correct.

Jo O’Hanlon

So, you didn't have email communication.

Elisha Yaghmai

Right.

Jo O’Hanlon

But, then that became online again at some point.

Elisha Yaghmai

The students fixed that actually.

Jo O’Hanlon

Oh, really?

Elisha Yaghmai

So, the students created a basically a chat group. I think it was on Yahoo if I recall correctly at that point.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

But that's how we were communicating with each other.

Jo O’Hanlon

Okay, interesting.

Elisha Yaghmai

So, the students set this up and began to, you know, in the administrators and kind of reach out to people and get things going. So, communication began. But then kind of after, as this environment really began to sour over time, then people started to look for alternatives to say, okay, I got to do something.

Jo O’Hanlon

Right.

Elisha Yaghmai

My education is being substantially disrupted here. I don't know what to do.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

So, then some people began to reach out. And then - initially the schools, so people reach out to different institutions, usually wherever they were from. There was an initially favorable response.

Jo O’Hanlon

From those institutions, yeah.

Elisha Yaghmai

From those institutions saying, yeah, we understand your situation, right? You can come and work with it. 'Cause we were, at the time, we weren't even thinking about transferring.

Jo O’Hanlon

Oh!

Elisha Yaghmai

We were asking, can I just rotate with you so that I'm doing something?

Jo O’Hanlon

Just to be doing some clinical work there.

Elisha Yaghmai

Can I just come in and do some clinical work? So that I can just keep moving forward, right?

Jo O’Hanlon

Ah, okay.

Elisha Yaghmai

And we can worry about what it looks like later. It wasn't that I want to transfer to you, it was that I just want to just not be sitting here doing nothing at all, right?

Jo O’Hanlon

Is that unprecedented, or does that happen sometimes within the medical school infrastructure?

Elisha Yaghmai

Well, so there is precedent for, if we're going to rotate at another institution. So, for example, like if you're a fourth-year medical student, you really want to do residency at some hospital, right? You might try to set up an away rotation there.

Jo O’Hanlon

Oh, Okay.

Elisha Yaghmai

Where you go there and work with them for a month so that they get to know you.

Jo O’Hanlon

So that's not totally abnormal.

Elisha Yaghmai

It's not, it's not insane.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

No, it's just not usually done during third year usually because you're usually rotating at your home institution.

Jo O’Hanlon

Right, right, yeah.

Elisha Yaghmai

So that was the initial thing. And so we went from favorable response. Yeah, we could probably do this to dead silence, to nope, not going to do it. And eventually what happened actually was that one of the students got word back from the administration in one of the medical schools that had been willing to take it…

Jo O’Hanlon

Yeah.

Elisha Yaghmai

To do a rotation with them, saying, "Sorry, we've received word "from your medical school to not accept you." Not, again, not to transfer, just to rotate and get some more clinical training, right?

Jo O’Hanlon

With the intention of returning to this institution when it was back up and running.

Elisha Yaghmai

With the intention of returning! With the intention of returning when things were back, right? So, they blocked that, and when that happened, that is when things began to go south.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

Because all of a sudden, we're saying, "Wait a minute, we weren't trying to look, leave.

Jo O’Hanlon

Right.

Elisha Yaghmai

We weren't trying to ask for our money back. We were just trying to find a place to go in a very unusual situation to keep training.

Jo O’Hanlon

Right.

Elisha Yaghmai

And you have gone – interestingly… Oh, and I should add in that environment. We were being told we could do this.

Jo O’Hanlon

Oh!

Elisha Yaghmai

I forgot about that aspect of it. We had even talked about it and they were told.

Jo O’Hanlon

With faculty.

Elisha Yaghmai

Oh, yeah. Go find you know if a place will let you work with them.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

Then go work with them.

Jo O’Hanlon

Because that alleviates their issue at the time.

Elisha Yaghmai

This is what we were told right. So, we were being told publicly, go seek this out.

Jo O’Hanlon

Right.

Elisha Yaghmai

Privately, those institutions, at least from what they shared with us, was they were being told by the very same people, don't take our students.

Jo O’Hanlon

Don’t let them in.

Elisha Yaghmai

That burned the trust down really, really quickly.

Jo O’Hanlon

Yeah, and a really quick question about the financial piece.

Elisha Yaghmai

Yeah.

Jo O’Hanlon

'Cause you had mentioned you're not receiving financial aid during this time.

Elisha Yaghmai

Right, yep.

Jo O’Hanlon

Would that financial aid have been from the school itself? Or is that from elsewhere?

Elisha Yaghmai

The money would come into the school and the school was-- supposed to distribute it out to you.

Jo O’Hanlon

Okay.

Elisha Yaghmai

So, there was loans and other things that you would take.

Jo O’Hanlon

Yeah, Okay.

Elisha Yaghmai

Medical debt. Medical student debt is usually very high.

Jo O’Hanlon

But because you weren't in a clinical setting right then, you weren't able to receive it.

Elisha Yaghmai

No, what happened actually was…they often messed up. At least at this era in that school, they often messed up your financial aid.

Jo O’Hanlon

Oh!

Elisha Yaghmai

So, our financial aid had not been distributed on time. It should have been distributed before the hurricane hit.

Jo O’Hanlon

Oh!

Elisha Yaghmai

It was not distributed on time, so we were already late.

Jo O’Hanlon

So, it wasn't even about the hurricane, initially.

Elisha Yaghmai

Right.

Jo O’Hanlon

And then it was just because the infrastructure was all bottled up.

Elisha Yaghmai

Once it all got, right, then it was like…

Jo O’Hanlon

Okay.

Elisha Yaghmai

Who knows when the money will show up, right?

Jo O’Hanlon

How you’re going to get that.

Elisha Yaghmai

And actually, in the end, for many of us, the reason we were able to, like, any ends meet was because at that point FEMA had made payments to people in the area.

Jo O’Hanlon

Oh!

Elisha Yaghmai

They just deposited money into your bank account.

Jo O’Hanlon

Okay, not even student-wise, just in general, yeah.

Elisha Yaghmai

I was down to, I forget what I had, like maybe $50 or something, like that was it.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

That was all I had. And then FEMA, (laughs) up and put some money in my bank account and that was how I was able to afford anything else at that point, right? So, because I was living entirely off financial aid.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

So, and I think many other students were in a similar situation.

Jo O’Hanlon

Right.

Elisha Yaghmai

So, that was the problem. So, the trust got broken because again, it was public statement here, go do this.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

And then private statements were actually actively subverting you in the background.

Jo O’Hanlon

Right.

Elisha Yaghmai

And so then we were like, well, if you're not being honest with us about this…

Jo O’Hanlon

Yeah.

Elisha Yaghmai

What else are you not being honest about.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

And then it was, well, then okay, then then add to that. Well, we have a plan.

Jo O’Hanlon

Right.

Elisha Yaghmai

Well, what is the plan? We'll tell you next week. Oh, the next week comes. We'll tell you actually next week.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

So, the trust began to break down. And then in that context, we began to see, okay, you've handled your undergraduates, you took care of your preclinical students in medical school, you took care of your, you know, fourth year…

Jo O’Hanlon

Right.

Elisha Yaghmai

You take care of everybody but us in this third year class, we're not taking care of.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

And again, in retrospect, that was probably the heaviest lift in terms of getting something done, but…

Jo O’Hanlon

Was to find these clinical spaces.

Elisha Yaghmai

Was to find these clinical spaces, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

But there was no honesty.

Jo O’Hanlon

Right.

Elisha Yaghmai

That was really the problem.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

It wasn't hey. This is a huge disaster…

Jo O’Hanlon

It was the CYA mentality.

Elisha Yaghmai

Yeah, yeah.

Jo O’Hanlon

Rather than it being about you guys like.

Elisha Yaghmai

Yes.

Jo O’Hanlon

Making sure everybody's taking care of.

Elisha Yaghmai

Or even making sure your communication

Jo O’Hanlon

or clear communication.

Elisha Yaghmai

Really it was about the communication, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

And I think that was the first problem, right? And it went back. I think their perspective, I think they felt this was a matter of institutional survival. To some degree.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

I think they thought that allowing people to leave in any context was going to lead to mass flight, which is going to lead to essentially dissolution of at least that year, possibly the institution.

Jo O’Hanlon

Right.

Elisha Yaghmai

At least it's going to lose all of its students or lose many of its students. I don't actually think that was true.

Jo O’Hanlon

Right.

Elisha Yaghmai

And I can say, speaking from the perspective of both the students and all the conversations we were having on the side.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

That wasn't where anybody started.

Jo O’Hanlon

Right.

Elisha Yaghmai

That was where we ended because of the perception of dishonesty and subversion.

Jo O’Hanlon

Right, yeah.

Elisha Yaghmai

On the part of the administrators that were responsible for that at that point in time.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

That was the issue.

Jo O’Hanlon

And how old were you then?

Elisha Yaghmai

I was probably 25, maybe 24, 25, yeah.

Jo O’Hanlon

Okay. I mean, had you felt, I feel like at that time in a lot of people's lives, that’s the time that you often are starting to kind of feel some disillusionment with some authority figures.

Elisha Yaghmai

Yeah.

Jo O’Hanlon

In a way that you haven't felt. Regardless of yeah extenuating circumstances. Had you maybe started to feel that at all prior to this, or was this really like glaring like opening that door toward like. “Oh! Like I'm not I'm on the path, but like it's not the”, you know, “yellow brick road that I was told it was.

Elisha Yaghmai

We had already. At least in that institution, we'd already had a little bit of that.

Jo O’Hanlon

Some of that? Yeah.

Elisha Yaghmai

A little bit of that, you know I'm just to give it here. Here's another example. So, I go to a lecture by the local, one of the local, I think he was at Toxicologist, if I recall it correctly. And he spent his hour with us trying to convince us that cigarettes actually were not harmful. This is in medical school.

Jo O’Hanlon

Oh!

Elisha Yaghmai

Cigarettes were not harmful.

Jo O’Hanlon

Why was that an important topic for him?

Elisha Yaghmai

Well, it turned out that he was one of the docs that testified on behalf of the cigarette companies in the past.

Jo O’Hanlon

Oh!

Elisha Yaghmai

Yeah. Yeah.

Jo O’Hanlon

Interesting!

Elisha Yaghmai

But this doctor was a faculty member right in the school.

Jo O’Hanlon

Huh.

Elisha Yaghmai

And so we're sitting there as, I think a second year medical student, we're sitting there saying, well, this kind of goes against, oh, I don't know…

Jo O’Hanlon

Most of the...

Elisha Yaghmai

Everything we've been taught everywhere else.

Jo O’Hanlon

Right.

Elisha Yaghmai

And all the scientific papers we can find.

Jo O’Hanlon

The warnings on the labels.

Elisha Yaghmai

But you're giving us, like you're giving us the industry lobbyist argument.

Jo O’Hanlon

Right.

Elisha Yaghmai

You know what I mean?

Jo O’Hanlon

Yeah, yeah.

Elisha Yaghmai

It was like a thank you for smoking moment, right?

Jo O’Hanlon

Right. Yeah, yeah. Right.

Elisha Yaghmai

But we're like, but this is…

Jo O’Hanlon

You’re a professor here.

Elisha Yaghmai

But you're not in Washington DC talking to a senator, right? You're a professor of medicine at a medical school.

Jo O’Hanlon

Yeah, right.

Elisha Yaghmai

So, there were experiences we had…

Jo O’Hanlon

That’s interesting.

Elisha Yaghmai

Like that would at least raise your eyebrow, which is probably the way I describe it.

Jo O’Hanlon

Yeah, yeah.

Elisha Yaghmai

So, there were elements of that there, but this was... I think the first big on in the medical world.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

Institutional failure, I think.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

That we saw and you know in retrospect again maybe institutional failure is too strong a word for the circumstances but

Jo O’Hanlon

And you guys were the ones paying the price for it, where you were left figuring out where to go.

Elisha Yaghmai

Correct.

Jo O’Hanlon

and then being told to go

Elisha Yaghmai

That’s right.

Jo O’Hanlon

and then being told that you can't go.

Elisha Yaghmai

Yes, that's right. Basically, just getting jerked around.

Jo O’Hanlon

So how did you end up finding where you ended up transferring? How did you find your way into that?

Elisha Yaghmai

So what happened at that time actually was that my girlfriend was at UT Southwestern.

Jo O’Hanlon

Okay.

Elisha Yaghmai

Now my wife, and so I thought, well, you know, maybe I'll just try to go up there.

Jo O’Hanlon

Yeah. And that's Dallas.

Elisha Yaghmai

That's Dallas, that's right. And I went through that iteration basically of going and talking to the administration and over time - and we had some conversations - and basically explaining. At this point, given everything that has gone on.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

I don't want to be there anymore because I have lost confidence in the institution.

Jo O’Hanlon

Right. So, you were initially seeking to transfer. You didn't do this piece of like trying to find a clinical place. Or did you also?

Elisha Yaghmai

Oh no, initially I had, and other colleagues had, but it became...

Jo O’Hanlon

Yeah.

Elisha Yaghmai

Okay this is not about just a rotation anymore.

Jo O’Hanlon

Yeah, yeah. No.

Elisha Yaghmai

This is, I don't think these folks, I think they've put the interest of the institution above the interest of the students that they're allegedly serving, right?

Jo O’Hanlon

Yeah, right.

Elisha Yaghmai

Which is kind of a common…

Jo O’Hanlon

It's an important part of your culture and your stance on a lot of things. I mean, that's, yeah.

Elisha Yaghmai

This was the-- Yeah. It's that problem that I think we see increasingly in American society, right, where the institution exists for the sake of its own perpetuation, right?

Jo O’Hanlon

Right.

Elisha Yaghmai

Allegedly it serves a mission.

Jo O’Hanlon

Right.

Elisha Yaghmai

But in reality, its main mission from its perspective is that it should keep going.

Jo O’Hanlon

Right, right.

Elisha Yaghmai

No matter who gets sacrificed or what has to be done, it should keep going.

Jo O’Hanlon

Yeah, yeah.

Elisha Yaghmai

There's never a point at which it says, well, maybe I'm either not fulfilling my mission…

Jo O’Hanlon

Right, should we look at ourselves.

Elisha Yaghmai

Or maybe I shouldn't even exist if I can't fulfill my mission.

Jo O’Hanlon

Right, right.

Elisha Yaghmai

Instead, it's just how do we keep these wheels turning.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

It's that institutional inertia. So it had that... feel. So, I went and had that conversation with them, ultimately, you know, they…

Jo O’Hanlon

With, just to clarify, with Southwestern.

Elisha Yaghmai

With Southwestern, yes.

Jo O’Hanlon

Yeah, yeah.

Elisha Yaghmai

So, I had the talk to the administrators there, and then while I was doing that, some other students were talking to other institutions, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

And so some of us were able to get transfers.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

Out at that point, and that is when the gloves really began to come off. So then other students saw that happening and see. Who felt very similarly.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

So, they also began to have those same conversations and were getting some favorable responses.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

And then that's when all that other stuff happened where people were having the transfers extended and then rescinded

Jo O’Hanlon

Right.

Elisha Yaghmai

Based on just phone calls that were going on in the back channels.

Jo O’Hanlon

All from like people in your cohort, like was it like a lot that were having that issue?

Elisha Yaghmai

It was a significant number.

Jo O’Hanlon

Yeah, yeah.

Elisha Yaghmai

There's a significant number of people. Because Tulane drew people in from around the country.

Jo O’Hanlon

Right.

Elisha Yaghmai

And so when this happened, people got scattered.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

They often went back to the home community. You know, and then the local medical school was willing to accept them.

Jo O’Hanlon

Right.

Elisha Yaghmai

And at that time, we looked up the regulations so that the only thing you needed to have was an accepting institution. So, it wasn't like you had to be cleared since you were leaving.

Jo O’Hanlon

Right, to leave yours.

Elisha Yaghmai

But what was really happening was the institution that was being left effectively did have to clear you.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

And was calling and getting people's transfers rescinded.

Jo O’Hanlon

Yeah, they were like blacklisting you guys basically.

Elisha Yaghmai

And forcing them to stay.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

That's correct.

Jo O’Hanlon

Yeah, and so as you transferred to Southwestern, were you able to start right away like and go in mid-clinical portion?

Elisha Yaghmai

Relatively quickly. I started on a rotation. I forget how long it took. It wasn't the very long.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

It was a couple of weeks, something like that. And then I started on a rotation there.

Jo O’Hanlon

Right, and when we were talking prior, you mentioned off camera that I want on film for us for our listeners but. You mentioned a difference in culture and in prestige at the institution you're relieving versus the institution you went to. Can you speak to that a little bit?

Elisha Yaghmai

Yeah, I mean so you know medical students tend to take rankings very seriously.

Jo O’Hanlon

Right, yeah. Oh yeah.

Elisha Yaghmai

What they actually mean is a very different question that's a whole different discussion in terms of what value they really have and how they're determined, but US News stands by them, so we won't get into that today.

Jo O’Hanlon

Okay. Another day.

Elisha Yaghmai

Yeah, there's a lot of stuff in that that is not really accurate.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

But be that as it may. Southwestern is a higher rated medical school in those rankings.

Jo O’Hanlon

Okay.

Elisha Yaghmai

That's not the same thing as in terms of what quality of education or whatever else is offered.

Jo O’Hanlon

Right.

Elisha Yaghmai

That's very difficult actually to compare.

Jo O’Hanlon

But in national rankings.

Elisha Yaghmai

But in terms of national ranking right it's a higher ranked place and then the culture was also very different, and I would say Tulane's culture was much more overall much more collegial and friendly.

Jo O’Hanlon

Okay.

Elisha Yaghmai

And Southwestern culture was much more non-collegial and unfriendly.

Jo O’Hanlon

What do you mean by that? Like…

Elisha Yaghmai

Oh, it was just much more abusive really. Yeah, yeah. 100%

Jo O’Hanlon

In terms of like your load, your workload. Or your?

Elisha Yaghmai

Oh, yea! I'll give you an example. So, I went into my obstetrics rotation.

Jo O’Hanlon

Ok.

Elisha Yaghmai

Obstetrics at South Ocean are very well-known, very well-respected residency.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

They recruit very well, and it's a very high intensity placement. They have very high volumes.

Jo O’Hanlon

Yeah, and obstetrics is like baby delivery, right?

Elisha Yaghmai

Baby delivery, right.

Jo O’Hanlon

Yeah, Ok.

Elisha Yaghmai

So, I went into that, that was my second rotation there. Bear in mind, the only thing I've done before is I did, I started up in psychiatry at the Children's Hospital.

Jo O’Hanlon

Ok.

Elisha Yaghmai

Which had a totally different system. Different computer system.

Jo O’Hanlon

Right.

Elisha Yaghmai

So, I'm going into OB, this is my first, I've never been in this hospital.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

I don't know the computer system, I don't know anything.

Jo O’Hanlon

Right.

Elisha Yaghmai

There is no allowance made for that whatsoever in terms of how we were treated.

Jo O’Hanlon

Bringing you up to speed.

Elisha Yaghmai

Bringing you up to speed. It was just expected like if you don't, I would get chewed out for not knowing a paperwork thing that there was no way for me to know because I had never been there before, right?

Jo O’Hanlon

No training on that end at all.

Elisha Yaghmai

There was no, there was no nothing.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

We just got thrown into it, right? Which understanding, again…

Jo O’Hanlon

Right, as a transfer

Elisha Yaghmai

We kind of got slung in the middle of the year. This is irregular. We didn't even start with orientation, right?

Jo O’Hanlon

Yeah. What about first students that had been there the whole time? Were they having similar issues?

Elisha Yaghmai

No, no, no, no, no.

Jo O’Hanlon

They were like being chewed out.

Elisha Yaghmai

Not from, well, yes, people got chewed out, but not in the same way because they at least knew what to do, right?

Jo O’Hanlon

Yeah. Yeah.

Elisha Yaghmai

And they'd been there for a couple of years already.

Jo O’Hanlon

They used that system.

Elisha Yaghmai

Right, they were in that. But you know, it was like, so for example, in OB, there was a resident room. There was a room on the OB ward, right? If you were a medical student, you couldn't go in there unless there was a resident there.

Jo O’Hanlon

Oh.

Elisha Yaghmai

Like let's say you weren't doing anything at the moment.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

You could not physically go into the room or sit in a chair.

Jo O’Hanlon

Which was like a break room.

Elisha Yaghmai

It was just a break room. There was nothing magical going on in there. It was literally a break room. You could not go in. But you had to sit in chairs along the wall and appear to be reading an OB textbook. That's what you could see. You either were in a room doing something, or you had to be sitting on that chair.

Jo O’Hanlon

Appeared to be reading. You don't have to read it, but you have to look like it.

Elisha Yaghmai

This is the case, right?

Jo O’Hanlon

Wow. Okay.

Elisha Yaghmai

So, I'll never forget one of the early ones. I get what we would do in there is go into baby deliveries…

Jo O’Hanlon

Yeah.

Elisha Yaghmai

or go into C -sections.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

These are the two things we would do. In the C -section as the medical student, you would stand there and hold the retractor.

Jo O’Hanlon

What is a retractor?

Elisha Yaghmai

A retractor is basically a device that's meant to kind of, so if they make an incision, they make a cut, right?

Jo O’Hanlon

Uh. Huh.

Elisha Yaghmai

To open up, to open up the abdomen, right?

Jo O’Hanlon

Yeah. Yeah.

Elisha Yaghmai

And then, you know, open up the uterus or the womb.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

So, they can get the baby out. Someone has to hold a metal device to just keep that open while they're trying to work, right? So as a medical student, you'd stand there and hold the retractor.

Jo O’Hanlon

Okay.

Elisha Yaghmai

And a lot of times, they're busy, they're doing whatever no one's talking to you, no one's teaching you anything, right?

Jo O’Hanlon

Really?

Elisha Yaghmai

You're just standing there as a hand and you're supposed to... to be learning, I guess, by osmosis when it's starting.

Jo O’Hanlon

Right.

Elisha Yaghmai

So by this time, I was like, I don't think C -sections, number one, I'm not learning anything when I'm in them.

Jo O’Hanlon

Right.

Elisha Yaghmai

Number two, I don't think that this is the thing that I really want to do in the long term. So, I don't know that I'm gaining very much from standing there. What I did want to do was be able to deliver a baby.

Jo O’Hanlon

Right.

Elisha Yaghmai

So, I tell my senior resident, can I not go to C-sections? Can I just go to the-- actual, you know, vaginal deliveries that are going on?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

Because I really do want to be able to do that and I need more exposure to that.

Jo O’Hanlon

Yeah, Learn more on that end. Yeah.

Elisha Yaghmai

That was my logic, right? You can critique it, you can say that was wrong,

Jo O’Hanlon

Right.

Elisha Yaghmai

But that was my reasoning. I tell the senior resident this, I go sit down on my chair. It's like four in the morning, right? And I'm sitting there trying to read my text. At four o’clock in the morning.

Jo O’Hanlon

Man. Yep.

Elisha Yaghmai

I fall asleep, right?

Jo O’Hanlon

In the chair in the hallway.

Elisha Yaghmai

In the chair in the hallway. I fall asleep doing this. I wake up, the attending physician is kicking my foot to wake me up. This is really the case, okay?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

He's kicking me in the foot to wake me up. I wake up, he takes me in the back room and chews me out because I have told my senior resident that I do not want to do any C-sections ever again. And that like this is totally unacceptable, right? And I'm like, well, that wasn't the conversation we had.

Jo O’Hanlon

Right.

Elisha Yaghmai

The conversation was, if I have a choice between these two things, I would like to do the deliveries for the reasons that I stated.

Jo O’Hanlon

Right.

Elisha Yaghmai

Right. But it was very - in other words it was a come in with guns blazing don't ask any questions.

Jo O’Hanlon

Right.

Elisha Yaghmai

Guns are blazing, right?

Jo O’Hanlon

More top down authority on like…

Elisha Yaghmai

Very much. Yeah, very very much.

Jo O’Hanlon

Was it more collaborative in Tulane?

Elisha Yaghmai

Yeah, I didn't do obstetrics there so I can't speak to,

Jo O’Hanlon

Right. Right.

Elisha Yaghmai

But in general yes the field was a little bit more…Was a little bit more collaborative in terms of working with your supervisor positions, right.

Jo O’Hanlon

Yeah. Yeah.

Elisha Yaghmai

So, there was there was that and then there was a there was an internal medicine rotation I had. So, what the what the attending there would do…His thing. He seemed to enjoy humiliating the medical students, like this was his thing. He was known for this.

Jo O’Hanlon

Yeah. Yeah.

Elisha Yaghmai

This wasn't just us.

Jo O’Hanlon

Like he had a fun hazing time.

Elisha Yaghmai

Oh hundred percent, right? And so, in the thing is this in medicine. Like any professional skill, right. The more you do it. The better you get at it, usually. Right?

Jo O’Hanlon

Hopefully.

Elisha Yaghmai

Hopefully, yeah, it’s not always true.

Jo O’Hanlon

If not, I hope you’re not doing that.

Elisha Yaghmai

But it could be true. And it feels easier to you, in other words.

Jo O’Hanlon

Right. Yeah.

Elisha Yaghmai

Over time, if you're trying to do basketball, you start off, you're shooting, you're not very good. You shoot several thousand shots a day or whatever it is. Eventually, it's really easy for you to make that shot.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

And then you look back at the 10-year-old who's you 15 years ago, right.

Jo O’Hanlon

Right.

Elisha Yaghmai

And they stink, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

You know, and it'd be like going to them and being like, "Why can't you shoot?" Right? You know?

Jo O’Hanlon

Right, yeah.

Elisha Yaghmai

You know, like, I'm fantastic at this! Why aren't you fantastic at it? Right?

Jo O’Hanlon

Yeah, yeah. That’s a good analogy, honestly. I’ve not thought about. I mean medical school in that way, but yeah for sure, yeah.

Elisha Yaghmai

It’s a hundred percent.

Jo O’Hanlon

Yeah. You guys are learning new muscle memory

Elisha Yaghmai

You are, right? Because so, the thing is that medicine - the practice of medicine - is rapid sequence… For non-surgical specialists at least. It's rapid sequence pattern recognition.

Jo O’Hanlon

Mmhmm.

Elisha Yaghmai

Right? What it means is, I have run through this this iteration.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

I've had x number of patients who have come in and told me this.

Jo O’Hanlon

Right.

Elisha Yaghmai

So many times, that I now know what the pattern is.

Jo O’Hanlon

Right.

Elisha Yaghmai

I know that when you tell me this set of symptoms, odds are it's this, and if it's not that, it's this second thing, and if it's not that, it's this third thing, right?

Jo O’Hanlon

Right.

Elisha Yaghmai

And we're gonna work through this list based on highest statistical probability.

Jo O’Hanlon

Right.

Elisha Yaghmai

People may not articulate it in those terms, but that's actually what's going on, or what should be going on.

Jo O’Hanlon

It's a flow chart basically within you, right?

Elisha Yaghmai

It's a flow chart. If you've internalized a flow chart. right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

And you've internalized a set of rough probabilities.

Jo O’Hanlon

Right, yeah, yeah. That you can do quickly as you can do it more.

Elisha Yaghmai

Exactly, right? So, when you start, it's like every time they come in, right?

Jo O’Hanlon

Right.

Elisha Yaghmai

You have to start from zero and be like, okay, all right. So, they said they have chest pain. All right, now what causes chest pain again? Right?

Jo O’Hanlon

Right, right, right.

Elisha Yaghmai

There's my list of things.

Jo O’Hanlon

Look at all the possibilities.

Elisha Yaghmai

Right, right, right.

Jo O’Hanlon

What's most probable to go next, yeah.

Elisha Yaghmai

Fast forward 15 years, right? If you tell me chest pain, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

I'm already asking you a series of questions, right? Rule this out. Rule that out. Check, check, check, check, check, check, check.

Jo O’Hanlon

Right.

Elisha Yaghmai

We do all of that in three minutes.

Jo O’Hanlon

Right, yeah.

Elisha Yaghmai

But that would have taken me an hour at the beginning

Jo O’Hanlon

Right! And maybe not even knowing which questions you needed.

Elisha Yaghmai

One hundred percent! Well, it's because I was going to ask you 100 questions, because I didn't know how to target my questions.

Jo O’Hanlon

Right, yeah.

Elisha Yaghmai

This is medical students are notorious for this.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

They take an hour to do an admission interview…

Jo O’Hanlon

Right.

Elisha Yaghmai

That the attending can do in five minutes.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

Right?

Jo O’Hanlon

Because of years of experience.

Elisha Yaghmai

Because of years of experience, you know what to ask.

Jo O’Hanlon

Right.

Elisha Yaghmai

You know how to cut it down quickly, right? What parts of information are irrelevant, you can filter those out.

Jo O’Hanlon

And probably you know how to circle back if there's something that was missed of a question

Elisha Yaghmai

Yes.

Jo O’Hanlon

That like could have been asked, but was highly unprobable.

Elisha Yaghmai

Right.

Jo O’Hanlon

To then when it's like, oh, now there's another piece of information or this didn't work, then you can quickly circle back to like, well, I would have asked this, but it was really low probability. What about this?

Elisha Yaghmai

Right.

Jo O’Hanlon

Like, yeah, that makes sense.

Elisha Yaghmai

You pull that out. Into that. this environment though, enter, and I think academia may be a little worse for this, but I couldn't speak to that 100%. What you have is this weird dynamic, right? Where you have very experienced people.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

Trying to teach people that have no experience

Jo O’Hanlon

Right.

Elisha Yaghmai

And much, much less knowledge. And it's a setup for abuse.

Jo O’Hanlon

Well, when the people that are over you in these scenarios, are they, other than being your advisor when you're in that setting, like, are they connected to the school? school regularly?

Elisha Yaghmai

Yeah, they're faculty. Usually, they're faculty.

Jo O’Hanlon

So, they are teaching persona. They're not.

Elisha Yaghmai

Theoretically, yes. Okay.

Jo O’Hanlon

Theoretically.

Elisha Yaghmai

Theoretically they're teaching, right?

Jo O’Hanlon

Okay.

Elisha Yaghmai

But academia has a lot of personality types in it, right?

Jo O’Hanlon

Right.

Elisha Yaghmai

There are people that are there because they want to do research, they could not care less about teaching.

Jo O’Hanlon

Right.

Elisha Yaghmai

They're just required to show up on the ward every now and then and teach people.

Jo O’Hanlon

Oh, okay.

Elisha Yaghmai

But really what they care about is the grant money they're getting, what's going on in their life, right?

Jo O’Hanlon

For the big research pieces.

Elisha Yaghmai

They don't care about teaching you clinically. It's irrelevant. Right? For that matter, they may not even be great even be great teachers, right?

Jo O’Hanlon

Right.

Elisha Yaghmai

I mean, a great researcher is not necessarily a great teacher and vice versa. I mean, they may be, but they also may not be.

Jo O’Hanlon

Right. But also, often are not. Yeah.

Elisha Yaghmai

But in a lot of medical schools, that's irrelevant, right? You're here as professor of blah, blah, blah.

Jo O’Hanlon

Right.

Elisha Yaghmai

You need to do X number of weeks of clinical teaching time on the works, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

And they're there the whole time thinking about, oh, my project, okay, what's going on with my test tubes, right?

Jo O’Hanlon

Right. It's like the high school coach who also has to teach.

Elisha Yaghmai

It's very much like that, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

And you care about one or the other.

Jo O’Hanlon

Right. But not great at.

Elisha Yaghmai

You know, you don't care as much about the other, right?

Jo O’Hanlon

Both. Yeah, yeah.

Elisha Yaghmai

And you may not be good at what you're doing. So, you have that. And then you have other people that, I mean, to some degree, they like the power dynamic, right? They like being the teacher, they like being this the center of attention of the team, right?

Jo O’Hanlon

Right.

Elisha Yaghmai

Right. They enjoy that vibe, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

They like the vibe of they're not working with colleagues, right?

Jo O’Hanlon

Right, right.

Elisha Yaghmai

They're working with people that are inferior to them, if not as humans, they're inferior to them in terms of professional knowledge and skill…

Jo O’Hanlon

Right.

Elisha Yaghmai

All the time.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

They're always teaching people that know less than them. They're always working with people that know less than them and have less experience, right?

Jo O’Hanlon

And they're saying that they like the type of people that enjoy that.

Elisha Yaghmai

Yeah, they enjoy that dynamic, right? Because there's a power dynamic, right?

Jo O’Hanlon

Yeah, right.

Elisha Yaghmai

There is a power dynamic. And medical school is very hierarchical.

Jo O’Hanlon

Right.

Elisha Yaghmai

Right. And if you want to achieve your goals, right, you need to please the people that have the power to write your recommendations.

Jo O’Hanlon

Right.

Elisha Yaghmai

You know, to give you grades, right? Yeah. to keep these people up.

Jo O’Hanlon

Without much pushback, I imagine.

Elisha Yaghmai

Very little.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

Very little, pushback because pushing back can get you in serious trouble.

Jo O’Hanlon

Right.

Elisha Yaghmai

So here again, actually backing up a moment 'cause you'd asked about Tulane, I forgot this aspect also. So, there was a well-known senior faculty member at Tulane who had a notorious reputation for harassing the female, the female medical students.

Jo O’Hanlon

Interesting.

Elisha Yaghmai

Including women that were in my class, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

That had their own personal experience with this.

Jo O’Hanlon

Someone that, in clinicals, or... like in a classroom setting.

Elisha Yaghmai

In clinicals, yeah, in clinicals, right.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

So they would go in and there'd be all kinds of, we can describe the hijinks and things that he would get up to, but he would get up to things that clearly were improper.

Jo O’Hanlon

Right.

Elisha Yaghmai

Made these women very uncomfortable

Jo O’Hanlon

Right.

Elisha Yaghmai

And they would go complain about it and not one thing would happen because he was a very high profile person.

Jo O’Hanlon

Really?

Elisha Yaghmai

He had a very famous name. He was quite powerful within the specialty in the academic world.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

So, they did nothing to him until the year he was going to retire. At which, point. Then after the file was who knows how thick of complaints, they finally decided to take action in the year that he had already said he was going to retire.

Jo O’Hanlon

Wow.

Elisha Yaghmai

That is when action is finally taken. We also, incidentally, I forgot that piece. We also saw that go on in that institution.

Jo O’Hanlon

Yeah yeah.

Elisha Yaghmai

So, we're sitting here hearing from female medical students about what their experiences are

Jo O’Hanlon

Right.

Elisha Yaghmai

And how they've gone to report this and not one thing has happened.

Jo O’Hanlon

Yeah. Abuse not for being students but just for being female.

Elisha Yaghmai

Right. Exactly. right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

But that what I'm describing is that dynamic, right?

Jo O’Hanlon

Yeah, yeah.

Elisha Yaghmai

This individual has power you don't yeah, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

And what the actual story that is was a circulation around this was that a resident a surgical resident at that time had tried to take this case forward.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

Got drummed out of surgery.

Jo O’Hanlon

Wow.

Elisha Yaghmai

That was this is the story that we medical students were getting right and this was for relatively recent, right? She tried to, she tried to say something. This guy's super powerful.

Jo O’Hanlon

Right.

Elisha Yaghmai

She got booted from the program or left the program, but then tried to stick somewhere else. And once again, those background calls go on, right?

Jo O’Hanlon

Run around.

Elisha Yaghmai

And all of a sudden, nobody wants you anymore, right?

Jo O’Hanlon

Yeah

Elisha Yaghmai

And you're not able to pursue your chosen specialty. Why? Because you dared to file a complaint against somebody with more power.

Jo O’Hanlon

Which in 2022 sounds astronomically asinine.

Elisha Yaghmai

Yeah, yeah.

Jo O’Hanlon

But in 2006, You know.

Elisha Yaghmai

This was 2003, 2004, 100 %

Jo O’Hanlon

Totally different story. I mean, not on what was happening, but on how we treat it as a society.

Elisha Yaghmai

Well, I mean, I think, you know, obviously we knew it was wrong.

Jo O’Hanlon

Right, of course.

Elisha Yaghmai

But the lesson...

Jo O’Hanlon

There wasn't a pathway.

Elisha Yaghmai

Yes.

Jo O’Hanlon

There wasn't a way to be heard.

Elisha Yaghmai

Well, the lesson you got was...

Jo O’Hanlon

Don't say anything.

Elisha Yaghmai

You push back against these people, right? They can ruin your career.

Jo O’Hanlon

Right.

Elisha Yaghmai

You're done, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

And no one will help you, right?

Jo O’Hanlon

Right, right! Yeah.

Elisha Yaghmai

That's the thing they even know. They know what is being done. They know why it's being done. Nobody's gonna help you.

Jo O’Hanlon

Right.

Elisha Yaghmai

So what do you learn from that? You learn, you know, I'm either gonna stick my neck out there and potentially lose my head.

Jo O’Hanlon

Right.

Elisha Yaghmai

Or I'm just gonna shut up and keep trying to push.

Jo O’Hanlon

Right. 'Cause someday I won't have to deal with this.

Elisha Yaghmai

'Cause someday I won't have to deal with him, right? I'll get out of this

Jo O’Hanlon

Yeah, yeah.

Elisha Yaghmai

And I'll finish my residency and then I can go somewhere else.

Jo O’Hanlon

Right.

Elisha Yaghmai

And I can work somewhere that makes me happy, right? But I just gotta put up with this.

Jo O’Hanlon

Right.

Elisha Yaghmai

That was the culture and probably to some degree, still is.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

Even if it's not.

Jo O’Hanlon

And that's what you were feeling, you know, in a male seat of the same student seat though, when you had transferred in those clinical areas.

Elisha Yaghmai

And so, to give you here again, like another example, so this one doc, what he would do is he'd come in every day. He would ignore the residents. He really didn't have much to do with it, at least not in front of the medical students. Yeah. So, we would, as medical students at that time, we were supposed to be on call every fourth night.

Jo O’Hanlon

Okay.

Elisha Yaghmai

On call means you're up all night going around with your resident to see patients.

Jo O’Hanlon

Okay, you are in the hospital.

Elisha Yaghmai

You're in the hospital, you're running around doing this, so this is every fourth night, right? Which means, you know, you. Over the course of a month, where you have about a week where you don't sleep at all, right?

Jo O’Hanlon

Right.

Elisha Yaghmai

You go the whole night without sleeping, right?

Jo O’Hanlon

Yeah, yeah.

Elisha Yaghmai

So, one week out of four, in fact, let me just imagine trying to do that every month, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

One week out of four, you're not sleeping. This is pretty common in the medical profession.

Jo O’Hanlon

Because you would have stuff you need to be doing during the day, too, you're saying.

Elisha Yaghmai

Exactly, yeah. So, you would go, you'd come in, you'd work all day

Jo O’Hanlon

Yeah.

Elisha Yaghmai

You would then work all night.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

And then you work the next day until about noon.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

This is how it was done at that time, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

But here's the thing. So, the normal policy in that institution was you come in, you write your, you work all day, you go all night, and then you were supposed to submit something called a history and physical document. What you were supposed to do was, take one of the new admissions that came in from that evening, right? And then four days later on your next on-call cycle, you were supposed to submit a written document that said, "Here's all the information I gleaned.”

Jo O’Hanlon

Oh, okay.

Elisha Yaghmai

Here's my thoughts about possible diagnoses and which one I think is the most likely and what treatment we should do," right?

Jo O’Hanlon

Okay, yeah.

Elisha Yaghmai

So everywhere else, all the other students for the most part, they had four days to turn out this written report.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

We had to present it by 8 a .m. that morning after we'd been on call all night.

Jo O’Hanlon

When did the night shift start?

Elisha Yaghmai

I think it was about seven o 'clock.

Jo O’Hanlon

Okay, yeah.

Elisha Yaghmai

So you had from 7 a .m., and I'm sorry, maybe it was about 12 hours approximately at night, and then you had to have this thing handed in by the time he showed up in the morning. So you had to write it overnight, right?

Jo O’Hanlon

While you were supposed to be doing your rounds?

Elisha Yaghmai

While you're supposed to be following your resident around and seeing patients.

Jo O’Hanlon

Okay, yeah.

Elisha Yaghmai

So, two things happen. The first thing is that we start because he's required us to turn in this paper, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

So we start saying, "Okay, residents, we need some time to write this,”

Jo O’Hanlon

Yeah.

Elisha Yaghmai

“We cannot follow you around all night." The residents get super angry with us for not following them around. So, we meet with them and say – I believe it was me and another medical student. "We can't go with you. We have to write these papers. We're being required by our attending physician to write these papers and we have to turn them in at 8 a.m." And you know this.

Jo O’Hanlon

Right.

Elisha Yaghmai

And their response goes, "Well, that's not our problem. That's your problem. You need to talk to them. But if you continue to do this, like we're gonna have to write you down on your evaluation, right?

Jo O’Hanlon

What? So, and would this attending position be over these residents as well?

Elisha Yaghmai

Yeah.

Jo O’Hanlon

So, they like that's their direct boss and they just still just be like whatever. I’m your boss.

Elisha Yaghmai

They didn’t care. This is the response we received. Yeah.

Jo O’Hanlon

Wow.

Elisha Yaghmai

That's it. I'm your boss and I want you to follow me around. And even though - so you see what I'm saying?

Jo O’Hanlon

But there was no backup from this attending physician…

Elisha Yaghmai

Right. That’s correct.

Jo O’Hanlon

To be like no guys. I actually need them to have this paper in at 8.

Elisha Yaghmai

We’re at the bottom of the hierarchy.

Jo O’Hanlon

Again, no communication across.

Elisha Yaghmai

Right

Jo O’Hanlon

And then you guys are screwed.

Elisha Yaghmai

Right, yep. So we're making our residents mad by not following - the culture at that place you follow them around until they until they dismiss you, you can't go anywhere, right? And if you do your name is mud, right? If you do that so we're in a position of, well, but if we do that then we can't finish our paper, if you can't do that then our attending will be mad, right? So, what do we do? We just got stuck in this purgatory.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

In these two things. So then, then what would happen is then you'd go, you'd hand in your, you'd hand in your document. He didn't want you to just hand it in. He wanted you to give an oral presentation. But before he would do the oral presentation, he would take you on about two and a half hour walk around. So, you'd walk around to see all these patients. And during that process, he would do a process that in medical parlance is called “pimping”, which basically means keep asking you questions. So, I'm asking you questions about all kinds of different aspects of the patient and their care and diagnoses. And what's the differential diagnosis.

Jo O’Hanlon

While in the room with them or after?

Elisha Yaghmai

Both. While in the room.

Jo O’Hanlon

Okay.

Elisha Yaghmai

While walking around, whatever else, right?

Jo O’Hanlon

Like quizzing you?

Elisha Yaghmai

Yeah, but it's constant quizzing.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

So, imagine you've been up since 7 a.m. the previous day. Well, even some earlier than that, right?

Jo O’Hanlon

Right, yeah, yeah.

Elisha Yaghmai

You're showing up at 5 a .m., right? To go in. So, you've been up since 5 a.m. the previous day. It's now 10 a.m. the next day, right? Okay. And you have somebody just blasting questions at you the whole time, right? And then at the end of that...when you go through that whole process of walking around, now he wants you to give an oral presentation of this multi-page paper that you just had to write, right?

Jo O’Hanlon

A few hours before that, so it's not very recently in your brain that's fried at this point.

Elisha Yaghmai

Right, yeah!

Jo O’Hanlon

Is there any break in this night?

Elisha Yaghmai

No.

Jo O’Hanlon

No, not at all.

Elisha Yaghmai

You just roll all the way through, right?

Jo O’Hanlon

Wow.

Elisha Yaghmai

And so, and then the thing was that there are different styles of this, right? So, some doctors, when they do this...their goal is to teach you.

Jo O’Hanlon

Right.

Elisha Yaghmai

Meaning they're asking you questions. The point is not necessarily whether you get it right, whether you get it wrong.

Jo O’Hanlon

Right. It's to be constantly seeing what you know, give more.

Elisha Yaghmai

To some degree to help you learn a thought process, right?

Jo O’Hanlon

Okay.

Elisha Yaghmai

You know the answer to this. Why don't you know the answer to this? Well, let's explain what thought process would get you to the right answer, right?

Jo O’Hanlon

Like partly like helping instill that flow chart within you. Like muscle memory.

Elisha Yaghmai

Yes. That’s precisely it. That's precisely it. And that's... that's, if you're gonna use that technique, not everybody does

Jo O’Hanlon

Right.

Elisha Yaghmai

But if you're gonna use that technique, that is how it should be used.

Jo O’Hanlon

That should be the goal.

Elisha Yaghmai

For this doc, the purpose was humiliation. The point was to rub your nose in what you didn't know and how much more he knew than you did.

Jo O’Hanlon

Really?

Elisha Yaghmai

Oh, 100%, yeah, 100%. That was the goal of the question asking process, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

So it would be, I'm gonna ask you questions, right? If you don't know it, I'm gonna just humiliate you for not knowing the answer to whatever the question is, right? In front of the whole team and everybody else.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

I'm just gonna tear you down for not knowing.

Jo O’Hanlon

So, this is happening in front of other people as well?

Elisha Yaghmai

100%. 100%.

Jo O’Hanlon

Yeah. Not just alone.

Elisha Yaghmai

So, the whole team, the residents, everybody else that's there, right? So, you're just getting dressed down for what you appear not to know.

Jo O’Hanlon

Hmm.

Elisha Yaghmai

And so, you know, there was one experience I remember having. The case was a guy that had come in with abdominal pain, right?

Jo O’Hanlon

Mmhmm

Elisha Yaghmai

And he had liver metastasis or something like that. So, you know, I wrote up my paper on potential causes of liver metastases in this case, right? The thing about this particular doc was that he really enjoyed cardiology. That was his thing. He knew way more about cardiology than any of us did at that point in time, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

So, and most of the cases we had coming in, a lot of them were heart cases.

Jo O’Hanlon

Okay.

Elisha Yaghmai

So, we learned very quickly, if you do a heart case, he's going to just tear you to shreds because he knows so much more than you do about this.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

So, we learned, the two of us learned. We probably shouldn't do heart cases because, you know, if you don't want to just get blasted. You got to do something that's a little bit out of his area of intense expertise.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

So we would do this, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

So, we pick side topics, right? And so, you know, I picked one that was abdominal pain. And I finished up my presentation, he's clearly very frustrated because there's really nothing that he can go to town on, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

It's a more limited topic, which was intentional.

Jo O’Hanlon

Right, yeah. You're, you're being smart and trying to dance around the abuse.

Elisha Yaghmai

We're trying, right? So he says so, he says you know tell me the differential diagnosis. Differential diagnosis means what's the give me a list of possible diagnoses.

Jo O’Hanlon

Okay.

Elisha Yaghmai

That could cause this symptom

Jo O’Hanlon

Okay

Elisha Yaghmai

. So, he says give me the differential diagnosis for abdominal pain, right? Okay, so I start naming diagnoses.

Jo O’Hanlon

Yeah

Elisha Yaghmai

So, I go on for about two minutes or so naming everything I can think of that can cause abdominal pain.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

I finish up and he's like, “Ridiculous. You forgot hereditary spherocytosis."

Jo O’Hanlon

Oh my gosh. Ridiculous.

Elisha Yaghmai

Right, right.

Jo O’Hanlon

Oh my gosh. How could you forget?

Elisha Yaghmai

Right. You know what I mean?

Jo O’Hanlon

I mean, when you type into Google, we now know that there are so many things.

Elisha Yaghmai

Right, yeah. I never forgotten that though. To his credit, I've never forgotten hereditary spherocytosis.

Jo O’Hanlon

Right.

Elisha Yaghmai

Okay.

Jo O’Hanlon

How often does it come up in a diagnosis for real though?

Elisha Yaghmai

But it was so, virtually never.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

But it was, I mean, it was, that, this was the goal, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

And so, there were lots of insults, there was lots of tearing down.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

Like on a very personal level.

Jo O’Hanlon

Right.

Elisha Yaghmai

Like on a very personal level. Like insulting your intelligence, insulting you as a person, not just you need to know more, right?

Jo O’Hanlon

It was an attack.

Elisha Yaghmai

You're an idiot, right?

Jo O’Hanlon

Yeah, yeah.

Elisha Yaghmai

It's like this kind of thing. This was the dynamic. So, you know, my co-medical student, right, started, taking this of those papers, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

I would try to write my, well, my co-medical student started doing was cutting and pasting out of like medical, pre-written medical journals, sort of look up a topic, cut and paste and slap it into the paper and then read that, right? As the thing, right?

Jo O’Hanlon

Oh my gosh. That’s funny.

Elisha Yaghmai

He didn't know that this was going on, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

So, he'd be like, oh, that's wonderful. You know, what a wonderful, I'm right.

Jo O’Hanlon

Oh my.

Elisha Yaghmai

Yeah, I'm like, well, you know, that was written by a medical professional, right?

Jo O’Hanlon

Right.

Elisha Yaghmai

That wasn't written by a medical student.

Jo O’Hanlon

A med student, yeah.

Elisha Yaghmai

You don't know this, right?

Jo O’Hanlon

Right.

Elisha Yaghmai

Okay, so I'm trying to write, I'm trying to do it allegedly the right way. I'm trying to write it myself, right?

Jo O’Hanlon

Right.

Elisha Yaghmai

And you are just ripping me to shreds, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

Well, this is going, so this is the dynamic, right? So I take that.

Jo O’Hanlon

Which kind of goes to what we've talked about before of like the type of person that ends up in medicine.

Elisha Yaghmai

Yes.

Jo O’Hanlon

Where it's like, you know, needing to just check the box, like not just check the boxes, but it's an achievement thing.

Elisha Yaghmai

Yes.

Jo O’Hanlon

Like he's like accolading this person and who's... got all the right information whether they've learned it or not.

Elisha Yaghmai

Correct right. They have learned a way around they've learned to achieve an outcome.

Jo O’Hanlon

Yeah, they've learned a way.

Elisha Yaghmai

Whether they learned that information or not is irrelevant.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

They learned how to present the appearance of knowledge.

Jo O’Hanlon

Right.

Elisha Yaghmai

Right and I don't I don't fault them for that it was extremely high stress.

Jo O’Hanlon

No.

Elisha Yaghmai

Awful situation, right?

Jo O’Hanlon

But points out a flaw.

Elisha Yaghmai

That's what was going on, right?

Jo O’Hanlon

Yes, yeah.

Elisha Yaghmai

You're teaching them to find a way to give you the outcome you say you want.

Jo O’Hanlon

Right.

Elisha Yaghmai

Whether or not it has any actual effect on how good of a doctor they are.

Jo O’Hanlon

Right.

Elisha Yaghmai

Or how knowledgeable they really are, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

And you're making no allowance for the fact that this person, by definition, has less knowledge and expertise than you do.

Jo O’Hanlon

Has not learned it, yeah.

Elisha Yaghmai

You are better doctor than them.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

That's why you're teaching them, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

The point is, it's not a battle of equals, right?

Jo O’Hanlon

Right, right.

Elisha Yaghmai

This is a battle of the clear power differential.

Jo O’Hanlon

It’s a mentorship for lack of, I mean…

Elisha Yaghmai

Except it's not, right? It's like a reverse mentorship. So, this is the dynamic and this was the problem. You learn to produce the desired outcome rather than go through the process that might actually make you better at the job in the long run.

Jo O’Hanlon

Right.

Elisha Yaghmai

So, I take that dynamic and I went to the clerkship director at that time and said, "Hey, this is the experience we're having.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

Like, we're getting just torn to pieces.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

What we're being asked to do is not comparable to what our colleagues, or other medical assistants are being asked to do by their attendings. We have, we are being held to a different standard.

Jo O’Hanlon

It was like you talked with your class and everything.

Elisha Yaghmai

Oh yeah, yeah, 100 % yeah, we knew what was going on.

Jo O’Hanlon

Yeah, yeah.

Elisha Yaghmai

So I go present this and he says, "Yeah, you know, "that's true, yeah, we hear about this guy every year. "Every year we hear about him." Yeah, he's like that.

Jo O’Hanlon

So…

Elisha Yaghmai

And I'm like, "Okay." and so what's the plan? Nothing. The plan was nothing. The plan was yeah, just suck it up like this. Yeah, we know he's like this. He treats everybody like this and just deal with it. Like that's the answer.

Jo O’Hanlon

You got the short straw.

Elisha Yaghmai

That's exactly that's exactly what it was. Yeah. So, you know, and then in that same dynamic, so I had actually - about that particular rotation. I'd written up like a letter

Jo O’Hanlon

Yeah.

Elisha Yaghmai

Outlining my stuff and I sent him a letter.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

And his response was, “I didn't read your letter. You know, it's too long.” Yeah.

Jo O’Hanlon

You sent it to your attending physician or to the...

Elisha Yaghmai

No, I sent it to the clerkship director.

Jo O’Hanlon

Yeah, yeah.

Elisha Yaghmai

So, I documented the things and sent him a letter. And his response was, "It was too long. I didn't read it. Just don't care."

Jo O’Hanlon

Wow.

Elisha Yaghmai

Right. So, you know, just deal with it, right?

Jo O’Hanlon

Wow!

Elisha Yaghmai

So, again, this was the... So, again, right? The vibe here is...

Jo O’Hanlon

Put up with it. You’ll be gone soon.

Elisha Yaghmai

Put up with it. We have an institution. We're going to do what we're going to do. If it's abusive, it's abusive. You should just live with that, right? Everyone else does.

Jo O’Hanlon

On this side of things, you've talked, you know, about some of the pieces that happen in New Orleans and said like you have more compassion on the faculty side being an adult now and on this other side, but thinking about this situation from where you sit right now, like…Hypothetically, what do you think are the reasons that they wouldn't just excuse this faculty member from their, you know, from their relationship with the university and instead find somebody better.

Elisha Yaghmai

Yes. I think it's one is that within medical education, there is to this day, still a normalization of an abusive dynamic.

Jo O’Hanlon

Really?

Elisha Yaghmai

I actually have much less empathy for those people that I was dealing with at Southwestern than I do for the Tulane people.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

Because with Tulane people, I can understand now as an older person with a family.

Jo O’Hanlon

Right. The personal stressors that were going on.

Elisha Yaghmai

The whole, whole world is falling apart right now, right? And you're not performing. performing at your best, but I can kind of understand why that might have happened, right?

Jo O’Hanlon

Right.

Elisha Yaghmai

But having since gone on to teach medical students and residents myself.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

I don't think there was a good excuse for the behavior that I saw from either of those individuals or anybody else that was around.

Jo O’Hanlon

It’s just the way that it's done.

Elisha Yaghmai

It's institutional culture, right?

Jo O’Hanlon

Yeah, yeah.

Elisha Yaghmai

And medical education, like I said, has that, it has that abusive element in it. It has always had that abusive element, at least in modern times, right? The word resident used to be because you lived at the hospital.

Jo O’Hanlon

Oh, interesting. Okay.

Elisha Yaghmai

That's where it came from. You were a resident because you used to live there and you lived there so that you could be on call every other night so that you didn't miss any interesting cases, right? That was the dynamic, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

And so it shifted and they eventually shifted the work hours and they did these other types of things to try to improve it. But built into this, this whole time is this sort of, it's this vibe where people may treat you well.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

But if they don't treat you well, you just shut up and live with it. I had another experience where there was an attending physician, an attending surgeon.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

You couldn't speak to him as a medical student. You were not allowed to talk to him. If you had a question, you had to ask the resident. And if the resident deemed it worthy to be passed on to the attending physician, this is within this century.

Jo O’Hanlon

Is it a portion of like, do you ever graduate from this abusive position? Is it hazing and then it becomes brotherhood ever? Or is it?

Elisha Yaghmai

I think if you stay in the institution, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

If you stay in the institution, possibly. I mean, I didn't stay.

Jo O’Hanlon

Yeah. I'm just like from an outsider. I'm like, you know, just thinking about this where I'm like, there are so many instances of abuse in our culture that I think we've exposed over the last 10 years, even that are some of that where we're like, yeah, that was never okay. Yeah.

Elisha Yaghmai

Right, yes.

Jo O’Hanlon

But there was a brotherhood that led people to be like, nah, that's fine, we all did it. We all went through those years. But there also has been a lot of abuse exposed in our culture.

Elisha Yaghmai

Right.

Jo O’Hanlon

In a lot of industries where we're all just like, yeah, that's not okay.

Elisha Yaghmai

Yes.

Jo O’Hanlon

And it's never been okay and it shouldn't, and it didn't ever pan to something else either. Why did we stay here so long?

Elisha Yaghmai

I think there was some element of a hazing and graduation into the fraternity on that front.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

But there also was an element that was just people abusing their power.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

And I think there probably still is.

Jo O’Hanlon

Because they had finally made it to the point where they had power, so they got to abuse.

Elisha Yaghmai

They had power, right? And, I will also say exactly that. It is a cycle of abuse thing, right. Almost undoubtedly, those people were abused going through their education.

Jo O’Hanlon

Sure.

Elisha Yaghmai

And as soon as they got in a position where they could hand down a beating, they decided to do the same thing to the people below them.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

Who then did…and I would say it also becomes a self -selecting thing. right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

Because when you're in an environment that is like that, some personality types are like, "I'm out of here."

Jo O’Hanlon

Right, yeah.

Elisha Yaghmai

I'm out. I'm leaving as soon as I can. It begins to self-select for the people that can tolerate that environment who then, whether they like it or can tolerate it, who then it perpetuated.

Jo O’Hanlon

Right.

Elisha Yaghmai

Because for them, it's like, "Well, it's worth passing through all this so that I can put my name up in the stars or the other stars of this academic institution,”

Jo O’Hanlon

Right.

Elisha Yaghmai

“I want to be there too.” So you select out for the people that don't like that and you select in for the people that like or tolerate it.

Jo O’Hanlon

Right.

Elisha Yaghmai

Who then perpetuate it to the next generation.

Jo O’Hanlon

Right.

Elisha Yaghmai

Who then do the same thing, right?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

This process keeps going through the generations and then what it produces in the most pernicious part of it is it produces people that their best skill is hiding their weaknesses. see what I'm saying?

Jo O’Hanlon

That's really interesting, yeah.

Elisha Yaghmai

And that's the problem, right? Medicine is—

Jo O’Hanlon

Rather than working on their weaknesses or just being honest about them.

Elisha Yaghmai

Or acknowledging them, right?

Jo O’Hanlon

Yeah, yeah.

Elisha Yaghmai

So, when you've had, when patients have an experience, for example, the doctor gives them complete certainty on, you know.

Jo O’Hanlon

Right.

Elisha Yaghmai

Whatever this is, and then they go somewhere else and that diagnosis was thoroughly wrong, right?

Jo O’Hanlon

Right.

Elisha Yaghmai

Why did that happen?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

Because in many cases-- Well, in many cases-- be a knowledge deficit or whatever else.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

But even how the knowledge deficit happened, because going through the training, the point of the training was to not be humiliated and exposed. You see what I'm saying?

Jo O’Hanlon

Yeah.

Elisha Yaghmai

The price of expertise is humiliation.

Jo O’Hanlon

Yeah.

Elisha Yaghmai

You have to be bad at a thing before you're good at a thing. But if you're not allowed to be bad at a thing, and this is this is the whole story of medicine, the medical training.

Jo O’Hanlon

Yeah, yeah.

Elisha Yaghmai

You're not allowed to be bad at it, right? Because you're being constantly judged and graded on these things. So, if you stink, right, well, then you're inferior.

Jo O’Hanlon

Right.

Elisha Yaghmai

So, your whole goal is to try to not appear to stink, even if you do.

Jo O’Hanlon

Right.

Elisha Yaghmai

So, you just avoid things that make you uncomfortable. You gloss over the things you don't understand, because if you ask a question, then they know you're stupid.

Jo O’Hanlon

Right.

Elisha Yaghmai

You see what I'm saying?

Jo O’Hanlon

Which never gives you an opportunity to actually change or grow.

Elisha Yaghmai

That's the issue.

Jo O’Hanlon

Yeah. Well, that is our time, but this has been, I mean, it's so illuminating, honestly. So that's where I'd like to pick up next time is about where you went from there into your residency and how that kind of went. But I mean, I think that we'll probably return to this topic about medical school at a later point of some of this piece of like, some of that culture and how that shapes the type of person that ends up coming out of medical school into the actual medical field, you know. That's our time today. Thanks for being with us again. And we'll pick up next time on your residency.

Elisha Yaghmai

Sounds good.