So what causes this unwelcome transformation?

Is it the patients? I think not. The vast majority of patients are pleasant and honest. The few dishonest or manipulative ones often are not even recognized by these students for their unappealing traits. The first time these students are told that a patient has lied about an opiate prescription, they get that “What do you mean there’s no Easter Bunny?” look.

Unfortunately, the bad influence comes from some of the residents and attendings who poison the well for these learners. By the time many students reach residency, bad habits of thinking the worst of people and saying demeaning things about them are commonplace. At many institutions, this is part of the resident culture. Cultures are hard to change.

I think the best we can do as individuals is to set the tone for empathetic encounters when we work. Our example of treating a cantankerous patient with respect or taking extra time with someone who is slow to understand sends a strong signal to others. When residents observe this over weeks and months, they will take on these behaviors as their own.

Unfortunately, we all have lapses and occasionally regress in haste to references such as “dirt bag.” Chalk it up to blowing off steam, but call yourself on it and make sure the learner knows where your heart is.

Many of us find humor in our interactions with patients. Some of this can be shared with patients, and some of it is best kept quiet. The key is to make sure that learners interpret the humor in its proper context and that patients are unaware.

Not long ago, there was a patient parked in the hallway about 5 feet from me. Her decaying sneakers rested on the floor beneath her cart. The odor was so bad my eyes were watering. Paint would have peeled if I had not intervened.

I quietly asked the nurse to “hermetically seal” the shoes before I was overcome. He did so and assured the patient that he wanted to keep her belongings in order while she was in the hall. After she was given good discharge instructions and assisted from the department, we had a good laugh about it—but she never knew. The humor was more rooted in my reaction to the smell than to the shoes themselves; nevertheless, it was best to keep the patient out of it.