Social critics, power, doctors and networks

To the thread of the disciplinary investigation initiated to M³nica Lalanda, I promised to help it and to support it in social networks. During some days I have reflected on the question, and here I bring my conclusions to you. A little ethics and medical deontology, to vary within this blog.

The problem of @mlalanda has raised to rivers of digital characters and even some forms (Spanish Huffinton Post and La Vanguardia, among others. Briefly, one is a specialist in Urgencies that its job in 2016 in the hospital left where it worked and exposed its reasons in its blog. Months later, its School of Doctors has initiated disciplinary investigation to him to study if it deserves a reprimand by his action, and also there is counted the happened thing to us in this other entrance of his blog.

M³nica Lalanda drawn by she herself

M³nica Lalanda drawn by she herself

The professionals who go away

Up to here, nothing strange. I am sure that every week some doctor leaves to his job by disagreements with the headquarters and/or the direction of the center. They will set out his reasons to the head, the direction, and there where they want to listen to them, since the human beings we needed to feel included us. In the following months, if they visit meetings and congresses of the specialty, they will tell his version them of the facts to his colleagues of profession. All normal one, up to here. I have been witness of this type of conversations, in which somebody complaint of its head, and receives the wink accomplice of the interlocutor, often with true affection. As I say, the human beings we needed to feel supported us, and we did not doubt in counting our sufferings, great or small, and we did not doubt in requesting affection and support.

The heads are human

The heads on watch are people who guess right and are mistaken. One always dreams about which his own head has more of first than of second€¦ Surely the own heads think that they guess right much more often than they fail. And perhaps not always he is thus. To be head on watch nowadays means to accept to work with the budgetary limitations of the public system of health. To go to meetings with Direction and to receive its directives. To plan the activity and to decide to whom to assign it. And mainly, to decide to what extent to obey to the direction of the center and to what extent to listen its subordinates (both sides usually are in faced positions).

Does the person who orders have to accept critics?

The eternal question. When you direct to people, and arises a critic, it feels fatal. I know it because I have been tutorial of residents during near 8 years. The first time that a resident suggested could be mistaken, left me paralyzed. And reflecting during several days. On the one hand, the indignation because somebody had questioned my capacity. On the other, the doubts on my activities and my formation.

Ex--Head on watch of @mlalanda had to feel very annoying when she verified that, due to the magic of the social networks, the complaint of M³nica was read by more than 10,000 followers, and not only by a few tens of colleagues here and there. It is a novel situation and he could only have compared if he had answered his complaints in a similar forum. But he is that to take control of a virtual audience of thousands of people he takes to his time and its effort€¦

As tutor hurt in his pride, I answered my residents critics who could elevate their complaints to the Commission of Teaching of the hospital. As in the later weeks they did not contact to me of this Commission, I occurred by endorsed. Surely they did not get to put a formal complaint. M³nica yes did it in its hospital. They never answered to him. Perhaps that is an endorsement for their ex--Head, no? To continue in your position in spite of a strong critic to your form to act is without a doubt a ratification in your merits.

They criticize to the person or his acts?

After the second and following critics person as tutor of residents, I reached the conclusion that it was not receiving a critic to all my person, but to certain concrete activities as tutor. That helped me to reflect on those activities, and on if it could realise them of better way or fairer form. I added some changes that increased the weight of other associates in final notes of the residents, so that it did not weigh plus my opinion.

The problem is that, in countries as ours, we took fatal to receive critics. In other places as England, where I worked years ago, they exist formation specific tutorial to teach to give €œfeedback to them€ to its students in formation. He is so delicate to do this to another human being who is needed to be very careful and to follow a milimetrado order. In a formation online of that country they recommended to enunciate the first good activities of the evaluated one, and next the €œareas of improvement€.

Truly, as the uncle of Spiderman shelp, €œa great power entails a great responsibility€. The power to describe colleagues in formation entails the responsibility to try to do it well. And I would add that also to become a skin something more thickness, not to drown us to the first negative critic.

€œMother, my brother has called me g€¦ and what follows€

My brother era 15 months younger than I. We were always very near in homemade responsibilities and certain learnings. We begin to use heavy insults almost at the same time (to my 7-8 years). As far as one a profanity escaped to him, ran shot towards our mother to make the pertinent accusation. And my mother, with all their patience, went to rega±ar to the violator.

Certainly you that you are reading this remember what greater satisfaction you felt when your mother gave his deserved punishment to a brother who was victim to you. Ja! Absorb that to you! If my brother received a rega±ina, he passed the rest of the day showing off me (and my brother to me, raging), enjoying that glorious sensation to feel endorsed and defended to me by the €œauthority€.

Until a day I began to complain (again) another profanity that had loosen my brother to me. €œMother, Javier has called me g€¦ and what follows€ (yes, she called dickhead to me). My mother shelp €œThat is bad, does not say that to your sister €œ, but it seemed to me that she had been lukewarm in his punishment. So I continued insisting €œBut she is that has called me€ €œMother, is that she has called it to me! Reg¡±ale! €œ. Until my santa mother was satiated and told me €œGood, and what if she has called it to you! You do not do case and point to him€

Hallucinating! That day I discovered that not always it was going to receive revenge! My mother, without realizing, taught something to me important then: that not always you will receive the satisfaction to see punished that is victim to you. And of I deduced there that always there would be somebody could insult or tell you something to you offensive, but that was not necessary to gather that glove necessarily, but to follow ahead. That was to make elephant skin, goes.

Schools of Doctors and complaints of associated

I have not had hardly contact with authorities schoolboy, reason why everything what now I write is suppositions mine.

I suppose that the medical codes of conduct try to avoid that we put green to a colleague in front of patients because that brings many damages to the medical evolution of that patient, and to the professional coexistence. On criticizing some to us to others in prevailed, in the confidence of an intimate conversation, I do not believe that no School believes that it can act. As I shelp above, the human being needs expansion, to loosen tension, and to feel supported.

I suppose that to the School of Doctors of Segovia all this subject is to him €œmaking ball€, or as minimum, discomfort. Ex--Head has put a claim that has been taken care of. The ex--attached has put another one but it has not followed the same course. The opinions fly as you shoot with an arrow through Twitter, in the Spanish medical press, and certainly in more traditional forums. When writing this, apparently are attempts of mediation and I cross the fingers so that they give result.

I suppose that both protagonists of  they feel that they need to be taken revenge, to see the other punished, reprobated, rega±ado, correcting. Although right now, the only person who faces the risk of not being able to exert the medicine in her province by a period of up to 1 year is M³nica.

We will see how he finishes, but I ask myself€¦

Really do the Schools of Doctors have to act as parents/mothers when a colleague spills negative critics on some parcel of our professional work?

He is proportionate that Head feels like victim so because they have told him that he is too authoritarian in the personnel management?

He is correct to use the terms €œtyranny€ and €œcortijo€ to define an authoritarian style of management? Will M³nica be regreting them to have used, because they can be considered offensive?

What will happen in the end? It isn't enough to him to that Head with following si©ndolo and thus it turns endorsed by the direction of his hospital? Be will sufficient M³nica to feel defended and considered by almost everything twitterland final, S.A. well she is expedientada?

I really tell you that I would not like nor a hair to be in the skin of the associated doctors who must decide on the file that occupies to us. Because the one of €œcortijo€ and €œtyranny€ makes me feel uncomfortable, but I know M³nica, esteem his talent as illustrator and author, and desire of heart who do not punish to him, because I do not believe that she deserves it.

€œSchool, my colleague has called to me tyrannous in social networks! €œ€¦ and now what?

You have lived sometimes some similar ethical conflict in your Faculty as student, in conflicts with companions or professors? It would enchant to me to read your opinion in the commentaries of down.


Almudena Trinidad

I am otorrinolaring³loga doctor in a hospital of Madrid and Professor Asociada de Medicina in the UAM. I help Medicine students to develop more effective techniques of study to obtain better notes, to remember during more time and to feel like more happy insurances and with its studies.

3 Commentaries
  • Juan Antonio Alonso
    Published to 22:31 h, 07 February To respond

    Very right vision of the subject. The School of Segovia is incomprehensible that persists in its intention to punish to the Dra Lalanda by an entrance to a blog with a critical tone (smooth for me) and without it names to anybody. Who of by alluded by something will be itself. On the other hand, to consider an email as public insulting document is absurd (or hostile) on the part of the school. That a head on watch denounces because feels alluded with that blog speaks by itself of that head. That the president of the school step the denunciation and initiates investigation, creates many doubts on his objectivity in the case and suitability for his position.

  • Miguel
    Published to 09:10 h, 08 February To respond

    Hello Almudena! Thank you very much to write on this subject. I have liked particularly the resemblances that you have used in each part and the detailed analysis of the different aspects.

    I agree with you in the difficulty to criticize in our culture. The south wind especially in Feedback. He is something that ground to request much, and south wind that the people put themselves uncomfortable because they see it as €œcriticizing€. It says much that in Spanish does not exist a word that defines the concept well. It wanted to contribute a vision that you have not mentioned in your post, and is the one of improvement of quality of systems and security of the patient.

    By the post and what of Monica I have been convinced that the critics did not make them arrive for the first time through post. What is possible and probable that has happened is that they have not been taken care of, or the famous one €œalready we will look it€. If so many of the things that shelp were on the system, with a direct hit on the security of the patients. It must be very frustrating and stressful to be working and knowledge that your patients are in danger by the attention system, and that are not mechanisms or these do not respond at the time of palliating these deficiencies.

    I agree with you in that the articles of the deontological code make reference to the medical critic, not of management or handling of the service. Also I agree with you in the sensation that could have had the head. Those that I believe that it is clear are that there is an intention to cover not only the critic to the head, but the critic to the system in if. It is not necessary more to see the impetus that put in denying the situation of urgencies in press conferences.

    As summary, I believe that as sanitary we must have fundamental to guarantee some equitable and safe systems of health for our patients, and that this to have supplants, whenever it is essential and the other channels have been run out, the one of €œnot generating public controversy€.

  • Mercedes Biosca
    Published to 17:34 h, 16 February To respond

    A very right exhibition. I recognize the description of the duality of the headquarters, under the directives of the Medical Direction and as leader of an equipment, whose opinion also deserves to be listened to. It is necessary to work in that, not always possible, balance.
    In my opinion, the detonating is the mediatic repercussion of the blog of the Dra Lalanda and the question is if the defense file as half and I make amends for, letter to the freedom of expression. We have to be controlled, to be judged and to be admonished by our publications in RRSS, to express our opinion from the respect? Then thus it happens with impunity€¦. Lamentable. How it express well to be €œto influencer€ is fruit of time and knowledge to gain the popularity and not everybody account with that endorsement, frightful and powerful. In any case, desire that the file is dismissed and thus also we will create precedent.

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