Handling a Toxic or Disrespectful Shadowing Environment Professionally

You’re standing at the nurses’ station on your third shadowing day.
The attending you’re with snaps at a nurse in front of everyone: “We’ve been over this a hundred times. Do I have to do everything myself?” People go quiet. The nurse’s face hardens. You’re frozen, staring at the computer screen, pretending to be invisible.

Your stomach drops because:

• This is the only physician who agreed to let you shadow.
• You were hoping for a letter of recommendation.
• You’re not sure if you’re overreacting… but the environment feels wrong.

You leave that day exhausted, dreading going back, and wondering: “If medicine looks like this, what am I doing?” And on top of that you’re asking: “Do I say something? Do I just survive and get the hours? Do I bail and risk looking unprofessional?”

This is the situation we’re handling: you’re in a toxic or disrespectful shadowing environment, but you still want to behave professionally and protect your future.

Let’s walk through what to do, step by step.

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(See also: Managing Shadowing When You Work Nights or Weekends to Pay Tuition for strategies on handling difficult situations.)

Step 1: Name What’s Actually Happening

Before you decide anything, you need clarity. A lot of premeds second-guess themselves because “medicine is stressful” and “maybe this is just how it is.”

Start by separating what you’re seeing into three buckets:

1. Normal stress behavior (not ideal, but not toxic)

   • Brief, sharp tone in a code or emergency
   • A surgeon being very direct in the OR for safety reasons
   • Constructive criticism delivered bluntly but focused on the work
     Example: “No, that’s not the right dose. It’s 0.5, not 5. Let’s correct that.”

2. Concerning but ambiguous behavior

   • Repeated sarcasm or eye-rolling toward staff
   • Dismissing patient concerns quickly
   • Mildly demeaning comments disguised as “jokes”
     Example: “Of course you messed that up again, why am I not surprised?” followed by a forced laugh.

3. Clearly toxic/disrespectful behavior

   • Yelling, humiliation, or ridicule
   • Racist, sexist, homophobic, or other discriminatory comments
   • Swearing AT people, name-calling
   • Intentionally ignoring or belittling patients or students
     Example: “You’re useless. I don’t know why they hired you.”

On your way home, write down exact words or actions:

• Who said what
• To whom
• Where
• How often
• How it made you feel

This isn’t just journaling. It helps you avoid vague “it just felt bad” thinking. When you see it on paper, patterns become clearer. You’re not deciding anything yet; you’re gathering data.

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Step 2: Check Your Safety First

Before professionalism, hours, or letters of recommendation comes this question: Are you safe?

Red flags that push this to immediate concern:

• The physician or staff directs aggression at you: yelling, intimidation, threats
• You’re pushed to violate clear boundaries:
  • Being told to perform procedures you’re not trained/allowed to do
  • Being pressured to look at charts or images you’re not authorized to access
  • Asked to lie or hide information
• You feel physically unsafe:
  • An angry family member shouting and security is absent
  • A provider throwing instruments or slamming doors
  • Any form of unwanted physical contact (even “joking” touches)

If you’re in that zone, you do not need to “stick it out.”

Here’s how to exit in the moment without burning the world down:

• If possible, step away:
  “Excuse me, I need to use the restroom for a moment,” and physically leave the area.
• If it’s escalating, find any staff member and say quietly:
  “Hey, I’m just a premed shadowing Dr. X and I’m feeling a little overwhelmed right now. Is there a safe place I can wait for a bit?”

Once you’re safe, you decide if you’re going back at all. For serious issues, you’re allowed to end the entire shadowing experience. That is not unprofessional; that is appropriate.

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Step 3: Decide Your Goal Before You React

When a physician is rude or toxic, two instincts fight:

• “Stand up for what’s right.”
• “Don’t ruin my chances for a letter or future opportunities.”

You need a clear goal for this specific situation, not just your general values.

Possible goals:

1. I want to quietly finish my hours and then never come back.
2. I want to transfer to a different physician/clinic if possible.
3. I want to stop immediately and report what I saw.
4. I’m unsure if this is bad enough to leave; I need more data and maybe a one-on-one conversation.

Pick one primary goal, knowing it can change later if new behavior appears.

Why this matters:
If your goal is #1 (quietly finish), your strategy is going to be about minimizing exposure and remaining neutral.
If your goal is #3, your actions involve documenting, finding the right person to report to, and possibly ending the shadowing now.

Without a clear goal, you oscillate and feel paralyzed.

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Step 4: How to Behave During a Toxic Shadowing Day

Let’s say you’re in a situation where the physician is frequently disrespectful to staff or patients, but not physically abusive or overtly criminal. You’ve decided, at least for now, to finish the scheduled days.

Here’s how to move through the day professionally while protecting yourself.

4A. Maintain professionalism even if they don’t

You cannot control the attending’s behavior. You can control yours.

• Stay neutral in your facial expressions when they snap at someone. No laughing along. No dramatic reactions. A calm, attentive, neutral face.

• Do not join in if they mock a patient, nurse, or another specialty. A simple non-committal response is enough:

  • “Hmm.”
  • “I don’t really know enough to comment on that.”
  • Small, closed-lip smile that doesn’t signal agreement.

• Be consistently respectful to staff:

  • Use names when you know them: “Thanks, Maria.”
  • Say “please” and “thank you” often.
  • If they explain something to you, “I really appreciate you walking me through that.”

Staff notice. A lot. You’re silently signaling: “I see what’s happening and I’m not like that.”

4B. Avoid being alone in emotional crossfire if possible

If you know the attending tends to blow up at the nurses’ station, position yourself:

• Slightly to the side or behind them
• With an easy excuse to move (e.g., “I’m going to step over here so I’m not in the way.”)

If they start escalating, it’s okay to quietly step a few feet back without making it a big performance. You’re keeping out of the line of fire, literally and politically.

4C. Script for deflecting direct disrespect toward you

Suppose they belittle you:

• “If you don’t know this by now, maybe medicine isn’t for you.”
• “Wow. Did your school teach you anything?”

You need a script that’s respectful but not self-obliterating:

Option 1 – Calm, factual:

“I’m still early in the process and learning as much as I can. I’ll definitely review that topic when I get home.”

Option 2 – Respectful, redirecting:

“I appreciate the feedback. I’d be happy to read more about that and come prepared with an answer tomorrow.”

Do not argue. Do not match their tone. You’re not trying to “win.” You’re trying to demonstrate maturity and avoid escalation.

If the comment crosses a line into abuse or harassment (personal attacks, comments about appearance, gender, race, etc.), you’ll need to reconsider whether continuing is acceptable (we’ll get to exiting gracefully later).

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Step 5: When, Where, and Whether to Speak Up

A lot of students ask: “Should I confront the physician?”

Sometimes. But not how people imagine it.

5A. When a direct conversation might make sense

Conditions that make a private conversation more realistic:

• The behavior is in the “concerning but ambiguous” bucket, not outright abuse.
• You’ve seen them be kind or appropriate at other times.
• You sense they might not fully realize how they’re coming across.
• You don’t depend on them for a critical letter, or you’re willing to accept the risk.

The goal of this conversation is not to fix them. The goal is to advocate for your learning environment and gather information about whether you should continue.

Use a respectful, curious frame, on neutral ground, away from patients and staff. Something like:

“Dr. Smith, thank you again for letting me shadow. I wanted to ask you something, if that’s okay.

I’ve noticed there are times when interactions get pretty tense, especially when things are busy. I’m still learning what’s normal in medicine versus what isn’t. As a student who’s trying to understand the culture, can you share how you think about communication with the team in high-stress moments?”

You’re not accusing. You’re inviting reflection. How they respond tells you a lot.

Watch for:

• Growth-leaning response: “You’re right, I can be harsh when I’m stressed. I’m working on it.”
• Justifying toxicity: “People here are incompetent. They need to be yelled at.”
• Defensiveness / hostility: “You have no idea what you’re talking about. You’re just a student.”

That response may make the decision for you.

5B. When you should not confront directly

Skip confrontation if:

• You’ve witnessed clear harassment, racism, or abuse.
• They’ve already dismissed or mocked you.
• They hold significant local power (small clinic where everyone defers to them and there’s no structure).
• You feel scared about retaliation.

In those cases, it’s usually smarter to exit and, if appropriate, report to someone who’s actually in a position to address it.

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Step 6: Exiting Gracefully Without Burning Bridges

If you decide this environment is not acceptable, you can leave professionally. You don’t need a dramatic speech.

6A. If you’re in an informal shadowing setup

This is common for premeds: you emailed or called, they said “Sure, shadow me,” and there’s no school or program overseeing it.

You can end it with a brief, polite message:

Email template:

Subject: Thank You for the Opportunity to Shadow

Dear Dr. [Last Name],

Thank you again for the opportunity to shadow you over the past [X days/weeks]. I’ve learned a great deal about [clinic/field] and appreciate the time you’ve taken to let me observe your work.

Due to some evolving personal and academic commitments, I’ll need to step back from shadowing for the time being and won’t be able to continue with the originally planned schedule.

I’m grateful for the experience and wish you and your team the best.

Sincerely,
[Your Name]

Short. Respectful. No accusations in writing. You can protect your values without writing a legal brief.

6B. If the shadowing is through your school or a formal program

Here, there’s usually someone between you and the physician:

• Pre-health advisor
• Clinical experiences coordinator
• Volunteer coordinator
• Course director

Your first move is not to email the physician. Your first move is:

“I’m having some concerns about my shadowing environment and would appreciate some guidance on how to handle it.”

Then, be specific but factual in a meeting or call:

• “I’ve observed Dr. X repeatedly yelling at nurses in front of patients.”
• “I’ve heard them make comments like ‘these patients are so stupid’ within earshot of families.”
• “This happens almost daily and is affecting my learning and comfort level.”

Ask for options:

• Transfer to a different provider
• Modify your schedule
• End the experience

If they ask you to put something in writing, keep it factual: dates, examples, who was present. Avoid speculation about motives.

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Step 7: Deciding Whether and How to Report

Not every unpleasant interaction requires a formal report. But some absolutely do.

7A. Situations where you should strongly consider reporting

• You witness discrimination: racist/sexist/homophobic remarks toward staff or patients
• You see serious patient safety violations that are being ignored
• There is harassment: sexual comments, touching, repeated personal remarks
• You observe retaliation against staff who speak up

In those cases, there are usually multiple reporting paths:

• Your school or premed office (if it’s a structured experience)
• The hospital’s student affairs / education office
• The hospital’s compliance / ethics hotline
• A trusted faculty member who can help you navigate options

When you report, focus on:

• What you saw or heard
• When it happened
• Who was present
• Whether it seemed like a pattern

Avoid statements like “He’s a narcissist” or “She doesn’t care about patients.” Stick to actions and words.

Your report may not lead to immediate visible change. But it creates a record, which often matters more than you realize.

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Step 8: Protecting Your Future Letters and Reputation

A common fear: “If I leave or speak up, will this ruin my chances?”

Here’s how to protect yourself:

1. Diversify your mentors early.
   Do not rely on one physician for all your letters. If you’re shadowing Dr. A but volunteering in another clinic, start building relationships there too.

2. Control who you ask for letters.
   You’re never required to request a letter from someone whose behavior you found toxic. Admissions committees care much more about the content and authenticity of letters than the prestige of the writer.

3. If asked about a short or incomplete shadowing stint in an interview, you can answer without trashing anyone:

   “I had an early shadowing experience that helped me realize how much team dynamics affect patient care and learning. It was not the best fit for me, so I transitioned to a different environment where I could see more collaborative care. That contrast actually reinforced the kind of physician I hope to be.”

No details. No names. No drama. But you’re honest about the fact that it wasn’t ideal and that you made an active choice.

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Step 9: Processing the Experience (So It Does Not Poison Your View of Medicine)

A toxic shadowing experience can shake your belief in medicine as a career. That’s not overreacting; it’s a normal response.

You need to decide what this experience means in your story.

Here’s how to process:

1. Talk to someone who isn’t in that environment.
   • A faculty mentor
   • A trusted physician at a different site
   • Your pre-health advisor
   • A resident or med student you know

Tell them what you saw, and ask: “Is this typical? What have you seen?”

Most will tell you:

• Toxic behavior exists.
• It’s not universal.
• You can choose your practice environment later more than you think.

2. Seek a contrast experience.
   Make it a priority to find:

   • A community clinic with a reputation for teamwork
   • A pediatric practice known for patient communication
   • A hospital service where nurses and physicians clearly respect each other

Even 1–2 days in a healthier environment can recalibrate your perspective. You’ll see that “doctor” doesn’t automatically mean “jerk.” It’s just that you happened to land in a bad microculture.

3. Decide how this will shape you.
   You can let this experience:

   • Convince you medicine is awful
   • Or clarify the type of colleague and leader you absolutely do not want to be

Later, this can become a powerful reflection point in your personal statement or interviews—if you frame it generatively:

“Early in my premedical journey, I shadowed in an environment where team communication felt tense and at times disrespectful. It was uncomfortable, but it made me pay close attention to the impact of tone and culture on patient care. In later experiences, I sought out teams that modeled collaborative, respectful care, and that contrast helped me define the kind of physician I hope to become.”

You don’t name names. You focus on what you learned.

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Step 10: What You Can Do Right Now

If you’re currently in a shadowing situation that feels toxic or disrespectful, do this today:

1. Write down the last three incidents that bothered you.
   Be specific: words, actions, who was present.

2. Classify them into the three buckets: normal stress, concerning, clearly toxic.

3. Decide your primary goal for the next 1–2 weeks of this shadowing experience:

   • Finish and leave quietly?
   • Transfer sites?
   • Stop immediately and seek help?

Then take one concrete step consistent with that goal:

• If your goal is to finish and leave quietly:
  Draft the polite exit email and keep it ready. You can send it after your hours are complete or earlier if needed.

• If your goal is to transfer or get guidance:
  Email your premed advisor or coordinator now:
  “I’m having concerns about my shadowing environment and would appreciate a quick meeting to discuss options.”

• If your goal is to stop immediately: Send the brief, respectful email tonight and mark the date in your notes. You’re allowed to protect yourself.

Open a blank document right now and write: “What I’ve actually seen” at the top. Start listing specifics. You’ll feel less confused and more in control the moment it’s out of your head and onto the page.