Hmmm..
The short answer to this is that we always keep it mind, or we do more than you might be inferring from what's being posted in this thread.
I could be wrong, but I think you misunderstand what some of us are saying, if you worried that we're not doing that.
So, I know that you can recognize a bad apple. And we've illustrated a few in the thread.
Humor me if you will in this particular discussion. We've defined what the bad apples can be - the ones that are 'dangerous or bordering on it' or have a tendency to bully others. I'll rephrase it that way.
to illustrate it further, it might be Doug Murphy from Scrubs, who is not competent for IM. Doug had a reputation for 'killing' patients as a joke in the show (Scrubs is satire). He eventually found his calling in pathology. And we got to enjoy more seasons of Scrubs with Doug in it. It can be like that, some residents are better suited to other fields, but still belong in medicine. On the job, we do introspection everyday, but in terms how we can get our "Dougs" through. the price that we sometimes pay as part of the "environment" is having to work overtime to try help our Dougs go home too. Or we may be taking the extra time to teach Doug to be more efficient etc. The risk we take is burnout, if the overtime is constant. The risk to burn out is increased medical errors. Not to mention, the longer Doug has patients he is responsible for, and the longer he's not improving, the greater the risk he is to himself and to his patients. So you have to balance that. Again, patients come first. It's not easy on anyone to see the "Dougs" go, particularly where everyone becomes emotionally invested in seeing the "Dougs" succeed. But there is a point where it will become unfair, not just to those around him, but patients. One day Doug could make a fatal error. in that the less supervision he has, the greater the chance that no one will have been there to save either of them - Doug or his patient.
The other type is the behavioral issues.
For example, bullying - as an extreme case. the *ideal working environment in any hospital under any circumstances, is zero tolerance for bullying. Yes, they deserve the opportunity to correct themselves. (*could be as simple as asking them to take a time out for an outburst, to get coffee/take a break if it was an intense day) But often they'll only have limited numbers of chances to do so - because there's only so much affected staff can take without it impacting on their own mental health. Again, I think everyone in the environment pauses to reflect. Because if that resident continues their behavior without check, they can become future senior residents, fellows or attendings. they're at risk of perpetuating that behavior, in that others will believe it's appropriate or acceptable as they progress into higher positions, and integrate into their repetoire. it's also at risk of poisoning the environment, where other staff will choose to quit over time because they cannot withstand that behavior and the establishment is allowing it to continue. no one wants to lose good staff, and everyone wants to attract and retain the best talent possible.
to break it down further, medical errors happen. we're human. whether it's done by doctors, nurses or other staff. it's impossible to not make mistakes, and could be affected by any number things on a particular day, like a higher than normal case load. if you work in a well supported environment, the proper response is allowing you to learn from mistakes without fear of reprisal - like getting yelled at or butchered. there definitely can be times and places for that response, occasionally, but if it's overblown and it's consistent, it's no longer safe for other learners and workers in the environment. For a satirical example,
crazy hooch. Humiliating your coworkers, by putting them down or demeaning them, is also not appropriate. you can ask people to pause and reflect. that's why there's evaluations, but even before anyone gets to that point, there's often verbal feedback either by other staff or your superiors. depending on the situation.
it takes a lot for anyone to get to a point where they even blow a whistle.
most working in healthcare, from nurses to residents to attendings, they know how much went into training the resident and how hard the resident worked to get there. they know what the gap will be if they have to replace them. the investment is not small. So hence, it has to be really bad. It has to be unbearable for a lot of people, for not a short amount of time. 'Good' programs know what's at stake when they go to 'pull the trigger' so to speak. there's multiple times that those involved in the process stop and reflect. (*i.e. are they doing right by the resident, other staff and patients? etc.)
EDIT: point being that there's a lot that's factored in and considered, in addition to the welfare of the resident. thinking further than the resident, you have to consider their future patients, that's a large responsibility on a program and it's attendings. it's very easy to "think about things", by the way. which is also very different if you're implying that change come as a result. If the latter, it has to be in context. if it's one troubling resident, does the whole environment need to change, disregarding everyone else? what would justify changing an environment further to keep someone who could be as above - a) dangerous v.s. b) a bully and what would you suggest? a non-malignant program would not take the 'easy' way out as others have mentioned previously. but it still has to balance this with patient and staff safety.
It's up to you if you want to worry about the environment having the ability of introspection. If you pick the right environment, you shouldn't need to. i.e. you should feel like it's a safe environment to grow, one that will help you be a better doctor not one that is going to tear you down at your first mistake. (*because they will have the ability to know when it's time to gently let you know, guide into the right path or escalate it further if that's not working. they will have stopped to think, is this a pattern, or was it something else going on, etc.)
You have to be careful in pointing fingers too quickly too.
because you don't always know the situation is, particularly where posters haven't gone into details. Some of the posts are often just sharing of 'war stories', not explaining a particular situation. There's different targeted audiences. We all like to feel less alone, so stories get shared.
if you're constantly questioning everyone around you, therein comes the question of what's happened to you, what in your environment caused you to feel threatened or feel that residents are constantly at threat of being harmed.
If I'm jumping to conclusions here, stop me.
I'm just trying really hard to understand where you're at.
If you're in a bad place in real life..
I mean..there's a number of supportive attendings in here who want to help you
(and by that, I mean other people in this thread, who are qualified to do so
)
. Sometimes you get an Elliott, circa 1st season when she and Carla had a beef. Be none of them. Your good PDs will not be like Dr. Kelso. Sacred heart is not out to get you 
(I just wanted an excuse to use that emoticon). Water cooler talk is just that. Try not to confuse it with indifference.
