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In 1965, William Goldring, a well-known professor of medicine at New York University offered a system of rating the ideal intern. Being unmarried got you 15 points.[355] One informal study found that the majority of pediatric(!) residencies did not notify their residents of the Family Medical Leave Act, despite the federal requirement to do so, and, "most did not anticipate it's utilization - maybe another self-fulfilling prophecy."[356]
Quoting from an article in JAMA, "there is the unspoken necessity to sacrifice one's family."[357] Most medical students are familiar with the fabled residency program that states with pride to prospective applicants: "None of our trainees have ever finished without getting a divorce."[358]
A large percentage of residents in survey after survey report experiencing significant problems with their significant others.[359] Fifty-five percent of married residents in one study, for example, felt that they did not have enough time and energy to "work on" the marriage.[360] Many residents expressed concern that their relationships would not persist through training.[361] Says one resident, "I gave up everything... - friends, happiness, and one marriage." From M. D. Doctors Talk about Themselves:
Quite as important, though less easy to measure, is the common tragedy of 'marital dry-rot.' By this I mean the marriage that has atrophied in terms of emotional closeness, intimacy and enriched sharing. As with dry-rotted timber, the outward form may remain, but the underlying strength and substance has eroded - collapse or crumbling is only a matter of time.[362]
Author-doc Robin Cook describes being an intern:
There is a[n] intensity in... repressed anger and hostility that leads towards greater isolation, more autistic behavior, stronger feelings of self-pity, and an inability to establish significant interpersonal relationships.... Our family, friends, and loved ones found us tired, preoccupied, unavailable. It took us days to return phone calls. We found it difficult to love, or be loved.[363]
In The House of God, the protagonist - upon finishing internship - describes his fiancé, "trying to teach me to love as once I did love, before the deadening by the year."[364]
Physicians, "frequently seemed unable to empathize with members of their own family."[365]
The situation continues after training. Surveying physicians, researchers found that half had been through marital counseling. The spouses' major source of marital dissatisfaction, other than the long hours that their partners were away at work, was reportedly the doctors', "poor capacity for intimacy and their lack of emotional support."[366] Quoting from the New England Journal, "A progressive emotional separation from family life in the early years of [medical] practice becomes a de facto divorce; the willingness and finally the ability to share feelings and experiences is lost."[367]
From an article entitled "Physician Heal Thyself":
Our armour of assumed omniscience and omnipotence has taken years to develop and is hard to discard. Many of us have developed a compulsive persona of exemplary independence, strength, and rationality which we are both ashamed and afraid to relinquish.[368]
Doctors don't just withdraw from their spouses. According to a New England Journal article, retreat from the nonmedical world in general usually begins in medical school and progresses into a near total avoidance of nonmedical socializing by private practitioners. The article's author asks, "Why do intelligent and successful physicians tolerate the failure of an unrewarding family life and surrender nonmedical interests, becoming narrow and boring?" Theories are offered:
Long hours and publicly visible fatigue justify economic prosperity to the physician who is uncomfortable with success in a fee-for-service practice.... Physicians may socially withdraw to avoid having their financial success observed by their patients.
A final factor is self-importance.... Physicians are often defensively locked into self-important, authoritarian professional roles.... Insecure physicians can maximize ego gratification at the hospital where they issue orders... [but] at home, the physician is just another suburban husband or wife.[369]
Sociologists have also looked at medical students:
In the first two years the student spends a great deal of time at home but is rarely home during the clinical years and when home, he or she is usually suffering from sleep deprivation.... For the student, there appears to be little energy left to be concerned about personal matters such as feelings of loneliness...."
The strain to which the internship schedule subjects a marriage is severe.... Marital relations are reduced to watching a spouse sleep, to listen to their waking delusions and occasional hallucinations, to endure the irritable and bitter abuse that the intern cannot heap upon its rightful targets (the hospital and his patients)....[370]
From the point of view of the spouse, an article entitled "The Medical-Student Spouse Syndrome: Grief Reactions to the Clinical Years," describes how spouses suffer the partial loss of a loved one when their medical student partners start third year. The author describes the way the spouses react to this loss as a grieving process with three stages - protest, despair, and detachment:
As the discrepancy between plans and reality becomes apparent, the second part of the protest stage develops as denial turns into anger.... The spouse feels angry at the student, but most of the time the student is not there to be confronted, and when the student does return home the spouse feels inhibited from venting feelings on one who has been awake for 36 hours and has only come home to sleep.... The venting of anger may only serve to make the home a punishing environment for the student, which the student then tries to avoid.
In time this poorly expressed rage leads to a numbing sense of despair, and the spouse becomes markedly depressed. However adaptive the stage of detachment may be, it has a potential for imposing its own stress on the relationship when there is a respite in the long hours the student spends away from home, as occurs during certain electives, for example.... Even when both the student and spouse arrange to spend time together, there is initially some discomfort. The detachment, the bachelor frame of mind, is found to be unworkable, and the previous level of intimacy must be reestablished.[371]
One spouse writes, "My mother told me never marry a doctor or a sailor because you'll be alone all the time. And she was right."[372] McCall's Magazine warned it's readers in an article entitled "Never Marry a Doctor," that, "Physicians are poor husbands, poor fathers, absent companions, prima donnas and about as useless in bed as an electric blanket when the power is cut off."[373]
[355] Barondess, JA. "On Interns and Interning." The Pharos 1998(Summer):13-16.
[356] Bradford, BJ. Letter. Academic Medicine 70(1995):175.
[357] Linzer, M. "Leaders or Lemmings." Journal of the American Medical Association 279(1998):341.
[358] Herrick, CR. "Cognitive Dissonance and Physician Training." The Pharos 1986(Fall):2-6.
[359] Landau, C, et al. "Stress in Social and Family Relationships During the Medical Residency." Journal of Medical Education 61(1986):654-660.
[360] Ineveld, CV. Canadian Medical Association Journal 150(1994):1549-1551.
[361] Damestoy, N, L Brouillette and LPD Courval. Canadian Family Physician 39(1993):1576-1580.
[362] Pekkanen, J. MD: Doctors Talk about Themselves New York: Delacorte Press, 1988:173.
[363] Gross, P. "Me, a Doctor?" New Physician 1988(September):37-39.
[364] Shem, Samuel The House of God New York : Dell Publishing, Dec. 1980.
[365] Andre J. "Learning to See" Journal of Medical Ethics 18(1992):148-152.
[366] Johnson, WDK. British Journal of Medical Psychology 64(1991):317-329.
[367] McCue, JD. New England Journal of Medicine 306(1982):458-463.
[368] Zigmond, D. "Physician Heal Thyself." British Journal of Holistic Healing 1(1984):63-71.
[369] McCue, JD. New England Journal of Medicine 306(1982):458-463.
[370] McKinnon, JA. "Life In A Short White Coat." New Physician:25-30.
[371] Robinson, DO. American Journal of Psychiatry 135(1978):972-974.
[372] Pekkanen, J. MD: Doctors Talk about Themselves New York: Delacorte Press, 1988:173.
[373] Zigmond, D. "Physician Heal Thyself." British Journal of Holistic Healing 1(1984):63-71.