[ Medical School Resources | Appendices | ]
What shall it profit a man, if he shall gain the whole world, and lose his own soul - Mark 8:36
From the British Medical journal Lancet:
The familiar complaint that medical education erodes the students' sensitivity to patients as people, turning nice kids into doctors who 'sweep in, grab the chart, and ignore the patient,' is usually attributed to poor teaching, Spartan training schedules and systems that reward doing procedures rather than talking with patients.[45]
Commentators explain how trainees take this out on their patients:
Feeling exploited, they often projected their perceived dehumanization on the only group who was less powerful - the patients.... 'The goal of every single day for the intern is to just finish it - complete it - and go on to the next day. That meant there was one less day having to do that, that's part of the trenches mentality....' 'They're slabs of meat and you're here to process.'
[Interns] themselves believe that they have been degraded; they lose control over their personal lives, which become dominated by work.... Such degradation breeds resentment. In their isolated subculture they manifest resentment for nearly everyone with whom they come in contact; however, it is the patient who becomes a major target for the young doctors' disgruntlement.[46],[47]
From an article in the trade journal Medical Economics: "Patients are the perfect victims, after all - sick and supine and in ridiculous gowns. It's the kick-the-cat syndrome."[48]
The idealism and concern for the patient with which house staff [interns and residents] may have begun internship were quickly effaced in the trauma of that year.... What they see for the most part is overall exploitation and apathy and a general disregard of most patients by almost everyone, including themselves.
Apathy, as Victor Frankl said, in which one achieves, "a kind of emotional death."[49]
Quoting from an article called "Mental Health of Medical Students," "Perhaps, as students and house staff, exhausted, suffering from social deprivation, adaptively denying our own needs in order to survive, we even unconsciously envy the patient who lies passively in bed while people cater to him."[50]
One doctor diagnosed herself with what she calls "toxic intern syndrome," which she says was brought on by abuse. A toxic intern, she writes, "interrupts patients during long, rambling, historical recounts, forcing them to get to the point... becomes oblivious to pain elicited during procedures... and gradually resents the sense of entitlement found in many medical patients."[51]
In one study, 70% of medical student surveyed in their second year mention the desirable aspect of working closely with people, but after third year, the percentage drops to 40%.[52] Internship may have the same numbing quality. From the New England Journal: "Among four pediatric intern groups, residents had more negative attitudes towards patients, worsened physician-patient relationships, and decreased positivity about life at the end of the internship year compared with the beginning."[53] Just what I want in a pediatrician.
Appendix 3b explores the development of cynicism
[45] Harper, G. "Breaking Taboos and Steadying the Self in Medical School." The Lancet 342(1993):913-915.
[46] Fox, RC The Sociology of Medicine Paramus: Prentice Hall, 1988:110.
[47] Fugh-Berman, A. "Let's Stop Terrorizing Doctors-in-Training." Medical Economics 69(1992):27.
[48] Ibid.
[49] Frankl, VE. Man's Search for Meaning New York: Pocket Books, 1997:24.
[50] Gordon, LE. "Mental Health of Medical Students." The Pharos 1996(Spring):2-10.
[51] James, D. "Deep Impact." New Physician 48(1999):16-25.
[52] Becker, HS Boys in White: Student Culture in Medical School New Brunswick: Transaction Publishers, 1991.
[53] McCue, JD. "The Effects of Stress on Physicians and Their Medical Practice." New England Journal of Medicine 306(1982):458-463.