[ Medical School Resources | Appendices | ]
The only condition of peace in this world is to have no ideas, or, at least, not to express them - Oliver Wendell Holmes
One activist on starting medical school: "I felt welcomed. I felt invited to participate... until I opened my mouth."[574] Commentators have emphasized that the disposition of medical students to remain silent is a means of surviving a medical school environment where the, "uncritical exercise of authority can smother dissent and questions."[575] Quoting from the American Journal of Psychiatry, "In all, house officership represents a major challenge to the independent thinking and action orientation of the activist medical student.... Complacency in a young physician increases his chance of survival."[576] One third-year medical student told of an acronym he constructed and repeated to himself whenever he felt tempted to raise his voice: "KMS, which meant Keep Mouth Shut."[577]
As reported in Getting Doctored, one intern, a refugee from a right-wing totalitarian state, expressed disgust at the timidity of the house staff: "Here, they don't need to use fascist tactics to get the workers to submit to abuses."[578] In an article about medical student abuse, medical students are described as loath to complain and risk dismissal after having invested so much financially, emotionally, and personally in medical school.[579] But, "Silence wounds our patients," a doctor writes in a JAMA article entitled "Speak No Evil." "It robs them of their autonomy. It robs them of their dignity. It places them in harm's way." Also, the author writes, "Silence wounds ourselves. It blunts us professionally. It blunts our moral convictions."[580]
Medical students as emotional chameleons. A letter from the Canadian Medical Association Journal:
I became increasingly unsure of when I could express my true compassion, when I would have to manufacture concern, when I was expected to offer psychological support and when I would be ridiculed for being too caring. But the exhaustion, the daily (and nightly) tasks of each rotation and the need to plan for my future prevented me from addressing these issues during medical school.[581]
"I will never be in the medical mainstream," one activist writes, "but how far will this process take me from feminist concepts of healthcare? I may end up in limbo, after mashing myself up into some facsimile of a doctor, biting off pieces of spirit to fit, finally, into that white coat."[582]
Activist or not, medical school chisels away at one's ethical foundation - Appendix 51b.
[574] Silver-Isenstadt, AD. "Times of a Medical Student Activist." Journal of the American Medical Association 276(1996):1435.
[575] Reiser, SJ. "The Ethics of Learning and Teaching Medicine." Academic Medicine 67(1994):872-876.
[576] Mullan, F. "A House Officer Looks at Medical Student Activism." American Journal of Psychiatry 126(1970):134-136.
[577] Reiser, SJ. "The Ethics of Learning and Teaching Medicine." Academic Medicine 67(1994):872-876.
[578] Shapiro, M. Getting Doctored Santa Cruz, CA: New Society Publishers, 1987:98.
[579] Holly, J. "Medical Student Abuse." Humanist 58(1998):3.
[580] Jones, TR. "Speak No Evil: Physician Silence in the Face of Professional Impropriety." Journal of the American Medical Association 276(1996):753-754.
[581] Dalfen, A. Letter. Canadian Medical Association Journal 160(1999):182-183.
[582] Fugh-Berman, A. "Singin' the Med School Blues." Off Our Backs 15(1985):10.