Appendix 29 - Macho Men

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]

From an article in Academic Medicine:

Medical students and residents often recount their times without sleep almost as badges of honor, tangible symbols of their dedication to the profession, and testimony to all that their sacrifice justifies the status of their profession. Although loss of sleep directly deprives the self, it tends to cast the day-to-day routines of patient care in the light of a higher calling.[345]

New York Times Magazine: "Since most of them [third year students] wanted to prove their dedication, no one would suggest taking a break for a luxury like lunch."[346] Medical students, too busy and too interested in flourishing within the system, "take pride in their own stamina without often questioning the ultimate need for it," according to an article in Pharos.[347]

Taking breaks, one third year student wrote, "is practically a cardinal sin in medicine, where your worth is measured by the size of the bags under your eyes, the varicose veins on your legs, and the number of meals you can miss in a row."[348] The unspoken message being "suck it up, get with the program, tough it out." Students thus become wary of expressing any need or question that might be construed as weak. This may be what changes many students from, "being open and caring to being guarded, even bitter," notes an Academic Medicine article.[349] "By framing medicine as a macho, military struggle," one doctor writes, "we have minimized the nurturing, compassionate, caring skills traditionally performed by women.[350]

From an article in the Humanist:

If patients were devoid of human needs, so too were physicians and those of us who wanted to become one. At a seminar, one woman in medicine, a physician heavily involved in medical student teaching, told us that when she was a resident and had been unable to find a baby-sitter, she had locked her children in the car in the parking lot of the inner city hospital where she worked and had checked on them from time to time during her shift - a statement made not in the spirit of a confession but in advancing herself as a role model of appropriate self-sacrifice.[351]

As reported in Strangers at the Bedside:

In an address to colleagues, the president of the American College of Cardiology declared that 'television, vacations, country clubs, automobiles, household gadgets, travel, movies, races, cards, house hunting, fishing, swimming, concerts, politics, civil committees, and night clubs' all are distractions... [that] leave little time for medicine.... To the master cardiologists, the study of cardiology is the only pleasure.' That his statement was not ironic or idiosyncratic is evident in the values that medical house staff everywhere are expected to adopt.[352]


[335] Stitham S. "A Piece of My Mind. Educational Malpractice." JAMA 266(1991):905-906.

[336] Holly, J. "Medical Student Abuse." Humanist 58(1998):3.

[337] McCall, TB. "The Impact of Long Working Hours on Resident Physicians." New England Journal of Medicine 318(1988):775-778.

[338] Francis, T. "Is This Any Way to Train a Doctor?" Diss. Columbia University School of Journalism, 1997.

[339] Green, MJ. "What (If Anything) is Wrong with Residency Overwork?" Annals of Internal Medicine 123(1995):512-517.

[340] Osborne, D. "My Wife, the Doctor." Mother Jones 1983(January):21-25, 42-44.

[341] Bell, BM. Letter. New York Times late ed., 9 June 1993:A20.

[342] Duncan, DE. Residents. New York, NY: Scribner, 1996:117.

[343] Zachary, M. "Sleepy, Dopey and Doc." Jacksonville Medicine 1997(October).

[344] Wiebe, C and R Schapiro. "The Fire This Time." New Physician 1987(September):19-26.

[345] Daugherty, SR and DC Baldwin. "Sleep Deprivation in Senior Medical Students and First-year Residents." Academic Medicine 71(1996):S93-S95.

[346] New York Times Magazine 1982(May):55.

[347] Reidbord, SP. "Psychological Perspectives on Iatrogenic Physician Impairment." The Pharos 1983(Summer):2-8.

[348] Fugh-Berman, A. "Med School Blues: Year Three." Off Our Backs 17(1987):15.

[349] Hundert, EM. "Characteristics of the Informal Curriculum and Trainees' Ethical Choices." Academic Medicine 71(1996):624-640.

[350] Weeks, JA. The Artful Science of Medicine White Knight Publishing.

[351] Bonsteel, A. "Behind the White Coat." Humanist 57(1997):15.

[352] Rothman, DJ. Strangers at the Bedside A History of How Law & Bioethics Transformed Medical Decision-Making New York: Basic Books, 1992:137.

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