Appendix 51b - Ethical Erosion

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]

From Harper's Magazine:

'I was once on killer call,' a resident on the West Coast told me, 'and had to tell a man he had terminal cancer. I gave him maybe three minutes of my time, checked him off my list, and headed off to do something else.' A few moments later, when the resident realized what he had done, he ducked into a supply room so no one would see him sobbing. 'I'd become a monster,' he told me afterward, 'and I hate myself.'[583]

The test of every religious, political, or educational system, is the man which it forms. If a system injures the intelligence it is bad. If it injures the character it is vicious, if it injures the conscience it is criminal - Henri Frederic Amiel

Quoting from the American Journal of Medicine, "The medical students' life of long hours, sleep deprivation, excessive responsibility, and dealing with unreflective and arrogant superiors inhibits the growth of compassion and empathy."[584] Medical students are told to treat patients as persons deserving of compassion, care and respect, yet they find they have no time and energy to do so.[585]

In an article "Why does Moral Reasoning Plateau During Medical School?" the authors hypothesize that instead what the students learn is, "how to survive in a threatening environment, how to please authority figures to avoid punishment, and how to avoid humiliation and loss of face."[586] Quoting from Pharos, "The suppressed pain in medical training, then, and its devouring of time, both interfere with moral vision. Medical students must set aside their own humanity to learn the science and technology of medicine."[587]

An article from Mother Jones describes how medical students learn how to view human beings as boring:

This parallels the likely conclusions of the first overall review of medical schools' curriculum in 50 years. Steven Muller, president of Johns Hopkins University and Hospital and chairman of the committee handling the review, said... that the panel's experts are concerned that 'total immersion' might be 'dehumanizing' and may lead to a 'fascination with technology that makes the device more important than the patients.'[588]

From Medicine as a Human Experience:

I stick to my assertion that the education of many, perhaps most, medical students is seriously flawed, that too often we wind up as narrow and dehumanized as the system which has trained us.[589]

Medical students risk being replaced by TS Eliot's "Hollow men... Stuffed men, leaning together, headpiece filled with straw."[590]

From the landmark 60's sociological study of medical school, Boys in White, "As they proceed through medical school, their distinguishing traits become blurred, and a commonalty emerges." One student:

Medical school is comparable to an assembly line where distinguishing background traits are lopped off and different parts and materials are added to make a final product. The peculiar habits and practices of Freshmen are pretty well done away with, so that by the time they become seniors they have been molded into a sort of uniform image.

From Harper's Magazine: "Trainees are made of soft clay that may harden until they are time-efficient slaves rather than physicians whose caring and compassion makes helping others their only consideration...."[591] A recent article in the New Physician describes one such hardened resident, "[She] first realized that she was not the humanistic physician she had hoped to be during her internship year, when a close friend informed her that he no longer wanted her as his physician."[592]

Medical student testimonials from Boys in White:

'As med school wore on I began to see that becoming a doctor meant giving yourself over to the system, like a piece of wood on a chipping machine. At the end of the machine I would be smooth and probably salable, full of knowledge. But as the chips flew away, so would those 'nonproductive' personality traits - empathy, humanity, the instinct to care.'

'Going through medical school is like getting your hand caught in a meat grinder. It just keeps grinding and scooping up more of you as it goes. You gradually get bundled into a processed package and pop out as a doctor....' 'It's a matter of survival,' one said, 'If you don't conform, you're out.'[593]

Not Known for their Bleeding Hearts

From the Milbank Quarterly:

Taken together, these [sociological] accounts make a few points consistently: that a good part of medical training consists of teaching students and house staff to manage their emotions, to concentrate on technical matters, and to ignore the social and psychological aspects both of disease and the patient who suffers from the disease.[594]

From an article in the Journal of Health and Social Behavior:

When we move to the level of individual students, we find that suffering is the most pervasive attribute in most sociological studies of medical school, internship, and residency. Sociologists are not known for their bleeding hearts; yet one reads page after page about physicians in training who are exhausted, demoralized, assaulted, insulted, and, finally, skilled at 'working the system.'

Sociologists' reputation among medical educators of being critical actually may be based on sympathetic observations about those being trained, which those in charge do not want to hear.[595]

John Stuart Mill: "Has there been any domination which did not appear natural to those who possessed it?"



[583] Duncan, DE. "Is this Any Way to Train a Doctor." Harper's Magazine 1993(April):61-66.

[584] Stern, DT. "Practicing What We Preach?" American Journal of Medicine 104(1998):569-575.

[585] Kopelman, L. "Cynicism Among Medical Students." JAMA 250(1983):2006-2010.

[586] Morton KR, et al. Letter. Academic Medicine. 71(1996):5-6.

[587] The Pharos 44:30.

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

[589] Rosenberg, J. "Life on the Wards." Medicine as a Human Experience Ed., DE and DH Rosen. Baltimore: University Park Press, 1984:1-19.

[590] Nisker, JA. Canadian Medical Association Journal 156(1997):689-691.

[591] Duncan, DE. "Is this Any Way to Train a Doctor." Harper's Magazine 1993(April):61-66.

[592] James, D. "Deep Impact." New Physician 48(1999):16-25.

[593] Becker, HS Boys in White New Brunswick: Transaction Publishers, 1991.

[594] Zussman, R. "Life in the Hospital." Milbank Quarterly 71(1993):167.

[595] Light, DW. Journal of Health and Social Behavior 29(1988):307-322.



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