Appendix 68a - Hamburger Machine

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]

A "house officer stress syndrome" has been described. It consists of, "episodic cognitive impairment, chronic anger, pervasive cynicism, family discord and depression."[807],[808]

Snarling Survivors

From The Intern Blues: The Private Ordeals of Three Young Doctors, one of the doctor's ordeals:

There are thousands of negative experiences... and you say 'What the fuck is this?' You wonder why you're subjecting yourself... to so much distastefulness and misery.... My internship was a draining dehumanizing, destructive experience. It's almost like we started out in July smelling of cologne and perfume, and dressed in freshly laundered formal evening clothes, well-mannered and even-tempered with warmth in our hearts and great expectations, but by the end of the year we had become tattered, unshaven, smelly, cynical, snarling survivors of a long and somewhat meaningless struggle with ourselves and the rest of the world.[809]

"To live by medicine is to live horribly" - Carolus Linnaeus.

The System Works

What does Norman Cousins have to say about internship? After two years of interviewing physicians and physicians-in-training he wrote an editorial in Journal of the American Medical Association. He referred to internship as a "human meat grinder." He asks, "Is the workload at times not so much a sampling of later challenges as it is an exercise in what I can describe only as disguised hazing at best and systemic desensitization at worst?"[810]

One purpose of any initiation rite - and medical school is in some ways one long initiation rite - is to separate one group from the rest, and bond its members through shared ordeals and secrets.... This system works too; God, how it works! Behold the medical profession, molded to perfection, brainwashed, narrowly programmed, right wing in politics, and fully dedicated to the pursuit of money.

"What's that hamburger machine that chops up nice kids and turns them into doctors I know?"[811]

One doctor writes, "It is difficult to equate the delightful, caring, and extremely gifted young people who one encounters on their entry to medical school with some of the horror stories... of disturbingly callous and rude behavior...."[812]

Steve Bergman, author of House of God:

I can almost tell a fourth year student from a beginning third-year just by looking at him. I can tell from the body language.... By the middle of [third]... year, these students who were open and eager and idealistic, they are closing down, and getting cynical, suspicious, tight, already kind of burned out.[813]

"In short, our transformation was part of a process of socialization," writes Martin Shapiro in Getting Doctored. "But this socialization transformed apparently nice people into Doctors who, frequently, were not nice at all."[814]

For more on the socialization process, Appendix 68b.



[807] Small GW. "House Officer Stress Syndrome.". Psychosomatics 22(1981):860-869.

[808] Landau, C., et al. Journal of Medical Education 61(1986):654.

[809] Marion, R. The Intern Blues New York: Fawcett Book Group, 1990:323.

[810] Cousins, N. "Internship." Journal of the American Medical Association 245(1981):377.

[811] LeBaron, C. Gentle Vengeance New york: Penguin, 1982:58.

[812] Weatherall, DJ. "The Inhumanity of Medicine" British Medical Journal 309(1994)527.

[813] Duncan, DE. Residents. New York, NY: Scribner, 1996:129.

[814] Shapiro, M. Getting Doctored Santa Cruz, CA: New Society Publishers, 1987:6.



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