Appendix 74a - Getting Away With Murder

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]

Only a god or a devil can write in another person's blood and not ask why they spilt it or what it cost - Edward Bond

The book Residents: The Perils and Promise of Educating Young Doctors describes modern residency's greatest myth: " - that their method of training is hallowed, their self-sacrifice always justified, and whatever suffering is inflicted on patients is either unavoidable, or inherent to learning medicine."[895] The New Physician: "The medical education system encourages people to hide what they don't know... and this leads to the unhappy situation where neophytes proceed without asking. It burdens the youth with enormous guilt by accepting harming patients as an intrinsic part of medical education."[896]

One Connecticut pediatrician recounted a grim joke, "Resident surgeons maim in July and August - when the interns are novices with careful supervision - but they kill in September and October, when they have more self-confidence and less oversight."[897] Bergman, in his sequel to The House of God wrote, "Friends, you enter an academic hospital early in July at no small peril to your life."[898]

Stressed to Kill

Bertrand Bell: "Today most patients in teaching hospitals are paying customers.... [We are] treating paying customers like they're indigents who supposedly won't care if you let loose undersupervised, inexperienced doctors to work on them."[899] Of the 114 residents that returned a JAMA survey in which they described their most significant mistake, 90% reported that patients had significant adverse outcomes as a result. Job overload was found to play a part in 65% of mistakes. Almost a third of the residents reported that their mistakes led to a patient's death.[900]

Until a physician has killed one or two he is not a physician - Kashmiri Proverb

An article called "Managing Medical Mistakes" published in Social Science and Medicine explored this phenomenon:

Half... of the new interns interviewed in the first two months had been involved in serious patient errors, many of which caused complications or death.... By the time they finish their residency, those [house officers] who perceived themselves as not having killed a patient regarded themselves as lucky....

While the doctors-in-training may feel guilt and remorse over the mistakes they made, they have developed elaborate mechanisms of distancing and denial, which, while not completely successful psychologically, are artifacts of a highly insular and self-protective subculture....[901]

As reported in International Journal of Health Services, a doctor remarked in a presentation to clinical medical students, "If you communicate well and are empathetic and sympathetic you can literally get away with murder." According to the article, the audience had little doubt that this was an overt reference to avoiding the personal impact of negligent practice by carefully managing interactions with patients.[903]

"Doctors learn to keep other doctor's mistakes secret from almost the first day they arrive at medical school."[902] See Appendix 74b.



[895] Duncan, DE. Residents: The Perils and Promise of Educating Young Doctors. New York, NY: Scribner, 1996:61.

[896] Durso, C. "The Examined Residency." New Physician 1998(December):8.

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

[898] Shem, S. Mount Misery New York : Ivy Books, Jan. 1998:501.

[899] Duncan, DE. Residents: The Perils and Promise of Educating Young Doctors. New York, NY: Scribner, 1996:44.

[900] Wu, AW, et al. "Do House Officers Learn from Their Mistakes?" Journal of the American Medical Association 265(1991):2089-2094.

[901] Mizrahi, T. "Managing Medical Mistakes." Social Science and Medicine 19(1984):135-146.

[902] The editor of the Lancet in Holton, R. "How Doctors Have Betrayed Us All." The Independent 14 June 1998:1,2.

[903] Annandale, E. "Professional Defenses." International Journal of Health Services 26(1996):751-775.



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