Appendix 75 - Anger

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]

From an article entitled "Subnormal Serum Testosterone Levels in Male Internal Medicine Residents":

[Researchers] unexpectantly observed a [highly] significant and marked depression of serum testosterone levels in healthy male internal medicine residents compared with other hospital personnel. Testosterone concentrations in these two groups were entirely nonoverlapping.... We conclude that the stress of residency leads to a quantifiable depression of gonadal function... [to a range which] may contribute to relative sexual inadequacy.[910]

Impotent Rage

From an article in a journal called Culture, Medicine and Psychiatry:

For the intern, reading a newspaper is an illicit luxury, and pursuing outside interests frustrating and futile. The language of house officers transforms the hospital and the doctor-patient relationship within it into a macabre world of human degradation and spiraling pain.

When evaluating a patient who is being admitted to the hospital, the intern learns to ask himself, 'How can this patient (or gomer or dirtball) hurt me?' [An intern writes in his diary] 'I don't want the asthmatic SOB to live if it means I don't sleep.' Sleep deprived and feeling trapped, [interns]... expressed their impotent rage in their language, their feelings, and their behaviors towards patients.[911]


In the spirit of informed consent a residency director at Harvard lists the risks of internship: "Acute and chronic delirium... depression... suicidal ideation... marital disaster... disillusionment..." and, "chronic rage and hatred. I know no real intern who has not on occasion been consumed with fire-breathing, retaliatory hatred for his or her patients."[912]

And for his or her students too. From the Journal of Medical Education, "The clerkship experiences for some medical students become the source of fear and frustration as they perceive themselves at the mercy of fatigued and angry house staff members."[913] Commentary surrounding the release of The House of God:

Ideally, the anger [expressed by residents against patients in the book] would have been directed at the true tormentors, such as the medical educators who glorified in and perpetuated the internship system and who showed, by their righteously horrified letters of condemnation to the editors of medical journals, how uncomfortable the book made them.[914]



[910] Singer, F and B Zumoff. "Subnormal Serum Testosterone Levels in Male Internal Medicine Residents." Steroids 57(1992):86-89.

[911] Groopman, LC. "Medical Internship as Moral Education." Culture, Medicine and Psychiatry 11(1987)207-227.

[912] Cassem, N. "Internship, Liberty, Death and Other Choices." Harvard Medical Alumni Bulletin:46.

[913] Weinstein, HM. "A Committee on Well-Being of Medical Students and House Staff." Journal of Medical Education 58(1983):373-381.

[914] Brody, H. The Healer's Power Danbury: Yale University, 1992.



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