Adversities Facing Medical Students, Residents and Physicians
According to Watson:" In the popular imagination, medical residency is less a
training program than a rite of passage. Those who successfully navigate this
process are crowned physicians, with the ability to make life-and-death
decisions. Those who don't succumb to the culling process that punishes and
rejects student and physicians with problems. The system, the theory goes, is a merciless but impartial
judge. Recently, stories have come to light that challenge this egalitarian
notion. Some residents claim that they have been forced out of programs, not
because of any deficiencies in their abilities or knowledge base, but rather
because they experienced serious physical illnesses that required accommodation.
Collectively, their stories paint a picture of an educational system that at
best has serious flaws, and at worst is punitive and discriminatory."
The biggest hurdle to much needed reform is the difficulty and reluctance to
overcoming a culture in which higher learning can take a back seat to
conformity. According to Pamela Wible, MD, founder of the Ideal Medical Care
Movement and author of the book Physician Suicide Letters—Answered, many
residency programs thrive on a culture of fear, which in turn creates conditions
in which mistreatment goes unpunished. "When a colleague is being publicly
mistreated, the other six residents are often witnessing it," she said. "This
creates fear. You don't want to be the next one to be mistreated."
Self-preservation can lead to complicity with these human-rights violations, Dr
Wible explains. For those seeking to reform a century-old system, discussion of
fairness will accomplish little. The system, they claim, is entrenched; those
who have successfully gotten through it themselves are not inclined to change
it The opinion of many practicing physicians is, "we had to do it, so you
have to do it too". Furthermore, pressure on trainees from physicians in charge
of residency programs can create a culture that frays what should be a natural
bond among residents who are going through something together. Those being
trained in the care of patients at their most vulnerable might be conditioned
against empathy toward their peers.
Medical Students Use Drugs
Dr George Lundberg expressed dismay over Pam Wible's report that 75% of
American medical students and residents are taking stimulants, antidepressants,
or other psychiatric medications. He wrote” One of the earliest and most
powerful lessons that med students have learned is how to study hard to get good
grades. The stakes are high. Many believe that success towards achieving this
goal is improved by the use of cognition performance-enhancing drugs (cPEDs),
usually amphetamines. Does this reflect a high degree of mental illness
requiring drug therapy in a majority of our upcoming physicians? Or has that
level of society's culture simply acknowledged better living through chemistry?
If the latter, state licensing agencies, hospital staff organizations, and
health insurance plans have not caught up with it. Students fail to report
using antidepressants, stimulants, anxiolytics, and mental health care, a denial
that has become the norm for docs.”
My concern for the well-being of students and professionals is enormous. Many, if not most, humans alter their consciousness and behavior by
deliberately consuming chemicals to alter they way their brain works. The
general principal is that materials that enter human noses and mouths play a
role in determining the nature and operation of their mind. We could think of
this as the local molecular flow through the brain that alters, expands or
contracts the contents of the mind. The brain, as the organ of mind, is the receiving set for the wisdom of the
universe. If the receiver is out of tune, not working properly, the wisdom of
the universe is either not received at all or the message is garbled.
Drugs bought on the street and in pharmacies that target the brain are used
excessively and inappropriately adding to increasing numbers of disturbed
and dysfunctional people. Because some brain dysfunction compromises judgment,
learning and motivation, family members, friends and professional advisors often
have to initiate drug withdrawal and provide the right direction and support.
Hospital Residents
A prominent issue for residents is the demands on their time and sanity
imposed by hospital administrations. Attempts to institute 16-hour-a-day
limits have been met with stark resistance from the medical community and
academic hospitals. In addition to entrenched cultural issues, there can be a
monetary incentive to maximize resident labor. Critics say this combination
results in famously demanding work weeks, which can be 120 hours and can, in
turn, leave residents with medical conditions open to disapproval. "Whether it's
because they're still in training or because they really do need this almost
slave-like production, there's an intolerance to residents having any sort of
lack of efficiency or production. If they can't keep up, then they stand out
from their peers as being unwilling to carry the load, but the inhumane system
is not addressed.
Sexual Harassment
Among the many experiences that make the medical workplace environment hostile to students and
medical personnel is sexual harassment. Women or more vulnerable than men. Seventy one percent
of female physicians and 25% of male physicians report having been sexually
harassed in training or medical practice in a recent poll. Sexual harassment
takes many forms: sexist comments or behavior; unwanted sexual advances, which
may be coercive; sexual threats; and bribery to engage in sexual behavior.
Perpetrators can be patients as well as fellow physicians. Medical students
encounter sexual harassment as often ;as physicians. 54% of medical students —
including 72% of women and 19% of men — said they had experienced a wayward hand
or remark. One in four of this group said these episodes affected their career
advancement. Women in medical practice have more ability to handle sexual
harassment than medical students and residents, who may not be able to find a
new school or training program to continue their education. The problem of
sexual harassment persists despite years of attempting to combat it through
institutional policies and education. (Robert Lowes. Most Female Physicians
Report Sexual Harassment at Job. Medscape August 24, 2016 )
An Impossible Job?
The medical Literature in the USA has focused on medical "burnout" and
expressed concerns about physician leaving medicine prematurely. Well- concealed
causes of the problems physicians face is the nature of medical practice itself-
uncertainties, information overload, overbearing administrations, patients
expectation and the nature of disease, an ever changing realm of complex, poorly
understood phenomena. Medical diagnosis is a difficult task that combines
intellectual and intuitive skills. Well-defined entities with structural changes
in tissues are the easiest to diagnose. Most medical technology addresses these
needs. The specification of coronary artery disease, for example, can be precise
and is a tribute to the combined effort of physicians, technicians, engineers
and equipment manufacturers to fully reveal a disease process. The precision of
these well-defined areas of medical concern may mislead the unwary into thinking
that all areas of medicine are equally well defined or can be well defined with
just a little more effort; however, most disease processes remain obscure and
are genuinely difficult to characterize and understand.
Common syndromes are diagnosed on clinical grounds often
with no objective evidence whatsoever. While the history of migraine headaches
is distinctive and an astute clinician can make the diagnosis on history, the
emergency room physician will have trouble deciding whether a patient with a
migraine story is really suffering pain or simply wants a narcotic drug. The
diagnosis of depression is another subjective syndrome that requires a
historical understanding more than positive lab tests. The irritable bowel
syndrome is also diagnosis of exclusion. The patient may suffer a great deal but
tests are repeatedly negative. The list of ill-defined syndromes is long. A
shift from category diagnosis to understanding the process of disease is helpful
to understand the patient but is often not acceptable to agencies that pay the
bills. The insistence for a disease category works against progress in
understanding disease, simply because everyone wants to know what this is called
and not where it came from and how to prevent it from happening.
Medical Costs
America spent an estimated $9,451 per person on healthcare ( i.e. medical
care) in 2015, by far the most of any country. However, among wealthy,
industrialized nations, the U.S. has the largest share of residents not getting
the medical care they need due to financial costs. Among the 35 member nations
of the Organization for Economic Co-operation and Development, America is the
only country without universal health coverage. This inconsistent coverage and
care can create large disparities in health outcomes between populations. For
the first time in decades, life expectancy in the United States fell in 2015.
With a life expectancy at birth of 78.8 years, the U.S. ranks 28th among OECD
countries. In addition, the U.S. is expected to fall even further behind other
countries in the future. By 2030, life expectancy in the U.S. is expected to be
on par with the Czech Republic for men and Croatia and Mexico for women. Poor
life expectancy in the U.S. is partially caused by differences in quality of and
access to care, as well as a number of socioeconomic conditions that can affect
health outcomes. As a result, longevity varies significantly from state to
state. Hawaiians have the longest life expectancy, of 81.2 years. By contrast,
the life expectancy in Mississippi is only 74.8 years, the shortest of any
state.
(Steven Peters States With the Longest (and Shortest) LifeExpectancy
Wall St. February 25, 2017)
John Watson. Do Unto Others: Treating Physician Patients. www.medscape.com. October;26,2016.
