Medical Training

Medical training regularly reinforces emotional detachment as faculty and students implicitly or explicitly ridicule those who display emotions and question their ability to serve as doctors. During daily rounds of the wards, faculty members grill residents on highly technical details of patients’ diagno- ses and treatments. Except in family practice residencies, however, faculty mem- bers rarely ask about even the most obviously consequential psychosocial factors. Rounds and other case presentations also teach residents to describe patients in depersonalized language. Residents learn to describe individuals as “the patient,” “the ulcer,” or “the appendectomy” rather than by name, thus separating the body from the person. The use of medical slang, meanwhile, which peaks during the highly stressful residency years, allows students and residents to turn their anxieties and unacceptable emotions into humor by using terms such as gomers for elderly demented patients and not citizens for unruly drug addicts. Such terms help doctors vent frustrations regarding the difficulties they face and maintain needed emotional distance but also reinforce disparaging attitudes toward patients. So, too, does language like “The patient denies nausea” instead of “Mrs. Clark reports that she does not have nausea.”

The structure of the residency years largely prevents residents from emo- tionally investing in patients. Long hours without sleep often make it impossible for residents to provide much beyond the minimum physical care necessary. When combined with the norm of emotional detachment, such long hours can even encourage doctors to view their patients as foes. As T. M. Luhrmann wrote in his memoir of medical residency: