The Harvard Way

S. Walker

JAMA 1985 Oct 11;254(14):1903-5.

 There are times, every day, I need to swallow the urge to cry. And I need to keep telling myself that I'll be a good doctor. Maybe it's just a product of the place where I was raised. People there were unassuming, and usually kind at first meeting. Here there is no "Nice to meet you," there isn't even a chance to make a mistake. They assume you already have.

They have a way of making you feel worthless. Where they're coming from, or why they feel so superior, I don't know, but I think it's ironic. We work like slaves, get very little sleep, and have no formal didactic teaching on which to base our knowledge of the vast field of surgery. And if we don't perform well on standardized tests – there's no explaining - there's no help – there can be no suggestions. We just get degrading letters in our mailboxes about how poorly we have performed, encouraging us to get into a study program. Excuse me, but I thought that was supposed to be part of the residency!

This is supposed to be the Mecca of medicine – and probably the country’s most renowned medical city. You’d think they'd be proud to share their knowledge; after all, it's a "teaching institution." Well, they've taught me to feel afraid, worthless, ashamed, and often that I don't "deserve" to be a doctor. Physicians don't have the respect they once had. It's our own fault; we have demonized ourselves.

In two months I'll pack up and go home – by my own choice. I know that I am a good, caring doctor. But my self-worth and sense of competency have had to come from within. They've done everything they can to tear it down. This experience did not build character, strength, or "make a man" out of me. I am not and never will be one of the "good old boys." It has only given me many months of disappointment and sorrow. It is sad that people so bright and so famous have lost the ability to do a simple thing – to treat all people as equals. Someday we may all be in a situation where we can't handle the rejection anymore.

JAMA Editors' Comments:

"This personal view generated a good many letters to JAMA. Some agreed with the author’s assessment of the often arduous training of surgeons at Harvard, and others, particularly faculty at Harvard Medical School, protested the singling out of their institution. The editors of JAMA stated that in publishing this article, "The Journal allows its readers to reach their own conclusions concerning the motives, balance, and accuracy of the piece."

The Steeper Obstacles Faced by Women in Medicine

by Dhruv Khullar

Happy medical residents are all alike. Every unhappy resident would take a long time to count.

A new study in JAMA Internal Medicine suggests yes.* Dr. Constance Guille and colleagues analyzed the mental health of more than 3,100 newly minted doctors at 44 hospitals across the country. Before starting residency, men and women had similar levels of depressive symptoms. After six months on the job, both genders experienced a sharp rise in depression scores — but the effect was much more pronounced for women. A major reason: work-family conflict, which accounted for more than a third of the disparity.

The structure of medical training has changed little since the 1960s, when almost all residents were men with few household duties. 

This article is worth reading by all trainees, prospective physicians, and practicing doctors.

Someday, this may be the reality

 *  Work-Family Conflict and the Sex Difference in Depression Among Training Physicians. Constance Guille, etl a.  JAMA Intern Med. 2017;177(12):1766-1772. doi:10.1001/jamainternmed.2017.5138  

Conclusions and Relevance:  This study demonstrates that depressive symptoms increase substantially during the internship year for men and women, but that this increase is greater for women. The study also identifies work-family conflict as an important potentially modifiable factor that is associated with elevated depressive symptoms in training physicians. Systemic modifications to alleviate conflict between work and family life may improve physician mental health and reduce the disproportionate depression disease burden for female physicians. Given that depression among physicians is associated with poor patient care and career attrition, efforts to alleviate depression among physicians has the potential to reduce the negative consequences associated with this disease.