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Show narcotics. He can accept jobs that require him to function entirely on his own, with no backup or supervision, as a physician. He is, finally, truly a doctor. The Impact of Medical Training During the entire process of training, from childhood education through residency, powerful forces are at work shaping attitudes and beliefs. Most of those choosing medicine cited interaction with their own physicians as a strong force pushing them toward medicine. This was generally because they saw their doctor as a good role model, feeling both the compassion exhibited and the respect garnered. A few cited the opposite, saying that their doctor had been unpleasant to deal with, and that they wanted to become a doctor "to do it right." Media images of physicians were frequently cited. Dr. Welby and Hawkeye of MASH were the two most frequently mentioned figures. Parental pressure was common, especially if others in the family were physicians. Many parents think it would be wonderful to have a doctor in the family, both for medical and social reasons. In college, stereotypes of pre-medical behavior provide powerful images. Pre-medical students are perceived as caring only about grades, not about learning. They are known to seek out easy courses to make easy A's, without trying to form a coherent course pattern to actually learn anything about the field. Many pre-meds major in biology, believing that this choice is favored by medical schools. Biology 101 thus frequently becomes the course to weed out pre-medical students and thin the field. Cheating and sabotage of other pre-med students experiments are common experiences during this time. Many of the prospective medical students are disgusted by this process, and elect to further their education in other fields rather than continue to associate themselves with the pre-medicine group. Based on counselor assessment or self-belief that their grades or MCAT scores are too low to gain admittance, Another group of prospective applicants turns away prior to actually applying for medical school. However, those who overcome their counselor's criticism and apply anyway often find themselves accepted despite their "low" numbers. Medical school is often perceived as an abusive institution, offering little support to the students, and requiring illogical adherence to rules, and teaching methods that offer little in the way of support or training in the provision of compassionate care. "First, do we teach how to satisfy the fundamental questions every patient who is ill and anxious brings to the physician? The patient wants to know: What's wrong? How did he get that way? Is it serious? Can you cure it? What will it cost in money and loss of dignity? What are you going to do? Will it hurt? These are simple questions. Yet, but to an alarming degree, patients may see many doctors, have multiple tests, pay numerous bills, and still not receive answers to these simple questions. Current curricula, testing methods, and the trial-by-ordeal proclivities of some faculty are perceived by many students as dehumanizing to a degree that erodes their own capacities for more humane relationships with patients" (Page, 1992d). McKegney (1989) conceptualizes medical education as a family system, and finds much to compare to an abusive family. "... [R]esidency training ... is certainly painful, resulting from neglect of physical and emotional needs. The basic human needs to eat and sleep seem somehow shameful, disruptions of the work of saving lives. To the rest of the world, this sounds outrageous, but the members of this family actually consider it a matter of some pride... Complaining about call schedules is acceptable, but admitting to feelings of pain, uncertainly, abandonment, and depression, even to themselves, seems intensely disloyal and threatens their sense 94 PHYSICIAN SOCIALIZATION |
