by Morley Evans
HAVE YOU EVER WONDERED WHY your doctor is an asshole, but you were afraid to say it out loud? Robert S. Mendelsohn, MD, explains.
Many thanks to June Gardner, a long-suffering hysterectomy victim in Australia (they gutted her like a trout), for bringing this nugget to my attention.
|Robert S. Mendelsohn, MD|
MEDICAL POLITICS, for example, is a cutthroat power game of the most primitive sort. I much prefer political politics, because there you have the art of the possible, which means you have to compromise. Medical politics is the art of sheer power. There is no compromise: you go right for the jugular vein before your own is torn out. There’s no room for compromise because churches never compromise on canon law. Instead of a relatively open process in which people with different interests get together to try to get the most out of the situation that they can, in medical politics there is a rigid authoritarian power structure which can be moved only through winner-take-all power plays. Historically, doctors who have dared to change things significantly have been ostracized and have had to sacrifice their careers in order to hold to their ideas. Few doctors are willing to do either.
Another reason why doctors are less prone to compromise is because doctors tend to restrict their friendships to other doctors. Close friendships between doctors and non-doctors are nowhere near as frequent as among other professions. Consequently, doctors rarely have to defend their opinions among people who don’t share their background and who might offer a different point of view. Doctors can develop their philosophy in relative privacy, foray at intervals into the public scene to promote these ideas, and then rapidly retreat to the security of other doctors who support the views of the in-group. This luxury is not available to others in influential positions in public life.
Of course, doctors do see their patients. But they don’t see them as people. The doctor-patient relationship is more like that between the master and the slave, since the doctor depends on the complete submission of the patient. In this kind of climate, ideas can hardly be interchanged with any hope of the doctor’s being affected. Professional detachment boils down to the doctor rendering the entire relationship devoid of human influences or values. Doctors rarely rub elbows with non-doctors in any other posture but the professional.
Furthermore, since the doctor’s ambitions project him into the upper classes, that’s where his sympathies lie. Doctors identify with the upper class and beyond, even. They view themselves as the true elite class in society. The doctor’s lifestyle and professional behavior encourage autocratic thinking, so his conservative politics and economics are predictable. Most doctors are white, male, and rich—hardly in a position to relate effectively with the poor, the non-white, and females. Even doctors who come from these groups rarely return to serve and “be with” them. They, too, become white, male, and rich for all practical purposes and treat their fellows with all the paternalistic contempt other doctors do.
When asked where doctors learn these bad habits, I used to reply that doctors learned them in medical school. Now I realize they learn them much earlier than that. By the time they get to premedical training, they’ve picked up the cheating, the competition, the vying for position — all the tricks they know they need if they want to get into medical school. After all, our university system is modeled after the medical schools, and our high schools are modeled after our universities.
The admissions tests and policies of medical schools virtually guarantee that the students who get in will make poor doctors. The quantitative tests, the Medical College Admission Test, and the reliance on grade point averages funnel through a certain type of personality who is unable and unwilling to communicate with people. Those who are chosen are the ones most subject to the authoritarian influences of the priests of Modern Medicine. They have the compulsion to succeed, but not the will or the integrity to rebel. The hierarchy in control wants students who will go through school passively and ask only those questions the professors can answer comfortably. That usually means they want only one question at a time. One of the things I advise my students to do in order to survive medical school is to ask one question but never ask two.
Medical school does its best to turn smart students stupid, honest students corrupt, and healthy students sick. It isn’t very hard to turn a smart student into a stupid one. First of all, the admissions people make sure the professors will get weak-willed, authority-abiding students to work on. Then they give them a curriculum that is absolutely meaningless as far as healing or health are concerned. The best medical educators themselves say that the half-life of medical education is four years. In four years half of what a medical student has learned is wrong. Within four years of that, half again is wrong, and so on. The only problem is that the students aren’t told which half is wrong! They’re forced to learn it all. Supervision can be very close. There is no school in the country where the student-teacher ratio is as low as it is in medical school. During the last couple of years of medical school, you frequently find classes of only two or three students to one doctor. That doctor has tremendous influence over those students, through both his proximity and his life-and-death power over their careers.
Medical students are further softened up by being maliciously fatigued. The way to weaken a person’s will in order to mold him to suit your purposes is to make him work hard, especially at night, and never give him a chance to recover. You teach the rat to race. The result is a person too weak to resist the most debilitating instrument medical school uses on its students: fear.
If I had to characterize doctors, I would say their major psychological attribute is fear. They have a drive to achieve security-plus that’s never satisfied because of all the fear that’s drummed into them in medical school: fear of failure, fear of missing a diagnosis, fear of malpractice, fear of remarks by their peers, fear that they’ll have to find honest work. There was a movie some time ago that opened with a marathon dance contest. After a certain length of time all the contestants were eliminated except one. Everybody had to fail except the winner. That’s what medical school has become. Since everybody can’t win, everybody suffers from a loss of self-esteem. Everybody comes out of medical school feeling bad.
Doctors are given one reward for swallowing the fear pill so willingly and for sacrificing the healing instincts and human emotions that might help their practice: arrogance. To hide their fear, they’re taught to adopt the authoritarian attitude and demeanor of their professors. With all this pushing at one end and pulling at the other, it’s no wonder that doctors are the major sources of illness in our society. The process that begins with cheating on a biology exam by moving the microscope slide so that the next student views the wrong specimen, that continues with dropping sugar into a urine sample to change the results for those who follow, with hiring others to write papers and take exams, and with “dry labbing” experiments by fabricating results, ends with falsifying research reports in order to get a drug approved. What begins with fear and fatigue over exams and grades ends with a drug or alcohol problem. And what begins with arrogance towards others ends up as a doctor prescribing deadly procedures with little regard for the life and health of the patient.
Dr Robert Mendelsohn