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Inside Doctoring: Stages and Outcomes in the Professional Development of Physicians

By Robert H. Coombs; D. Scott May et al. | Go to book overview

The developmental personality changes which result from medical socialization, as now constituted, are not conducive to preparing the doctor emotionally so that he can meet the needs of dying patients and their families in the depersonalized hospital setting. Little recognition currently exists among medical educators that the doctor's role is more than that of gatekeeper of the nation's health--that, in fact, he also presides over the death scene. 24 If he is to fulfill the role which is increasingly expected of him, he must be better prepared to deal with the subjective features of this poignant experience.


NOTES
1.
For background information concerning the cultural roots of death orientations in American society, see Parsons and Lidz ( 1967).
2.
For a discussion of the competing demands inherent in the doctor's role, see Merton ( 1957), especially pp. 73-79.
3.
The topic of death and dying was but one of many covered during the interviews, which varied in length from 1.5 to 3 hours, depending on student loquatiousness. More than 200 items of information were included in the recorded questions and answers. Results of the larger study will soon be published in a book entitled Students into Doctors: Professional Socialization in Medical School (by R. H. Coombs , in preparation).
4.
Interviews were conducted on the West Coast before Dr. Powers accepted her present position. The 13 physicians interviewed ranged in age from 30 to 57, with a mean age of 41. Three were women, ten were men, and all but one, an anesthesiologist, were currently in psychiatric training or in the private practice of psychiatry. The physicians interviewed have a wide variety of experience. Eight were in general practice prior to beginning psychiatric training; among these the average length of general practice was 12 years, with a range of from 2 to 25 years. One physician interviewed had been an anesthesiologist for 7 years. Two physicans who took part in the study had been in the service after internship and prior to psychiatric training. The two physicians remaining had gone directly through psychiatric training. One of the physicians was a minister and one was a social worker prior to going to medical school. Ten of the 13 physicians interviewed went to medical school in the United States, and three were trained in foreign countries.
5.
A further discussion on the topic of the medical center as a social system is given by Bloom ( 1971).
6.
An earlier report about the coping mechanisms utilized by seasoned clinicians in stressful hospital situations is provided in Coombs and Goldman ( 1973). This research, part of the larger study of medical socialization, was based upon participant observation in an intensive care unit.
7.
Kasper ( 1959) first emphasized that medical students are desensitized not to death, but to the symbols of death.
8.
For further discussion on this and other aspects of the desensitizing experience, see Lief and Fox ( 1963) article.

-277-

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