Medical Student Abuse: A Student's Perspective
Holly, Joyce, The Humanist
I was forty years old, the offspring of a family in which there had never been a physician, when I was offered admission to medical school. Since I was interested in making a career change, I accepted the admission offer eagerly. During the last few weeks of the summer before starting classes, I read several books about the medical school experience. They included tales of hardships suffered by M.D. students. After I graduated, I was asked by acquaintances whether medical school was as difficult as all that. I replied that what I experienced was as bad as any of the accounts I had read.
Some of the worst nightmares I had while in medical school concerned a twenty-five-year-old Chinese American classmate I will call Young Lee. I met Lee in 1993 at the outset of two years of M.D. study, which I undertook at an institution I will call Infirmity State University.
Lee couldn't always be counted on to act as a reliable member of a team. Although holding his own academically, he soon was at odds with other students, myself included, because of his eccentric talk and behavior, including occasional outbursts of profanity. However, he was never overtly threatening to anyone. I thought his problem was merely immaturity. But the school administration decided otherwise when one day, unwitnessed by any third party, he an another classmate got into a heated verbal altercation. Apparently there were some in the class who felt that Lee had made a pest of himself long enough. The upshot was that the classmate called the police alleging that, in her presence, Lee had tried to commit suicide by jumping from the second-floor student lounge window.
Lee denied the accusation. I, myself, don't think it was credible on its face. The school authorities, however, siding with his accuser, offered Lee a choice of seeing a psychiatrist or being arrested. As soon as the hapless Lee submitted to the former, he was suspended, not on academic grounds--Lee was passing his subjects--but on the grounds of alleged mental instability.
The Catch-22 character of this incident left me shaken. Later, I obtained a pamphlet published by the American Medical Student Association entitled "Staying in Medical School: Understanding Your Student Rights." I learned that what had occurred was not so unusual. Pressuring a student to see a psychiatrist of the school's choosing as a condition of continuing M.D. study not only has been a time-honored tactic in medical education for winnowing a class but has been used with disproportionate frequency against students who belong to ethnic and racial minorities.
The Young Lee incident was the first hint I had of the extremes of student abuse in U.S. medical schools. Legislation exists in most states to limit abuse against doctors who serve as hospital residents, and while such legislation has not eliminated all abuses, it has addressed some of the worst mistreatment which was once a fact of daily life. But the problem of medical student abuse--the mistreatment of students working toward the M.D. degree--has not yet been addressed by comparable legislation. Since published documentation is limited to a few technical scholarly sources, the public is mostly unaware of medical student abuse. Like sexual assault, it is a secret topic, rarely publicized by its victims, with the result that its actual magnitude is hard to evaluate. Nevertheless, it takes a variety of forms, and no medical school is immune.
Why does abuse occur? According to my experience, medical school administrators and faculty members justify abusive practices by stating that they are merely challenging students appropriately to prepare them for the role they must play later as hospital residents--"happy slaves," as one hospital department chair once commented in sharing his conception of ideal residents. M.D. students, for their part, have invested so much financially, emotionally, and personally in medical school that they are loath to complain and risk dismissal. …