Few outsiders realize that student illness is frequently, and ironically, a by-product of medical training. This unique study by a medical doctor and trained anthropologist debunks popular myths of expertise and authority which surround the medical establishment and asks provoking questions about the acquisition and dissemination of knowledge within the field. In detailing all levels of basic training in a London medical school, the author describes students' 'official' activities (that is, what they need to do to qualify) as well as their 'unofficial' ones (such as their social life in the bar). This insider's exposé should prompt a serious reconsideration of abuses in a profession which has a critical influence over untold lives. In particular, it suggests that the structures and discourses of power need to be re-examined in order to provide satisfactory answers to sensitive questions relating to gender and race, the dialogue between doctor and patient and the mental stability of students under severe stress.

Recent surveys of medical students reveal stark conditions: more than a quarter have experienced episodes of depression during their medical school and residency careers, a figure much higher than that of the general population. Compounded by long hours of intellectually challenging, physically taxing, and emotionally exhausting work, medical school has been called one of the most harrowing experiences a student can encounter. Plumbing the diaries, memoirs, and blogs of physicians-in-training, Suzanne Poirier's Doctors in the Making illuminates not just the process by which students become doctors but also the physical, emotional, and spiritual consequences of the process. Through close readings of these accounts, Poirier draws attention to the complex nature of power in medicine, the rewards and hazards of professional and interpersonal relationships in all aspects of physicians' lives, and the benefits to and threats from the vulnerability that medical students and residents experience. Although most students emerge from medical education as well-trained, well-prepared professionals, few of them will claim that they survived the process unscathed. The authors of these accounts document--for better or for worse--the ways in which they have been changed. Based on their stories, Poirier recommends that medical education should make room for the central importance of personal relationships, the profound sense of isolation and powerlessness that can threaten the wellbeing of patients and physicians alike, and the physical and moral vulnerability that are part of every physician's life.

The United States does not have enough doctors. Every year since the 1950s, internationally trained and osteopathic medical graduates have been needed to fill residency positions because there are too few American-trained MDs. However, these international and osteopathic graduates have to significantly outperform their American MD counterparts to have the same likelihood of getting a residency position. And when they do, they often end up in lower-prestige training programs, while American-trained MDs tend to occupy elite training positions. Some programs are even fully segregated, accepting exclusively U.S. medical graduates or non-U.S. medical graduates, depending on the program’s prestige. How do international and osteopathic medical graduates end up so marginalized, and what allows U.S.-trained MDs to remain elite? Doctors’ Orders offers a groundbreaking examination of the construction and consequences of status distinctions between physicians before, during, and after residency training. Tania M. Jenkins spent years observing and interviewing American, international, and osteopathic medical residents in two hospitals to reveal the unspoken mechanisms that are taken for granted and that lead to hierarchies among supposed equals. She finds that the United States does not need formal policies to prioritize American-trained MDs. By relying on a system of informal beliefs and practices that equate status with merit and eclipse structural disadvantages, the profession convinces international and osteopathic graduates to participate in a system that subordinates them to American-trained MDs. Offering a rare ethnographic look at the inner workings of an elite profession, Doctors’ Orders sheds new light on the formation of informal status hierarchies and their significance for both doctors and patients.

In the late nineteenth century, medical educators intent on transforming American physicians into scientifically trained, elite professionals recognized the value of medical school design for their reform efforts. Between 1893 and 1940, nearly every medical college in the country rebuilt or substantially renovated its facility. In Building Schools, Making Doctors, Katherine Carroll reveals how the schools constructed during this fifty-year period did more than passively house a remodeled system of medical training; they actively participated in defining and promoting an innovative pedagogy, modern science, and the new physician. Interdisciplinary and wide ranging, her study moves architecture from the periphery of medical education to the center, uncovering a network of medical educators, architects, and philanthropists who believed that the educational environment itself shaped how students learned and the type of physicians they became. Carroll offers the first comprehensive study of the science and pedagogy formulated by the buildings, the influence of the schools’ donors and architects, the impact of the structures on the urban landscape and the local community, and the facilities’ privileging of white men within the medical profession during this formative period for physicians and medical schools.

“A fascinating journey into the heart and mind of a physician” that explores the doctor-patient relationship, the flaws in our health care system, and how doctors’ emotions impact medical care (Boston Globe) While much has been written about the minds and methods of the medical professionals who save our lives, precious little has been said about their emotions. Physicians are assumed to be objective, rational beings, easily able to detach as they guide patients and families through some of life’s most challenging moments. But understanding doctors’ emotional responses to the life-and-death dramas of everyday practice can make all the difference on giving and getting the best medical care. Digging deep into the lives of doctors, Dr. Danielle Ofri examines the daunting range of emotions—shame, anger, empathy, frustration, hope, pride, occasionally despair, and sometimes even love—that permeate the contemporary doctor-patient connection. Drawing on scientific studies, including some surprising research, Dr. Ofri offers up an unflinching look at the impact of emotions on health care. Dr. Ofri takes us into the swirling heart of patient care, telling stories of caregivers caught up and occasionally torn down by the whirlwind life of doctoring. She admits to the humiliation of an error that nearly killed one of her patients. She mourns when a beloved patient is denied a heart transplant. She tells the riveting stories of an intern traumatized when she is forced to let a newborn die in her arms, and of a doctor whose daily glass of wine to handle the frustrations of the ER escalates into a destructive addiction. Ofri also reveals that doctors cope through gallows humor, find hope in impossible situations, and surrender to ecstatic happiness when they triumph over illness.

On average, a physician will interrupt a patient describing her symptoms within eighteen seconds. In that short time, many doctors decide on the likely diagnosis and best treatment. Often, decisions made this way are correct, but at crucial moments they can also be wrong—with catastrophic consequences. In this myth-shattering book, Jerome Groopman pinpoints the forces and thought processes behind the decisions doctors make. Groopman explores why doctors err and shows when and how they can—with our help—avoid snap judgments, embrace uncertainty, communicate effectively, and deploy other skills that can profoundly impact our health. This book is the first to describe in detail the warning signs of erroneous medical thinking and reveal how new technologies may actually hinder accurate diagnoses. How Doctors Think offers direct, intelligent questions patients can ask their doctors to help them get back on track. Groopman draws on a wealth of research, extensive interviews with some of the country’s best doctors, and his own experiences as a doctor and as a patient. He has learned many of the lessons in this book the hard way, from his own mistakes and from errors his doctors made in treating his own debilitating medical problems. How Doctors Think reveals a profound new view of twenty-first-century medical practice, giving doctors and patients the vital information they need to make better judgments together.

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