Date of Award

January 2017

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

John Warner

Second Advisor

Naomi Rogers

Abstract

In the 33 years since Libby Zion’s death in 1984, the medical profession has proved strongly resistant to shortening residency work hours. Why has this mindset persisted in the medical profession, despite public opinion skewing strongly in the opposite direction? What are the justifications used by the physician community to rationalize training residents this way, and what might be the broader implications of such a stance? In this thesis, I examine the above questions via a qualitative analysis of language used in the residency work hour debate in major medical journals, newspapers, and social media.

I describe what I term “American medical fundamentalism”: a belief system promoted by the medical profession, with “patient care above all else” as its central tenet and self-sacrifice as a means of achieving that goal. I assert that this latter concept is tied deeply to the identity of the medical profession, and that opposition to residency duty hour regulation is an external manifestation of a deeper existential crisis among physicians, as they confront a shifting landscape that threatens their previously elevated professional position and authority.

I also note that the language used to describe professionalism in medicine draws from traditionally “masculine” values, and that the arguments against stronger residency work hour restrictions uncomfortably parallel those used in the mid-twentieth century to advocate against training women physicians. Finally, in the context of growing awareness of an epidemic of burnout in the medical profession, I suggest that equating self-sacrifice with compassion and competence is not only inaccurate, but also dangerous, and necessitates a reexamination of the values underlying the medical profession’s conception of what it means to be a “good doctor.”

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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