Effects of Training

New physicians are fully trained, and the training experience changes them. At this point of examining anew their life direction, they profit by insight about the effects of training. I like to use a didactic method; give them a little “chalk talk”. Here is a sample message for this part of orientation: Our perspective of what is meaningful and significant is deformed by the pressures of culture. The medical training culture is very effective at changing our drive and direction. Dr. Rachael Remen refers to this as the “shadow” of medicine. The practice of medicine has its good side. Most of the practice of medicine is inherently good, but there is a shadow side as well. Dr. Remen noted that the “shadow” of medicine is what prevents you from standing up in grand rounds and saying that medicine is an expression of love for our patient. A freshman medical student might be foolish enough to say that, but our medical schools, our residency training, and our crisp, cool professionalism squeeze those thoughts out of the public forum, and ultimately out of the minds of practitioners. The shadow of medicine is very functional. It focuses on getting things done, but the shadow behaviors can be disturbing. They can be things like browbeating the staff, sounding off to patients, or throwing instruments in the operating room. Frankly, behaviors like that are unacceptable in our hospital. We have a Code of Conduct. Read it. Learn it. Don’t break it.