REFLECT

Model stories written by young professionals/students.

 

Our Moral Distress: Sacrificing Quality Today for a Better Tomorrow

 

We’ve all been there. Whether it is applying for your first job or your first job in a technical field, as you are perusing the job description, your heart sinks. The words “previous experience is required” shut yet another door. How in the world are we expected to get job experience if they don’t even let us trust us with the smallest of responsibilities to begin with? It’s a catch 22 and, as Becker et al. describe in Boys in White, medical students are no exception. Medical school puts them in a free market environment in which the commodity is experience. However, to obtain this valuable experience, certainly other personal values will be faced with conflict, hence presenting moral dilemmas.

First of all, one of the foremost tenants of practicing medicine is to provide treatment(s) to the best of your abilities. According to this tenant, medical students would never practice medicine again, since physicians (with their greater amount of experience) can typically provide better treatment. In this case, a conflict is seen between beneficence and experience as a student. In order for this student to one day practice beneficence as a physician, they must gain experience now. Despite this dilemma, we invest in the future of tomorrow by providing experiential opportunities for medical students.

Very much so related to this, we see the value of experience even placed in seeming opposition to the value of a human’s life.  If one were to reflect upon the mission of a physician, one would likely come to a conclusion related to that of the prevention and treatment of disease, or the health and wellbeing of patients. In this context, would it ever be appropriate for a physician to hope for illness and potentially fatal trauma to occur to their patients? Yet, medical students yearn for the opportunity to be on hand in just such cases.  As recorded in Boys in White, a medical student was running a typical examination and taking the patient’s history when the patient went into pulmonary edema. The student was able to recognize the symptoms and take appropriate action. This experience drew noticeable attention from staff members and “a good deal of envious eyeing of Green by other students, and the staff member and resident both looked at him as though he had had some kind of really great experience” (243).  In essence, he was said to be ‘lucky’. Lucky that he had been around a man who needed immediate, and severe, medical attention. Lucky that a man had almost died. As an individual, they know the value of a life. However, the supply for such experience is low, which increases the value of experience. This case of moral distress changes the individual. Any other non-medical student would find the idea of near-death trauma to be devastating and never wished upon an individual. Medical students plead for such cases.

In another example, health issues are trivialized as medical students make experience their core value.  A student was scheduled to scrub down an operation room in preparation for a nephrectomy. The other students congratulated him on his accomplishment of removing a kidney. That is, in removing it from the operation room in an aluminum plan. This surgery was likely a life preserving operation, yet since the student had only trivial responsibilities, the occasions became a moment of jeers and teasing. 

As a result, medical students often feel unprepared to become full-fledged physicians. Since experience is the main commodity, the driving force of the medical student economy, it is difficult to provide sufficiently for this demand. While students were studying for quizzes about traumatic injuries to the chest, the observer said, “I suppose you know what to do about all of those, too.” To which the reply came, “Sure, simple. Call a doctor” (Becker et al. 264). As a direct result of the need for more and more experience, students never feel experienced enough. They draw a line between themselves and the “real doctors.” This distinction shows a level of unpreparedness which is not to be desired. It implies that upon entering the work field as a physician (with full responsibility), they may still not feel properly experienced. The moral distress upon medical students initiates emotional removal from patient cases. The value of a life becomes only as interesting as the student’s personal involvement allows in the situation. However, as physicians place greater care on personal patient care, the students will likewise begin to value the life and wellbeing of the patient more so than the experience itself.

-S Maxwell Scalf 

Howard Becker, Blanche Geer, Everett Hughes, Anselm Strauss, Chapter 13, “The Assimilation of Medical Values by Students.” Boys in White: Student Culture in Medical School (University of Chicago Press, 1961)