Getting rid of patients: contradictions in the socialisation of internists to the doctor-patient relationship

Abstract

This article examines the impact of the professional socialisation of internists on the doctor-patient relationship. Utilising observation and interviews, the study found that the world of house staff (interns and residents) was defined by a paradoxical perspective on patients--characterised as a "Get Rid of patients' (GROP) orientation. This perspective was shaped by the poor conditions of public institutions, administrative mandates, demographic and disease factors, a narrow definition of professional practice and normative standards of professional conduct. There was active support and reinforcement from colleagues for GROP behaviour; peers, rather than attending faculty became the most important socialisers. To implement the GROP perspective, coping strategies emerged within the house-staff culture. These included the utilisation of the hierarchy and techniques such as negotiation, objectification, intimidation, omission and avoidance. No time in their training was identified as the right time to acquire humanistic doctor-patient relationship skills. Contrarily, the structure of the socialising institution was organised into a hierarchy in which the most obvious criterion and consequence of status was autonomy over or removal from the establishment of meaningful doctor-patient relationships.