Coping with Patients: Subcultural Adjustments to the Conditions of Work among Internists-in-Training

Interns and residents in internal medicine use a variety of strategies to distance themselves physically and emotionally from their patients. These strategies include avoidance of patients, narrowing of doctor-patient interaction, and treating patients as non-persons, These subcultural adjustments enable doctors to cope with heavy case loads and other demands of graduate medical training. The stress of the work situation leads interns and residents to express strong negative feelings about all aspects of their work. Subcultural adjustments and emotional stress impair doctor-patient relationships and decrease the quality of medical care in teaching hospitals.