Taking advantage of residents is common in hospitals
A note written by Dr. Simin Kazemi
Medicine is a modern institution, but the relationships within it are highly traditional and patriarchal. These relationships include doctor-patient, teacher-student and hospital hierarchies. These relationships are based on the culture left over from the pre-modern society, which does not fit well with a modern institution.
The traditional teacher-apprentice system had different aspects. On the one hand, knowledge and skills are transferred from the teacher to the student, and on the other hand, it has been the mediator of the transfer of cultural and moral values. In this system, the teacher has a higher status than the student and having knowledge/skills gives him the power that obliges the student to obey. Obedience and submission of the student has been necessary for the continuation of this relationship. Now, in the meantime, the teacher’s emotional and supportive relationship with the student has been the spice of this relationship.
In Iran, the hospital is known as a symbol of modern medicine, but the master-apprentice system continues in the same traditional and old way. In the hospital, power relations are not only unbalanced between professor and student (resident/intern), but a hierarchical system prevails in which after the professor, the fourth, third, second, and first year residents are placed. In fact, the lower a person’s position in this hierarchical system is, the worse the situation is for him, and the deeper the obedience and submission to the higher ranks, and the more opportunities for exploitation and oppression.
This master-apprentice system has an economic function for the hospital and professors and guarantees the interests of the hospital and professors. Currently, residents are the cheap and almost free labor of hospitals, and the master-apprentice system gives the professors the authority to exploit this cheap labor for their own benefit. While the residents are in charge of diagnosing, treating and managing the patient’s condition and are on duty for long hours, the professors spend time outside the hospital; But in the end, the fees that are paid go entirely into the professors’ pockets, and the work and effort of the resident is meant for them. This system is a clear example of exploitation that is very common in teaching hospitals.
The remarkable thing about the hospital professor-disciple relationship (which is the legacy of the pre-modern social system), is that the spiritual and emotional aspect that previously existed in such a relationship is dim. In a position of authority, the teacher does not consider it his duty to support the student, but sees him as a tool that can be used. The values and norms that are transmitted in the hospital master-apprentice relationship include blind discipline and obedience and submission and a hierarchical system that must be followed without question. In fact, this is a part of the rules and customs governing hospitals, which is reproduced regularly.
The main cause of this situation is the medical education system established by the Ministry of Health, and there has been no change in it so far. It seems that what has led to the continuation of this situation is the state of the medical profession in the society. Medicine is one of the professions associated with power/wealth/status, and since medical education is supposedly free, the governing body in the Ministry of Health can set conditions, restrictions and requirements for entry into this caste. No one can dispute it. It is as if it is intended to take maximum advantage of someone who is going to take advantage of becoming a specialist doctor in the future, such as long and exhausting shifts, the obligation to serve several times the duration of education (based on the acceptance quota) and… On the other hand, those who perpetuate this system are either beneficiaries themselves or are under the influence of powerful professors to maintain this system.
This post is written by NA752