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August 26, 1998

Mistreatment and Maladaptations During Medical Internship

JAMA. 1998;280(8):699-700. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-8-jbk0826

To the Editor.—Having completed a medical internship last year, I found the work by Dr Daugherty and colleagues1 characterizing resident satisfaction in the first postgraduate year of particular interest. While many types of work require precision (eg, computer programming) or concentration (eg, air-traffic control), medical internship is unique in requiring both from workers in a chronic state of fatigue. Living in the hospital for protracted durations prevents residents from obtaining respite from their job-related frustrations. The intrusiveness of being on-call barely allows even a few minutes of privacy. For days at a time all personal activities are continually subordinated to the mantra of patient care. On-call responsibilities make residents exhausted, lonely, and unable to meet their own needs.2,3 This in turn magnifies the effects of perceived mistreatment, which may otherwise be mitigated by positive life experiences. Experimental studies have been unequivocal in documenting that the sleep deprivation of residency has a deleterious effect on residents' mood and sense of well-being.4

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