Personal views: The machismo of medicine
Authors: Stephen Dinniss
Journal: BMJ (1999)

Irecently enjoyed a dinner with a group of junior doctors, and as always it was not long before the conversation turned to medicine. Of course, it was not an academic discussion of the latest advances in surgical procedures, nor the swapping of vignettes from recent journal articles, but the more common subjects of medical disasters, hospital mayhem, and job dissatisfaction, with the usual smatterings of blood, guts, and excrement thrown in.


These are the usual themes of the junior doctors’ dinner conversation. Small, harmless stories are told first, but it proceeds in snowball fashion gathering momentum in a spiral of oneupmanship. Who has the worst rota? Who is working for the least supportive, slave driving consultant? Who has the goriest story of trauma and disaster to tell? A young senior house officer tells the story of an 18 year old who threw himself in front of a train and is brought to the accident and emergency department in two ambulances. But this is immediately surpassed by the specialist registrar with the tale of the death of a 6 month old baby subjected to indescribable abuse by drug addicted parents. Stories typically begin with “When I was doing that job” and “That’s nothing compared with....” A senior house officer working a 1 in 3 rota is shouted down by stories of the old days when 1 in 3 was luxury. 


We as doctors need to admit the burdens we carry





We use denial and machismotodown play the effect



There is no time for condolences or discussion of the impact that these events have had on what is a typical group of young adults out for a meal. Anyway, that would go against the grain of the general ethos of medicine. Machismo flows as freely around the table as the wine does. Women are not exempt, and younger doctors with fewer stories to tell run dry, but there is always someone else to fill the quiet.

I, of course, am not without fault and pitch in with my latest story of the psychiatric patient found in a pool of blood after cutting his throat and both antecubital fossae. I relate to my colleagues how, as the only doctor in the hospital, I handled the situation with authority and confidence. No mention of the fact that I was physically shaken afterwards and had blood soaked dreams that night. No mention of how I jealously watched the nurses leave the hospital together at the end of their shift to go out for a drink and talk through what had happened. They, of course, would have the nursing debriefing the following day to work through the way the event had affected them. I was left, as the youngest and most junior member involved, to continue my 24 hour shift without another word.

In the age of improved working conditions for junior doctors this is still a neglected area. People, and that includes the doctors themselves, must realise we are not a group of thick skinned, desensitised robots for whom traumatic events are like water off a duck’s back. We must realise the true effect that our job has on us, which is reflected in appalling rates of drug and alcohol misuse, suicide, and divorce. Difficult working conditions, long hours, and frequent exposure to traumatic situations lead to copious emotional burdens that we carry home with us. We use denial and machismo to down play the effect.

That night’s conversation was not an example of callous, arrogant young doctors spouting off about work, as people at the next table may have thought. In truth, it was a group of young adults performing a necessary and vital act of trying to cope with stresses that people in other professions cannot imagine. We allow ourselves the catharsis of telling stories when in medical company as our own form of lay therapy. It unburdens us at the end of the day and allows us to return to work tomorrow.

There needs to be acknowledgment of the emotional and psychological impact that our jobs have on our lives. Unburdening ourselves under the guise of telling horror stories should not be the only method we have of dealing with this. Many hospitals now provide support in the form of counselling services to doctors, and this has to be a positive step. But most doctors avoid such services for fear of being labelled as someone not coping, which is the worst admission for a junior doctor pumped up with the machismo of the profession. More important than demanding that the hospitals provide such services, we as doctors need to admit the burdens we carry in order to begin to deal with them. We must use the services available to us and demand that those available are appropriate and sufficient. Mind you, if we do succeed in finding other channels to unload our baggage, what does that leave us to discuss around our dinner tables?