The Culture of Medicine

The profession of medicine has a distinct culture that evokes responses ranging from respect and trust to allegations of elitism and condescending paternalism. Once we become part of a culture, its values and formal and informal rules of conduct become invisible; they are second nature. So contributors to the February 2015 issue attempt a difficult task when they undertake analyzing the culture of medicine from within, often through the lens of medical education and training—focal points for admission to the profession and transmission of its values and attitudes to the upcoming generation of physicians.

Volume 17, Number 2: 105-189 Full Issue PDF
  • From the Editor
    Feb 2015

    I Am JOE

    Audiey C. Kao, MD, PhD
    Announcement about the name change from Virtual Mentor to AMA Journal of Ethics.
    AMA J Ethics. 2015;17(2):107-. doi: 10.1001/virtualmentor.2015.17.2.fred1-1502.
  • From the Editor
    Feb 2015

    Describing a Culture from Within

    Marta Michalska-Smith
    What we are expected to read between the lines or pick up on without being told is as much a part of culture as anything codified.
    AMA J Ethics. 2015;17(2):108-110. doi: 10.1001/virtualmentor.2015.17.2.fred2-1502.
  • Case and Commentary
    Feb 2015

    Professionalism and Appropriate Expression of Empathy When Breaking Bad News

    Amy Blair, MD and Katherine Wasson, PhD, MPH
    There are at least two considerations here: the patient’s perception of a physician’s empathic expression and the physician’s level of comfort with expressing empathy and attending to patients’ emotions.
    AMA J Ethics. 2015;17(2):111-115. doi: 10.1001/virtualmentor.2015.17.2.ecas1-1502.
  • Case and Commentary
    Feb 2015

    Paternity Leave in Medical Residency

    Nathan E. Derhammer, MD
    Although the Family Medical Leave Act (FMLA) covers parental leave within a year of the adoption or birth of a child, medical residents should be aware that leaves of absence require careful planning and may extend their training.
    AMA J Ethics. 2015;17(2):116-119. doi: 10.1001/virtualmentor.2015.17.2.ecas2-1502.
  • Case and Commentary
    Feb 2015

    Balancing Supervision and Independence in Residency Training

    Amy H. Buchanan, MD and Aaron J. Michelfelder, MD
    Effective resident education balances supervision to ensure patient safety with independence to ensure the resident’s professional growth; achieving this balance requires mutual trust.
    AMA J Ethics. 2015;17(2):120-123. doi: 10.1001/virtualmentor.2015.17.2.ecas3-1502.
  • Case and Commentary
    Feb 2015

    Redefining Professionalism in an Era of Residency Work-Hour Limitations

    William Malouf
    The 2011 duty-hour restrictions and the shift to team-based care challenge the medical profession to reconceptualize the traditional ethic of individual physician responsibility for patients.
    AMA J Ethics. 2015;17(2):124-128. doi: 10.1001/virtualmentor.2015.17.2.conl1-1502.
  • Medical Education
    Feb 2015

    The Role of the Hidden Curriculum in “On Doctoring” Courses

    Frederic W. Hafferty, PhD, Elizabeth H. Gaufberg, MD, MPH, and Joseph F. O’Donnell, MD
    The hidden curriculum may undermine the messages, skills, and values that “On Doctoring” courses intend to convey.
    AMA J Ethics. 2015;17(2):129-137. doi: 10.1001/virtualmentor.2015.17.2.medu1-1502.
  • Medical Education
    Feb 2015

    Communication Skills Training in the Twenty-First Century

    Thomas W. LeBlanc, MD, MA
    Patient-centered communication skills should be taught, practiced in simulation, and evaluated, just as technical skills are.
    AMA J Ethics. 2015;17(2):138-141. doi: 10.1001/virtualmentor.2015.17.2.medu2-1502.
  • In the Literature
    Feb 2015

    Role Models’ Influence on Medical Students’ Professional Development

    Martha Peaslee Levine, MD
    Medical educators must become aware of undesirable behaviors or attitudes that they may inadvertently be modeling to students in the clinic because the implicit messages students receive can profoundly affect their behavior and interactions with patients.
    AMA J Ethics. 2015;17(2):142-146. doi: 10.1001/virtualmentor.2015.17.2.jdsc1-1502.
  • Health Law
    Feb 2015

    Challenging the Medical Residency Matching System through Antitrust Litigation

    Richard Weinmeyer, JD, MA, MPhil
    The legal challenge to the residency training system and the match by which medical school graduates are assigned to residency programs alleged that they impose anticompetitive restraints on medical residency placement, hiring, and salaries. The challenge was dismissed in federal court in 2004.
    AMA J Ethics. 2015;17(2):147-151. doi: 10.1001/virtualmentor.2015.17.2.hlaw1-1502.
  • Policy Forum
    Feb 2015

    Equity for “DREAMers” in Medical School Admissions

    Mark G. Kuczewski, PhD and Linda Brubaker, MD, MS
    Medical schools need to be transparent about their admission policies and to develop equitable financial aid packages for applicants with DACA (Deferred Action for Childhood Arrivals) status, who would contribute to a diverse health care workforce able to meet the needs of evolving communities.
    AMA J Ethics. 2015;17(2):152-156. doi: 10.1001/virtualmentor.2015.17.2.pfor1-1502.
  • Medicine and Society
    Feb 2015

    Professional Socialization in Medicine

    Brandon Vaidyanathan, PhD, MSc
    One way of transmitting culture is through narrative scripts—ideas about the kind of self one ought to become—that shape medical students’ ideas of what desires, attitudes, behaviors, and dispositions are expected or unbecoming of professionals.
    AMA J Ethics. 2015;17(2):160-166. doi: 10.1001/virtualmentor.2015.17.2.msoc1-1502.
  • Medicine and Society
    Feb 2015

    Derogatory Slang in the Hospital Setting

    Brian Goldman, MD
    Although use of derogatory medical slang is disrespectful and unprofessional and therefore should be discouraged, looking at it more closely may afford an opportunity to address physicians’ frustrations or sense of helplessness in treating certain kinds of patients.
    AMA J Ethics. 2015;17(2):167-171. doi: 10.1001/virtualmentor.2015.17.2.msoc2-1502.
  • Viewpoint
    Feb 2015

    Promoting the Affordability of Medical Education to Groups Underrepresented in the Profession: The Other Side of the Equation

    Marc J. Kahn, MD, MBA and Ernest J. Sneed, MD
    Increasing the racial and socioeconomic diversity of the physician workforce requires revising admissions standards, providing financial education, and developing programs to expose high school students to health care fields.
    AMA J Ethics. 2015;17(2):172-175. doi: 10.1001/virtualmentor.2015.17.2.oped1-1502.
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    Podcast
    Feb 2015

    Ethics Talk: Accepting Applications for Medical School from "DREAMers"

    This month, AMA Journal of Ethics theme editor Marta Michalska-Smith, a second-year medical student at the Loyola University Chicago Stritch School of Medicine, interviewed Linda Brubaker, MD, MS, and Marc G. Kuczewski, PhD, about Stritch’s admissions policy welcoming applications from students of DACA status and the challenges and promise of implementing this strategy.