es. So why don’t highly skilled laborers who
work 80-hour weeks in evidence-based med-
icine not receive an evidence-based parental
leave? I think it’s rooted in what I call, “Amer-
ican Med-chismo.”
American Med-chismo could be best
understood by a quote from Sir William
Osler, one of the founders of Johns Hop-
kins: “The practice of medicine ... is a life
of self-sacrifice and of countless opportu-
nities to comfort and help the weak-heart-
ed, and to raise up those that fall.” No ques-
tion, it’s an idealistic and lovely sentiment.
But recall that at this time (1890s) resi-
dents (almost entirely men) resided (liter-
ally) in the hospital. This period of social
and familial isolation was euphemistically
referred to as a “monastic” existence.
To a resident of and for the hospital,
duty hours would have been a laughable
idea. It was not at all uncommon for physi-
cians to lean on cocaine or morphine as
fuel. Forget about paid parental leave.
And the Med-chismo culture persists.
Physician trainees are criticized for a lack
of dedication when they pursue less
time-intensive specialties and lifestyles.
For example, JAMA Surgery reports that
women considering motherhood experi-
ence “substantial negative bias” because
maternity leave is resented. Many hospi-
tals do not offer leave for parents who are
not giving birth, and an uncompensated
burden is placed on colleagues who cover
for new parents.
Yet Med-chismo is not without comor-
bidities. Physician burnout—a nebulous
phenomenon that involves emotional ex-
haustion, cynicism, and dehumanization—
is on the rise. Unsurprisingly, it’s associat-
ed with lower patient satisfaction, more
medical errors, drug and alcohol use among
doctors, even suicide. Over half of doctors,
and up to 75 percent of residents, experi-
ence it, depending on specialty. But the
rates aren’t the same for everyone; resi-
dents with children have lower rates of
burnout and cynicism. Perhaps this is why
residents in the U.K. and Europe have more
evidence-based paid parental leave poli-
cies. Or maybe they just believe the science.
—Daniel Barron@sciam
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