it's nine pages long , so this can be considered a summary ;
Hospital administrators engage in abusive discipline because they can. The perpetrators must account to no one and nothing in the typical contract signed by a doctor joining a medical residency places limits on her or his superiors' disciplinary prerogatives. Yet such practices take place under a veil of secrecy. Those who perpetrate them depend on the intimidated silence of the victims who, after years of expensive medical school training, are afraid to risk reprisal by complaining. Abusive discipline thus thrives not only on the arrogance of the powerful but on the shame and fear of the powerless.
In the shadowy disciplinary armamentarium of medical education, the dirtiest secret is disciplinary psychiatry. It exemplifies the medical community turning on its own. Disciplinary psychiatry can be defined as coerced subjection to psychiatric intervention as a condition of remaining in training. Medical educators use it not only against doctors in residency but also against medical students in the process of earning a medical degree.
The term disciplinary psychiatry refers not to a situation in which a person with an established diagnosis of mental illness is enrolled for medical training but to one in which the medical education administrators seek to establish a diagnosis of mental illness in a trainee by forcing him or her to see a mental therapist of the institution's own choosing.
Disciplinary psychiatry, instead, requires a resident to undergo mental evaluation or therapy--while the resident is nevertheless allowed to remain actively engaged in patient care duties. This is what makes the practice disciplinary rather than, say, precautionary, because in such an instance there can be no pretense that the institution is intervening as a precaution on behalf of anyone's well-being. Indeed, it's possible to maintain that, in the past, the practice has been used because the trainee is of the "wrong" race, gender, or political philosophy.
The tactic of disciplinary psychiatry confronts the trainee with a catch-22. The medical education administrators don't summarily terminate the resident but they stipulate that renewal of her or his contract for the next year's training is subject to a special condition. In sum, they offer the trainee a choice of either being fired when the contract expires or submitting to evaluation or treatment by a mental health professional administrators have chosen. If the trainee accedes to this, the trainee is eventually removed from the training program anyway on the grounds that seeing a psychiatrist comprises facial evidence of his or her unfitness to ever practice medicine. But if the student refuses therapy, she or he is removed from the training program on the ground of disobedience.
Either way, a resident so removed from a training program has very little chance of ever working again as a physician. Any future residency or licensing body to which this person might apply will inquire as to the circumstances for having left a prior training program without finishing. Upon inquiry from such parties, the medical administrators will respond saying that the director of the program had instructed the trainee to undergo psychiatric intervention. The inference will be made that, if such an authoritative figure saw fit to so direct the trainee, then the trainee must, by logical inference, be mentally ill. This is the defamatory aspect of disciplinary psychiatry.
