Defence mechanisms in medical students: An Australian perspective

ObjectiveMedical students' entry and adaptation to the health system represents a unique psychological challenge. To operate successfully within a hospital's institutional culture, they must learn its unspoken rules and their place in its hierarchy. Such a transition is complicated by anxieties inherent to being in the hospital, a place where disease can end in death rather than discharge. In defence against these anxieties, medical students deploy a range of individually and institutionally preferred defence mechanisms. This article will provide a psychoanalytical account of these defences and consider their implications for medical education and patient care.ConclusionsWhilst fending off anxiety, defence mechanisms may also impede delivery of patient-centred care. Insiders like medical students and educators must convert this insight into strategies that circumvent destructive defences and their distortion of patient-doctor relationships. Healthcare's inevitable anxieties can be defended against in more constructive and creative ways that enhance the quality of care. The choice to take or resist such a creative path carries major implications for healthcare in Australia and elsewhere.