The cycle continues when residents become the supervising physicians. They pass the abusive schedules and expectations down the next class of residents as a kind of initiation and hazing to the next level of the hierarchy.

The authority structure and power culture prevents learning in more senior doctors. With exhausted residents and junior doctors looking to advance in a strict system, they lack the mental clarity, energy (from exhaustion), and power to challenge and introduce new ideas.

Collaboration and whole-body medicine become impossible. Pre-defined treatments are pushed and liability is held above solutions.

Evidence? — ^ All concluded from my own, extensive Western medicine experiences in “learning” hospitals and perspectives friends serving as doctors, nurses, specialists in the different political hierarchies of our medical system.