A degenerative psychospiritual disorder marked by the erosion of professional identity and self-worth, emerging in medical residents who find themselves routinely performing custodial tasks beneath their training, yet expected to smile through it.
Symptoms:
Title Collapse: Increasing dissonance between the letters “MD” and the toilet brush in hand.
The Pager Gag Reflex: Triggered by being called for a code blue and then told to “grab a mop afterward.”
Loss of Clinical Voice: Progress notes are replaced with custodial logs
Sanitary Delusions: Belief that in residency one must clean to ascend.
Progression:
Stage I — Compliance: "Of course, I’ll do it. It’s just being a team player."
Stage II — Erosion: Starts apologizing for things they didn’t cause.
Stage III — Conflation: Forgets the distinction between being a doctor and being disposable.
Stage IV — Assimilation: Attending physicians ask them to take out the trash
Pathophysiology:
The syndrome arises from a persistent mismatch between training and task, expectation and reality, value and valuation. It feeds on systemic understaffing, hierarchical indifference, and the myth that resilience means never saying no. It festers in residents who swallow their shame, then swallow it again the next night, until they cannot remember what they ever wanted to become.
Prognosis:
Some burn out spectacularly. Some quietly rot in call rooms. A few rise, swearing they'll “change the system” someday.
Symptoms:
Title Collapse: Increasing dissonance between the letters “MD” and the toilet brush in hand.
The Pager Gag Reflex: Triggered by being called for a code blue and then told to “grab a mop afterward.”
Loss of Clinical Voice: Progress notes are replaced with custodial logs
Sanitary Delusions: Belief that in residency one must clean to ascend.
Progression:
Stage I — Compliance: "Of course, I’ll do it. It’s just being a team player."
Stage II — Erosion: Starts apologizing for things they didn’t cause.
Stage III — Conflation: Forgets the distinction between being a doctor and being disposable.
Stage IV — Assimilation: Attending physicians ask them to take out the trash
Pathophysiology:
The syndrome arises from a persistent mismatch between training and task, expectation and reality, value and valuation. It feeds on systemic understaffing, hierarchical indifference, and the myth that resilience means never saying no. It festers in residents who swallow their shame, then swallow it again the next night, until they cannot remember what they ever wanted to become.
Prognosis:
Some burn out spectacularly. Some quietly rot in call rooms. A few rise, swearing they'll “change the system” someday.
Description:
Sanitosis does not begin with a breakdown. It begins with a glove. Then a spill. Then a body without transport. Then a room with no Environmental Services. Then another. And another.
Soon, the resident is not helping clean, but cleaning to survive—scrubbing stretchers at 3am, bagging soiled linens, wiping down urine-soaked floors so the next trauma bed can be turned over.
No one notices.
Worse: everyone expects it.
Sanitosis does not begin with a breakdown. It begins with a glove. Then a spill. Then a body without transport. Then a room with no Environmental Services. Then another. And another.
Soon, the resident is not helping clean, but cleaning to survive—scrubbing stretchers at 3am, bagging soiled linens, wiping down urine-soaked floors so the next trauma bed can be turned over.
No one notices.
Worse: everyone expects it.
by Janitorial MD June 06, 2025
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