A guest post


Category : Medical Rants

Our esteemed colleague the Whistleblower tried to post this as a comment. For some reason my software keeps rejecting him. So I will publish this as a guest rant:

After a day of bowel burrowing, I am pleased to respond to this blog’s esteemed host. While he disagrees with me, I am not certain that I disagree with him. Indeed, I would relish the opportunity to offer a spirited riposte, but it appears that there’s not much daylight between our views.

I agree that night call is an essential element of housestaff education. Indeed, I have never advocated against it. My rant is against those who argue that a grueling schedule for interns and residents is itself an integral element of physician education. In other words, to these macho men, who used to walk 7 miles to school through frigid snowstorms (uphill both ways, of course), fatigue and exhaustion are not simply an inevitable result, but are an objective. I think this is an absurd anachronism that persisted in medical culture for decades too long. Comments on this blog and elsewhere demonstrate that many medical folks still maintain that an inhumane schedule is just what the doctor ordered. I disagree. When do these superheroes suggest that housestaff read and study?

I worked 36 hour shifts routinely in my training. I don’t think that this prepared me for my post-training career. If my shift were 24 hours instead, would I be a clumsier colonoscopist today? Would I not have the requisite skill or stamina to handle middle of the night clinical issues? I am sure that solid training programs can function well without having hospital corridors appear as a scene from the classic film Night of the Living Dead, where zombie interns are somnambulating.

My comment about $$$, which may have been misunderstood, referred to the cheap labor that overworked housestaff provided to hospitals. Indeed, many of the tasks that we performed did not have educational value for us.

I appreciate the Ranter’s concerns on resident’s missing legitimate educational opportunities because of regulations to limit their work hours. There may need to be some creative scheduling in order to minimize these occurences. It may be that every resident cannot attend every conference every time.

I am not suggesting that housestaff be coddled. I don’t think that senior residents need to tuck in their interns at night after serving them some milk & cookies. But, which resident would you want caring for your family? One whose mental status was between stupor and coma, or one who was alert and could do serial 7s successfully? Isn’t this self-evident?

I remember the Libby Zion case well. This tragedy served as a portal for the public to view what was happening in teaching hospitals. Why did the medical profession require external scrutiny and opprobrium to admit (grudgingly) that reform was needed?

I am not a medical educator, but a mere colonoscopist and Whistleblowing scrivener. Medical training will always be arduous, but it shouldn’t subject young physicians beyond what is necessary for their education and training. They need time to think, read, absorb and reflect. If it means that training periods need to be extended, then this should be considered. I can’t speak to the mechanics and logistics of devising medical training programs that provide a decent experience for patients and housestaff, but I am confident that this can be accomplished.

The Ranter and I agree that reform was necessary. I suspect, however, that many still believe that medicine’s best training days are behind us. I am pleased that training has become more humane. How can we expect humane physicians to emerge from an inhumane crucible?

We’ve come a long way. We’ve been pushed most of the way, but at least we’ve moved forward.

Agree that dialogue is a great pleasure. Tomorrow, back to burrowing.


end guest rant

Comments (2)

Work hours can be regulated, however, the hours spent on educational activites does not need to be regulated.
There are mashok V. Dafny professionals who worked while they studied. Are physicians different?

A post script to the post from JAMA. http://jama.ama-assn.org/cgi/content/short/302/14/1565

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