In Defense of Scut

You see, there’s more to being a doctor/surgeon than just learning how to fix a hernia or run a code. There’s a mindset that has to take hold. Call it indoctrination if you like but it’s a process that attempts to transform a self-satisfied, smug, well-educated medical student (I certainly fell into that category) into the sort of selfless, compassionate, dedicated, thorough, and mindful physician that we all deserve (a gradual transformation that doesn’t end just because you’ve become an Attending, believe me). The scut work and mindless b.s that junior residents used to have to endure has a lasting effect. One’s immersion into the totality of hospital life as a trainee leaves a lifelong mark. Even today, I make my rounds the same way I did when I was an intern. I sit in front of the computer and dutifully write down all the vitals and lab results of my patients in little chicken scratch boxes. I review the xrays and medicine lists. I make up a preliminary plan. And then I go see everyone, one by one. It’s very banal and systematic. Nothing’s changed, only the degree of ultimate responsibility.

I expect to get some passionate attacks at even citing this blog entry. Obviously I am out of touch with work life balance. I am a relic.

I worry about how we should be balance learning with work hour requirements. I reject the idea that our training was barbaric. It was hard, but being a physician is and should be hard. Our profession is too important to take lightly.

I am not convinced that we make more and worse errors with 30 hour shifts (or even, heaven forbid, 34 hour shifts) than with multiple hand-offs. I have often opined that if we fail to train residents adequately, the downstream errors (once they enter practice) will multiply.

Tiger Woods did not become great simply because of talent. He practices hard and spends long hours practicing. He continues to practice hard.

Being a great physician requires an investment of time. We risk having less well prepared physicians if we are not extremely cognizant of numbers of patients needed to achieve expertise. We should not settle for training mediocre physicians. The public needs us to train excellent physicians.

The Buckeye Surgeon makes some interesting points. Some readers will argue against him vigorously, but would you rather have a surgeon who went through his training or one going through training with much less operating room time?

Related posts:

1. More thoughts on work hours
2. Work hours – the problems of bureaucracy
3. Adapting to work hour restrictions
4. Duty hours, patient safety and resident education
5. Duty hours, the ACGME and the surgeons

Related posts brought to you by Yet Another Related Posts Plugin.