Thursday, April 26, 2012

Doctor and Patient: Reinventing Year Three of Medical School

A recent article by Pauline Chen, MD in the New York Times discusses changes in the medical studies curriculum which are meant to ensure that medical students retain their empathy. Unfortunately the process can and will become undermined by a vicious residency training system. I found that it wasn't medical school that made me cynical. It was a general surgical residency where I was working every other night on call, over 120 hours a week. Didn't know there were 120 hours in a week? Well, I didn't either until I did the math. This translates into up at 5 am, at the hospital from 6 am, then overnight until the next evening at 10 pm, then home for a few hours of shut-eye before you repeat. No wonder I quit my surgical residency after only 6 months!

During that time I was distressed at how I was expected, even encouraged, to continue to care for patients despite overwhelming exhaustion. When I collapsed from the stress I was told that this was somehow my problem, and not the result of my grueling schedule. When I went to a therapist, the situation was normalized and I was prescribed Paxil to deal with my depression and anxiety, when I should have been told to leave. The entire medical education system, I soon realized, was set up to get the most amount of labor from the youngest, and financial incentives existed to maintain the status quo. Residents are essentially an itinerant work force: residents are only trainees from between 3 to 7 years and then they move on. Unionization is nonexistent, or discouraged, and most trainees feel that putting up with the crazy hours is the way to pay their dues and the payoff will come later, in the salaries and perks that come with being an attending surgeon.

I genuinely don't think the system will ever change unless there is some pressure from the outside (i.e. federal regulation) to reform it. The doctors and hospitals who currently benefit from the cheap labor of residents in teaching hospitals have no incentive to change it and the residents are powerless to.

While I admire those educators at Harvard who are willing to invest in improving medical school experiences for their third-year students, they really need to take a look at their own backyard first and first examine their residency training programs. Start with Harvard. That was the where the surgery program I quit 10 years ago was. I wonder if it has changed...