Rite of passage for the wrong reasons


September 25, 1990|By Dr. Kenneth Burke | Dr. Kenneth Burke,Dr.Burke is the chief resident of an internal medicine program in Maryland.The opinions in the article are his own and do not reflect those of the adminstration of his hospital.

I am the chief resident of an internal medicine training program here in Maryland. For a long time, I, like others before me, have kept quiet about the grueling hours that a resident must work. After reading B. D. Colen's article (Weighing In, Sept. 4), I have decided to be silent no more.

Residents at my hospital work 110 hours a week during their first two years of training. Every third day, they work a 36-hour shift.

Ostensibly, this is so that a resident will see "disease processes in evolution and be capable of handling its many facets," or so we are led to believe.

As Mr. Colen points out, this is a rite of passage. When I have mentioned to my superiors that this schedule is inhumane, I have been curtly told, "I did it! Hell, when I was a resident, I used to perform urine tests myself -- we didn't have a fancy lab like you do!"

These "When I Was a Resident" stories cause my ulcer to flare.

Most senior attending physicians were residents when there were relatively few antibiotics, certainly fewer disease entities, and undoubtedly nowhere near as much technological data to sift through.

Intensive care and cardiac care units were unheard of. Patients were admitted for "observation" (a practice not performed today because of insurance regulations and reimbursement schedules).

And, perhaps most importantly, that era was prior to the birth of the "beeper" -- a device that is analogous to an alarm clock on amphetamines, shrieking every two minutes or so.

I would gladly challenge any attending physician to spend one month "on call" today. And I would also like to ask any of them if they enjoyed the hardship of residency, or am I missing some masochistic delight due to my fatigue?

I, too, have fallen asleep behind the wheel on more than one occasion -- beginning my voyage in the right lane and waking up in the left.

I, too, have fallen asleep on the floor, only to awaken to the "thud" of my cranium as my 2-year-old daughter lifted my head by the ears and observed the effects of gravity on her old man's noodle.

I have stood in the hallway at 3 a.m. feverishly searching for a drug dosage only to realize -- after 5 minutes -- that I was looking in my telephone directory and not in my prescription book.

While I do all this, my supervising physician is fast asleep at home. In two years of residency training, I can count on one hand the number of times that an attending physician arose in the middle of the night to see a sick patient.

The bottom line is money -- hospitals get the most amount of work from the fewest amount of people for the least amount of money by using residents.

For those of you who may say, "If you don't like your job, then quit," I can only respond as follows:

I like my job -- caring and curing. What I don't like, or understand, is the torture that I must endure to have the "right" to do that job.

American medicine is in trouble. Doctors are considered incompassionate. Maybe it's because they had the compassion squeezed out of them in their early years of training, but they're too tired to notice.Dr. Burke is the chief resident of an internal medicine program in Maryland. The opinions in the article are his own and do not reflect those of the administration of his hospital.

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