Tolerating the Intolerable

(Just an addendum to the previous post in which we discussed Med School Hell, a subversive anti-medical school blog.)

I am not advocating Brother Stox’s point of view, nor am I condemning it. It’s his point of view and he’s entitled to it. Since I’m not a mind-reader I’m not going to speculate on his motives for going to medical school either. We all have our reasons and there is no wrong one.

But let me reiterate that everything in Stox’s blog is true. I have experienced everything he mentions and most of those things made me just as angry. It’s just that we arrived at different conclusions about the medical profession from the same information. I decided that I liked Emergency Medicine enough to outweigh some of the things I don’t like, Stox didn’t really like anything about clinical medicine and decided to cut his losses rather than make himself miserable to satisfy somebody else’s expectations.

I will say that I have never seen such disregard for other people as I have seen in medical school and during my intern year. As many of you know, I spent many years in the Marines, one of the hardest and most disciplined branches of the military. Unlike medical training where the hierarchy is unofficial and supported by nothing but usage and tradition, in the Marines the hierarchy is absolute law, codified in the Uniform Code of Military Justice and carries severe penalties for those who violate it.

I was a Platoon Sergeant and exercised a level of control over my Marines which most of you can not conceive and would never tolerate for an instant.

And yet, I would have been ashamed to treat my Marines in the casual, oftentimes cavalier way that medical students and residents are treated by their attendings and even other residents. One example of this is the all too common practice of an attending keeping his subordinates waiting without explanation at the end of day when most of us would like to go home. It would seem to be nothing more than common courtesy to at least call the senior resident and inform him of the delay, either allowing his people to go home or giving them a reasonable time when they may expect to round. Apparently it is beneath the dignity of most attendings to stoop to such courtesy.

And yet, my Company Commander, a man with the legal authority to send his Marines to their certain death, regularly passed the word to his subordinates to cut the troops loose for liberty if his staff meeting or other company business would delay his presence at the afternoon formation. This was considered common courtesy and is the the rule, not the exception in the Marines.

Additionally, in the Marines it is all right to dislike the Marines. Nobody ever questions your motives, acts hurt if you don’t pretend to like everything, or expects you to kiss up and be happy and enthusiastic all the time. It is enough that you do your job, carry your own pack, and look after your Marines. This is not the case in medical school. I’m sure Brother Stox had a difficult time with his attendings and faculty, many of whom probably disliked his honesty.

As you know, like Brother Stox, I also intensely dislike call, long hours, and the expectation that we need to devote our entire lives to medical training. I’m sure I’ve made this clear many times. I think call is ridiculous as it is usually just an excuse to use the residents as cheap labor. Blah blah blah. I know all of the counter-arguments about education and “patient care coming first” but this is all nonsense. We need to be on duty at all hours to admit and take care of patients. No question about it. But the way to do it is by having a shift system, not the inhumane practice of making residents miss one night of sleep out of every four or worse.

And I don’t care a bit for the 80-hour work week either. It’s better than 120 hours, of course, but it doesn’t go far enough. If residents knew how much money their hospitals get for their service, and if they weren’t also terrified of losing their jobs by stepping out of line, they wouldn’t tolerate for one minute both the long hours and the crappy pay. We only do because, frankly, the residency programs have us by the balls and they know it. It’s the same with medical school where as long as their are people willing (hell, begging) to be abused nothing is ever going to change.

Now, I like my new residency program a lot. The hours are decent, our attendings are fantastic, and the education is first rate. I also like nasty, smelly, dripping crack whores and other disgusting patients which Stox does not. I’m sure there are plenty of benign residency programs out there where the residents are as happy as is possible for the pitiful salary they earn. But there are also a lot of truly malignant organizations so you need to be careful, if quality of life is important to you, both of where and into what you match.