"Now that the joke has
The article "End
of the Medical Marathon?" (October/02) discussed
in detail the disagreements over whether long working
hours with little "time off" causes any detrimental
effects on patients. Some say yes, and some say no.
The major point,
however, is being overlooked. The major casualties
of the "old-fashioned" house-officer schedule
are the medical trainees themselves. As a product of the
"Spartan Code" that was exemplified during my
residency training (neurological surgery) at the University
of Chicago in the Sixties, I can speak to the effects
of that existence on not only myself but among my colleagues
I met no one in the postgraduate medical
programs at the University who was anything but dedicated
and capable. Yet, as I review the careers of some of my
colleagues, I see a trail of tragedy and pain. Among my
own contemporaries, I saw a large number of people who,
during and after their training, experienced the ravages
of alcohol and drug abuse, multiple divorces, premature
illness such as heart attacks, and at least one documented
suicide, and I have come to attribute this to the dehumanization
process to which we were all subjected during our training.
I can well recall an incident in which
I asked my superior for permission to "leave early"
(6 p.m. on a day when I had been up all night the night
before caring for patients and had already turned over
my patients to another resident for the following evening).
My wife had called me complaining of a high fever and
chest pain. I was told, "If your wife is that sick,
then call an ambulance and have her brought to the hospital,
and if she is not, you don't have to leave early."
Neurosurgeons are not supposed to put their families ahead
of their profession.
Years after I completed my training,
the (new) director of the program, upset after the suicide
of one of our colleagues, asked me whether I thought that
there was "something wrong with our selection process."
I responded that it was not the "selection process"
but rather what we did to the trainees while they were
in the program that was causing the emotional and physical
It is not only the patients who suffer
from the current approach to postgraduate medical education
which, although somewhat less toxic than in days of old,
still represents not only a strenuous process but a grossly
dehumanizing one as well.
Robert A. Fink
Robert A. Fink, who received his
medical degree from the University of Maryland, Baltimore,
in 1961, was a house officer in neurological surgery at
the U of C Hospitals from 1962 to 1966. He has a private
practice in Berkeley and is an associate clinical professor
of neurological surgery at the University of California,