IMAGE:  December 2002 GRAPHIC:  University of Chicago Magazine
Volume 95, Issue 2
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"Now that the joke has been had..."

Marathon medics
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 as well.

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 carnage.

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
Berkeley, California

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, San Francisco.-Ed.

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