Wednesday, October 27, 2004


Sleepwalking Through Surgery

Megan McCardle, currently guest-blogging at Instapundit, asks a good question: why does the medical profession overwork its interns?

I have no patience with the way hospitals work their interns and residents. I've never heard a good explanation for why we want our junior medicos, who provide a lot of our front-line care, in a state of perpetual exhaustion; most revolve around the utterly unconvincing idea that they somehow need to learn to work under pressure, as if they were all going to be disaster-relief doctors. After a few weeks, older doctors assure me, they learn how to cope.
She eventually concludes it's done because they are such cheap labor, which is true, but I think there's a social factor at play, as well.

I think it's also an important rite of passage. They're being indoctrinated to be doctors, and there's a lot of pride in that, and maybe a bit of tribalism too. Becoming a doctor should be seen as difficult; it justifies the prestige and wealth of the position, and instills a sense of pride and purpose in those who achieve it. They'll be all the more proud of their accomplishment, and presumably devoted to their profession, for having busted a gut to get there. And the the rest of us will accept it that way, too.

Could we accomplish the same thing without putting exhausted rookies in charge of life or death situations? Of course, and I think we should. But we won't get there without first understanding why we've got the system we've already got, and the rite of passage is a part of it.