Sunday, February 10, 2008

My Training Experiences

I read an article about residency training in "Pharos," the Alpha Omega Alpha magazine. AOA is the Phi Beta Kappa for medical students. It spoke of the long hours house officers have to be on duty. Of all the people in the world, doctors (in charge of training programs) should know best that prolonged wakefulness and lack of sleep could lead even the best trained and most motivated doctor to make avoidable mistakes. This provoked me to write this and send it to the author of the article.
79. Training experiences
My internship and residency experience
When I graduated from medical school in March 1946, I thought that I wanted to be a thoracic surgeon-based more on my admiration of Duane Carr, a Memphis thoracic surgeon, than on my talents and inclination.
I chose Henry Ford Hospital for a rotating internship majoring in surgery. My work (training) schedule was as follows: Two of us interns would be assigned to a floor. One would be in the operating room assisting (far down the line). When the operating schedule for the assigned room was over, the intern could go home. We did not receive quarters or food, but did receive a stipend in lieu of maintenance. Since I was married, this worked out very well. At first I received $150 a month, but this was soon raised to $170. We had no children and my wife had a full time job.
The floor intern took care of the patients (under supervision of residents and a full time paid staff). This intern had the responsibility for working up (examining) patients admitted that afternoon for surgery the next day. When these tasks were done, the intern could go home.
We had night residents-one on medicine and one on surgery. These doctors went on duty at 10:30 and off the next morning at 7. Since we did not have charity patients (except the children from the Michigan Children’s Service (Protestant) and St. Vincent de Paul (Catholic) orphans, we did not have a big emergency service as so many charity hospitals did.
My internship was for fifteen months due to the end of the nine-nine-plan that was in use during World War II.
I then had obligated service with the Army due to my having been in medical school on the Army Specialized Training Program. After twenty months as a medical officer at the 130th Station Hospital in Heidelberg, I returned to Ford Hospital. During my army service I had decided that I really wanted to be a physician rather than a surgeon.
Medical residents were assigned two months stints on various services. Ford Hospital had sub-specialists even back then. Cardiac, Respiratory, Metabolic, Gastro-Enterology, Preventive Medicine, Rheumatology, Pediatric Cardiology (Mason Sones had his training there), Allergy, several General Medicine sections and New Patient Group (where patients new to the Ford system had a complete physical), Neurology and Psychiatry.
I spent two years rotating and then I was appointed one of five assistant resident physicians. We supervised the interns and took call every five evenings from 5 until 11 after which we could go home. In this position I was paid the princely sum or $400. That was a lot for those days and the dollar had a lot more purchasing power than it has now. My wife continued to work until she had our first child in October 1950.
So enlightened treatment of house officers began long ago. I felt that I had a superior training and was well equipped to practice internal medicine. Back then in this town, Kingsport, Tennessee, internists did all the medical consulting work Later on I was involved with training the first crop of interns associated with the medical school established in Johnson City (twenty miles from here)-the Quillen School of Medicine of East Tennessee State University.
Later on I helped with the instruction of the medical residents.
As to working hours in training, eighty hours is plenty. There are only a hundred and sixty-eight hours in a week. Of all the people who should know better than to have someone awake and working for thirty-six hours straight, it should be doctors. Training should not be an ordeal or trial by fire. Doctors should have a life-not that I am not in favor of doctors being dedicated to the care of their patients. During the earlier years of my time in Kingsport, I was working about seventy hours a week.
I reluctantly retired at age seventy-five. The onset of “subspecialitis” and the invasion of medicine by lawyers, insurance people, government regulations and business men took much of the fun out of it.
Donald W. Bales, M. D. AOA of Tennessee.