It’s Good So Many Want To Be M.D.S

Dear Ann Landers: In your response to “A Witness in N.J.,” you asked for comments from doctors about the problem of overworked resident physicians. As executive director of the Association for Responsible Medicine, a non-profit patient-rights group, I would like to present the patient’s point of view.

The patient is the one who pays the price for a doctor’s exhaustion. Studies show that error rates at teaching hospitals are more than 400 percent higher than at other hospitals. Patients believe the attending physician is performing the surgery while the resident looks on. In reality, it is the other way around.

The other consequence of overworking residents is that it sends them the wrong message about their own fallibility. Doctors who believe they are capable of giving a patient their best effort no matter how tired they are will eventually believe they can perform delicate operations throughout their careers, regardless of their diminished physical or mental capacity and the increased risk to the patient.

Airline pilots, train engineers and even bus drivers have standards for the number of hours they are allowed to work. The medical profession has no such standards with regard to patient safety. That is why more than 1 million people are killed or injured by medical mistakes every year. - Ray McEachern, Association for Responsible Medicine, Tampa, Fla. (www.a-r-m.org)

Dear Ray McEachern: Your letter is enough to scare the living daylights out of all us “consumers.” It also makes us want to stay away from teaching hospitals, which I always thought were the best. Keep reading for another point of view:

Dear Ann Landers: Back in the 1950s, my training in surgery was at Bellevue Hospital in New York City, where an ambulance arrived every 30 seconds. We worked every day and every other night for five years. When our chief took pity on us and lightened our “on call” to every three days, the residents circulated a petition demanding to go back to every other night so we could keep up with our patients.

There is no time when one feels more alive or awake than at 2 a.m., trying to stop the bleeding from a duodenal ulcer or when treating victims in a bad car crash. I stand in awe of doctors who went to Vietnam and Korea and operated 24 hours a day.

Money was never a factor. We were there for training. The most I ever made was $65 a month as a fifth-year resident. Massachusetts General and Harvard paid nothing.

I agree that this profession is in crisis. It’s too late to go back to the time before government, insurance companies and HMO bureaucrats interposed themselves between a doctor and his patient. I cherish those days in training. - Raymond O. Frederick, M.D., St. Louis

Dear Dr. Frederick: Thank you for your experience-laden perspective. Here’s more: Dear Ann: “Witness in N.J.” is right when she says the unreasonable hours worked by resident physicians are better for the hospital’s bottom line than for the training of young doctors. I always said the first 24 hours on call were not a problem. It was the next 12 that were the killer. - Ob/Gyn in North Carolina

Dear Ob/Gyn and all who wrote: After reading my mail, one might wonder why anyone would want to be a doctor, but thank God so many do. Sad to say, many of the top-tier medical schools in the United States are turning away applicants because they simply cannot accommodate them.