Grueling feference to residencies in the US...

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The surgeon-author Richard Selzer writes the following in an introductory piece to a text entitled Ward Ethics―Dilemmas for Medical Students and Doctors in Training:

"Medical students are so altruistic and humane when they start and then somewhere along the line they lose it, it’s beaten out of them. My own training as a surgeon is an example. Training in surgery has traditionally been carried out "en militaire." It was awful when I was in training because the brutality was handed down from the chiefs of surgery all the way to the chief resident, the intern, the medical students, and the nurses. We learned to pass on the brutality because it had been done to us and if you quailed or if you showed any kind of fear or sense of having been embarrassed, then you lost points and you were subject to further ridicule. It was a bad way to become a doctor because it was inhumane. You were brutalized emotionally, and sometimes physically, and it still goes on. "

Basically, I wanted to ask your opinion as residents how much does it picture the reality.
Is residency such a dehumanizing process?

 

[Blade28]

Is it as bad as before? Definitely not.
Does this culture still exist? Absolutely.

 

[DebDynamite]

Is it as bad as before? Definitely not.
Does this culture still exist? Absolutely.

Totally.

 

[Blade28]

I should add that I was referring to General Surgery, in particular - other fields may be a little more warm and fuzzy. 🙂

 

[I am Hans]

I would look at Selzer's works with the knowledge that he trained over 50 years ago when residency was much, much different than it is now. Residents may have lived in the hospital (ie, "house officers"), had no work hour restrictions, little time for outside interests - including family and there was a great deal of pride and public respect in being a physician

Selzer retired from active medical practice many years ago...perhaps 20...and has not worked in the academic sector during more recent changes in training - reduced work hours, more women, more ancillary services, changes in payor/payee issues, etc.

Finally, he has admitted in the past that his works can border on fiction...that is, he is not writing a factual recounting of his experiences, but rather the experiences as he remembers them, perhaps embellished for good storytelling although always trying to give the reader the general sense of what his experience was.

That is not to say that there has been a GREAT deal of change in residency training...much of what he writes about the loss of innocence and altruism is true for many, as is the often daily humiliation and disrepect that training physicians are dealt. General surgery probably is worse than most and resistent to change...there is a lot of machismo and pride in who works the most hours, has the worst Chief, etc.

So, take Selzer's words with a grain of salt...the flavor of what he writes about is still there, but the meal is a bit different (lousy analogy I know, but it sounded good when I thought of it!)

 

[mlw03]

The surgeon-author Richard Selzer writes the following in an introductory piece to a text entitled Ward Ethics―Dilemmas for Medical Students and Doctors in Training:

"Medical students are so altruistic and humane when they start and then somewhere along the line they lose it, it’s beaten out of them. My own training as a surgeon is an example. Training in surgery has traditionally been carried out "en militaire." It was awful when I was in training because the brutality was handed down from the chiefs of surgery all the way to the chief resident, the intern, the medical students, and the nurses. We learned to pass on the brutality because it had been done to us and if you quailed or if you showed any kind of fear or sense of having been embarrassed, then you lost points and you were subject to further ridicule. It was a bad way to become a doctor because it was inhumane. You were brutalized emotionally, and sometimes physically, and it still goes on. "

Basically, I wanted to ask your opinion as residents how much does it picture the reality.
Is residency such a dehumanizing process?

i can't speak to residency, but i can say that as a third year medical student i was dumped on more by general surgery and ob/gyn far more than the other clerkship's residents. that said, they still weren't that bad to me as a student. however the surgical and ob/gyn residents definitely seemed to work incredibly rough hours. i'll also say that at surgical M&M there was definately a "how tough are you" attitude among the surgeons who clearly got their rocks off by berating the residents. i imagine this will change with time as a somewhat more humane generation of surgeons takes the place of these crusty old white men who clearly devote their entirely lives to being surgeons. but until some of these bastards die off, watch the hell out. i think you'd be hard-pressed to find a lot of people who didn't think general surgery is still the most brutal residency out there in terms of dehumanizing its residents.

 

[3dtp]

... however the surgical and ob/gyn residents definitely seemed to work incredibly rough hours. i'll also say that at surgical M&M there was definately a "how tough are you" attitude among the surgeons who clearly got their rocks off by berating the residents. i imagine this will change with time as a somewhat more humane generation of surgeons takes the place of these crusty old white men who clearly devote their entirely lives to being surgeons. but until some of these bastards die off, watch the hell out. i think you'd be hard-pressed to find a lot of people who didn't think general surgery is still the most brutal residency out there in terms of dehumanizing its residents.

I agree with you. But, this is also highly program dependent, even inter-specialty. My OBG program was highly humane, and although I took credit for causing a complication in an M&M, my attending who actually did cause the complication immediately stepped in and told the assembled multitude waiting to hang me upside down that, in fact, I had not caused the complication and had performed properly, but as he put it, "in fairness to the resident, we should be aware that his attending was the one that caused [the complication]" There are many programs where that wouldn't have happened.

That being said, there are OBG, surgical, internal medicine and many other programs that are brutal and run by brutes. It is a shame we can't safely put up a "rogues gallery" to list the evil programs and evildoers who run them.

 

[speyeder]

It depends. Some of the surgical subspecialties are not as malignant. Ophthalmology in particular is pretty laid back for a surgical field.

 

[Annette]

Some of the altruism and humanitarianism is beaten out by residency, but also by the patient population. I gave up counting how many people had "scored" narcs out of me. Some of the more demanding patients tried and tried my patience many times. (Ma'm if you don't let the surgeons take your leg, you WILL lose your life. "You want to chop off my leg just because I'm black!") The self-described "brittle" diabetic drinking regular soda pop while waiting for me in the exam room. Just learning that you just can't help somepeople takes alot out of you.

As residents, you are treating some of the worst-off people there are- poverty, mental illness, drug addiction, abuse. Then there are the people who really touch your heart, and you can't do a damned thing to help them. If you don't steele your heart, you can't survive.