From: km@speedy.cs.pitt.edu (Ken Mitchum)
Newsgroups: sci.med
Subject: Re: Questions for MDs
Date: 30 Jul 92 13:36:23 GMT
Reply-To: km@cs.pitt.edu (Ken Mitchum)
Organization: Computer Science Dept., University of Pittsburgh

In article <55403@mentor.cc.purdue.edu> hrubin@pop.stat.purdue.edu (Herman Rubin) writes:
>In article <15851@pitt.UUCP> km@cs.pitt.edu (Ken Mitchum) writes:
>
>			....................
>
>>Training is a side issue. I have no objection to cutting down on
>>intern and resident hours, if the number of years of training is
>>increased to make up for it. You can't learn the same amount
>>working 40 hour weeks as working 80 hour weeks.
>
>One can even raise the question as to whether one learns more in
>80 hour weeks than in 40 hour weeks, or less.  
>
>But in any case, the amount of training should be totally irrelevant.
>We should not be at all interested in time served as a student or an
>apprentice or whatever.  It is the knowledge and ability which is what
>should be considered.

Herman, again, you are talking about a subject of which you know
absolutely nothing. The knowledge a medical student has when then
MD is granted at the end of medical school is very minimal. The
real learning comes in internship and residency (and possibly
fellowship) and you learn medicine only one way: by seeing and
caring for patients. 

TIME is extremely important for several reasons. Doctors have to be
trained so thoroughly that the vast majority of their work becomes
routine and automatic, and that means that you have to see common
things over and over again.  When I get someone bleeding from
esophageal varices, I have to do about thirty things in the first five
minutes, and order about thirty more things, and that has to be so
automatic in my mind that I don't miss one thing and have the patient
die. 

You can criticize and say that all the doctors should see patients
when they've had a full night's sleep, but the real world is
different: unless you have a very genteel practice, you are always
going to have to see and treat patients at inoportune times and
in the middle of the night. What most people don't understand is
that the interns and residents are deliberately overlearning a
great many routine things so they can do them at 3 am with no sleep.
The risk from this is minimal, as interns and residents do not
function alone, and they are seldom all trashed at the same time.

TIME is also important because there are some diseases you only see
rarely, and if training is abbreviated, you won't run into them. There
are several diseases that I have only seen once, and if my training
had been abbreviated, I would have missed them. 

There are aspects of medical training that really are hazing, and 
these should be elliminated, but the time spent in training is not
one of them. The time element varies quite a bit between specialties,
and this is natural: the specialties that rarely deal with emergencies
and think-on-your-feet situations have far less grueling schedules. 

Herman, I know that you would like to be treated by a doctor who
sits in a library and doesn't waste his/her time touching people,
but I wouldn't. I have known a few physicians like that and without
exception they are idiots.

 -km