Practice makes perfect.

I survived my tenure as the Chief Medical Resident at a university teaching hospital. I watched internS coming and residents going as their ambitions were being ctystallized against a professional and personal life they may not have bargained for. There has been much discussion in the medical literature about the changing nature of medicine. A social, bureaucratic, and technologic revolution in the way medicine is practiced is upon us. This has triggered the uneasy notion amongst house staff that all is no longer goldplated. Education about human beings and their diseases is becoming blurred as a primary reason behind pursuing training in a teaching program. Traditional priorities are being rattled. The generic problems facing house officers have not changed; daily crisis management remains the same. However, personal confusion about what is happening in their own profession has house staff questioning older role models and motivators. Training programs are no longer viewed as protected arenas of medical education. Residents often believe that they are simply performing a job, are less willing to work hard, and are more willing to insist on being rewarded with more time off. Percolating under the surface is the belief that the end is not only unclear, but perhaps a bit tarnished. Future paths, once mapped out so clearly, have begun to buckle under some extraordinary pressures. Profound social changes influencing the way medicine is practiced and paid for have had tremendous impact upon house officers. Physicians are torn in several directions as are their patients. Consumers are developing a heightened awareness of patient rights paralleled by increased expectations that medical care will remain personal. This is happening within the context of highly stylized health plans that evoke from physicians a quality control often first benefiting the organization, of which patients are but one tier. One wonders whether the greater public good reigns supreme in the minds of new physicians who thought that they were their patient’s advocate first and society’s second. Responsibilities and intuitions are being shaken. Administrative duties are becoming more important in a physician’s training. Allegiance to residency as a primarily academic process is being questioned by trainees. A recent study [2] investigating physician job satisfaction in a teaching hospital found that alienation felt among house staff was “indicated by unfavorable attitudes toward their role in making administrative and organization decisions . . . [This is] work over which they had the least control.” Clearly, as medical practice becomes infused with more bureaucratic calculus, care must be taken within training programs not to have the human factor devalued. Healthy physician-patient communication cannot be formed without this happening. New technologic aspects of medicine have affected both patient care and physician training. Technology can at times blur the border between learning about the art of practicing medicine and the potential for overdependence on computerized algorithms. House staff can be overwhelmed by such devices and often feel obliged to use them. To some extent, patients themselves have been conditioned to expect that all available computers be mustered toward solving their particular problems. Indeed, physicians feel forced to comply. However, every complaint cannot be processed by a data base, just as every insurance claim for an expensive test cannot be approved. Expectations by both consumers and providers need to be re-personalized. The humanization of medicine has to be stressed, not stripped, and recaptured, not COdt?d. Baron [3] states that in some facets of medical care, a “shift in focus from human experience of illness to various technologic facts of disease” has occurred. What the patient tells us has diminished in intensity and necessity. “We seem to have a great deal of difficulty taking serious-