Medical Training

Beneath the vivid imagery within the House of God, Shem unveils in his novel a certain degree of truth about conditions in residency that are both equally shocking and disturbing. Although set during the 1970s, many residents still continue to be overworked and underpaid today. It is unnerving that hospitals would allow the quality of care from their doctors to be comprised by factors such as sleep deprivation, fatigue, and in Shem's novel, alcohol. In addition, I was most intrigued by the dynamics between the resident, Roy Basch, and the relationships he forms with the colorful spectrum of characters in the medical hierarchy from the Fat Man to the gomers to Dr. Sanders.

There are regulations that limit residents to an 80-hour week, but these are mere voluntary guidelines especially for hospitals that are short-staffed or do not have deep pockets. I would like to believe that the conditions in which Roy Basch and his fellow interns worked in are entirely fiction, but therein lies two real problems in medicine: cost versus care and instruction of residents. From concierge doctors and the pharmaceutical industry to healthcare and the medical resident, the issue of cost versus care arises in various aspects of medicine. Most doctors do not enter the medical field because of the money, but it is definitely in their minds that medicine is a stable, comfortable, and lucrative profession. Shem's novel also raises the question is the medical hierarchy necessary? If not, is there a better method of teaching medicine than doing on actual patients? Is there no other way than placing human lives in experienced hands for the sake of learning how to place an IV, for example? Even with the attending physician or Chief resident overseeing the procedure being performed, as a patient I would want the most experienced doctor in the room to be giving me the best care available. How do I trust a doctor that has barely got his feet wet?

There are no perfect answers to my questions. I would like to suggest that regulations in residency be more stringent and enforced in hospitals when necessary. There is enough emotional stress and pressures from family without the physical stress and fatigue that accompanies lack of sleep and back-to-back on-call shifts. I do believe in interactive teaching by doing because only then can you apply what is learned in the textbook, but I disagree with the hierarchy in medicine. The intern on the bottom rung should feel free to address his concerns to the attending physician or Chief resident without fear or judgment. It is difficult for me to imagine the difficulties of being an intern, but I do hope that I can learn and prepare to the best of my ability for what may lie ahead.