Saturday, June 11, 2011

Another dark corner of health care… Residency

Passages that make you wonder about the people taking 17% of GDP:

I could spend days telling you tales of horror, but one quick instance springs to mind. I had a bad two months at a county hospital because many of the physicians who worked there demanded that I do things that I felt were not only bad ideas, but also borderline unethical. I refused, and also refused to keep my mouth shut about it. When the end of the rotation came around, I sat with the physician who was to evaluate me. He told me I was going to get a crappy evaluation. He asked me why I couldn’t just keep my head down and conform. This guy had literally made a career out of “sticking it to the man”, and was known as an iconoclast; the irony was lost on him. He ended by telling me he felt compelled to try and sabotage my fellowship application. He said this with a straight face.

Even today, ten years later, I shake with anger as I write this.

This kind of thing happened every day. Physicians don’t talk about it, but we all have stories. The system covers up incompetence and punishes independence. We keep a hierarchical structure in place which continually reminds you that someone is on the bottom. And, more than anything else, we fight to defend this system against all encroachment. We all know, deep down inside, that having an underclass of physicians who will do all the crappy work, all night, all weekend, for relatively little money is the only way to hold it all together.

It’s rotten, it’s wrong, and I loathe it.

I’ve said before that doctors are people and subject to the same biases and failings as anyone else.  When we turn a blind eye to those failings and put them on a pedestal we shouldn’t be surprised that abusive practices proliferate.  The residency system is one manifestation of such practice.  Can you think of any other service which systematically exploits recruits like this?  I can

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