A dark shade of gray

May 18, 2008 at 8:53 pm | Posted in interviews | Leave a comment

Well, I didn’t get that spot. All day Friday it felt like a truck had run over me. My poor patients had a very crappy doctor that day. And it’s still unclear what I’ll be doing next year. I know this much, however: I will not be doing something in medicine other than neurosurgery. Thank God I’m not in a position where I have to take whatever field I can get into.

I haven’t published the posts in question, but I very nearly walked away from medicine entirely last June. The only reason I didn’t was because I gave my word to my program director. People may flatter themselves that there were other reasons. But in reality, every other consideration weighed against that decision. Not that the loyalty has been repaid at all.

So I’ve already thoroughly considered my options in that respect. And as a side note, you’d think people would know me well enough by now to know that I don’t make empty threats, I don’t take positions I can’t defend, and that having given my word pretty much outweighs any other consideration, as long as it’s not taken lightly in return.

There is a significant amount of institutionalized lying in medicine. And unfortunately, the work hour rules have had the effect of institutionalizing it further. My program is practically the poster child for work hour compliance, and even here we can’t make it work when there’s zero tolerance even for trivial, but honestly reported, violations. Sometimes it just doesn’t make sense to hand off a task when it will take the next person twice as long to do it half as well.

And in a conflict between telling the truth and having your program’s accreditation yanked vs. doing the right thing by your patient and lying about how long it took you, there is simply no right answer. So people lie of their own accord, knowing that if they are caught they will be completely disavowed by their program for doing so. But knowing, also, that if they don’t their program may be shut down – ironically, for training exactly the kind of surgeons everyone wants to have: dedicated, honest, thorough, skillful.

Contrary to what you might expect from the above rant, I do think work hour restrictions are a fundamentally sound idea. I just think the ACGME is a little too inflexible in their application, and has implemented a black-and-white rule for an issue that really needs a case-by-case application of human judgment instead. Much like all the rest of medicine.