Sophie’s choice

May 29, 2008 at 7:01 pm | Posted in professional ethics | 1 Comment

Dr. Alice has made some interesting points about work hours, over on her blog. I think we are mostly in agreement over the issue. Particularly in how it often pits integrity against professionalism, a conflict with no room for compromise on either side.

Our attendings may think us weak because we’re not tested as they were. They should walk a mile or two in our shoes, because I’m pretty sure every single one of us would choose to stay until our job was done, if the associated sacrifice of other values weren’t so repugnant.

I don’t know, maybe it’s not so repugnant to some people. But do I really want colleagues who will lie just to stay out of trouble? Integrity is one of the few things that no one can take from you without your consent and cooperation. To throw it away over a ridiculous and arbitrary rule is sad.

The thing is, there have been rotations where the only thing that kept me going was the knowledge that I could only be tortured for a defined period of time. And then I would have 10 hours to myself before I had to face it again.

But there have been other rotations where I’ve felt offended that some nameless, faceless organization has decided that I have to go home after only 14 hours, and can’t come back until 10 more have elapsed. Especially on neurosurgery, it was very tempting to lie.

And then there’s the issue of proving yourself. It’s hard to do when the requirements are such that even the wimpiest of people can probably suck it up and deal. I’d actually welcome the opportunity to prove that I’m the equal of any old-school neurosurgery resident.

But contrary to Dr. Alice, when people talk derogatorily about women surgeons (although, honestly, no one in my program would dare), I don’t try to hide from view. I think of myself as a surgeon, not as a woman surgeon.

This is a handy mode of thought, because it allows me to separate work-related conversations from social chit-chat. They are two separate conversational styles, and if you’re going to be a surgeon, you need to be able to speak directly and decisively. Which is not, in general, how “nice” feminine women talk. So if you want to be both, you have to know the time and place for each.

It’s really a non-issue for me, because I’ve pretty much been a surgeon by personality all my life. Just ask any of my friends or exes. And no one’s ever called me unfeminine.

But professionalism vs integrity? I’m not comfortable choosing either at the expense of the other. And shame on the ACGME, and in fact the whole medical education system, for putting residents in a position where they have to.