It's an unfair question, of course, but it needs to be asked. This material was originally published as an issue of The Wednesday Letter for July 2000.
This is one in a continuing series of answers to that question. I invite my readers to suggest answers of their own!
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Today's answer:
What's wrong with doctors is their What's wrong with medical education? For one thing, there is a common teaching procedure of giving doctors (when they have become interns) regular schedules so that they get no sleep for 24 to 36 hours. Their schedules are often planned, deliberately, to put the student-doctor into a state of sleep deprivation for the psychological purpose of seeing how he will "act under stress." That may appeal to some, but a more realistic explanation for this procedure is to brainwash the young interns. |
People who want to become doctors are often, initially, motivated by the very highest principals of wanting to help and serve. They also know that there are tons of materials that they don't yet understand. So, they are usually eager to learn and willing to listen.
When they are sleep-deprived is the very best time to teach them according to many educators. They don't have the strength to disagree -- it's just like learning under hypnosis. It "works" in the sense that they learn the data implanted into them, but the process bypasses any shred of personal judgment.
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In a sleep-deprived state the intern will accept the false datum that "60 mg of vitamin C per day is all that anyone needs, and he can get it from his diet!" That is a false datum, but the intern who hears that after 36 hours of no sleep is very likely to accept it without question. Likewise, he will accept a great deal of other information, about drugs, medical procedures, and even medical ethics. Dr. Bok, once the President of Harvard University, criticized his own Harvard Medical School because during the entire medical education, the medical student spent less than 5% of all his class-room time on the three subjects of "preventive medicine, nutrition and medical ethics." Even then, during this tiny amount of time, they "learn" false information. |
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Some of the most dubious information is saved for the time of the internship. The actual teachers during a doctor's internship are nothing more than senior interns -- it is verbal data coming into the head of a sleep-deprived medical student.
Dr. Robert S. Mendelsohn was a regular guest on my nightly radio show many years ago, and commented about this frequently. He even suggested that a medical student who tried to exercise too much "independent thought" during his internship would likely be flunked out. Medical situations often call for quick decisions, and that is no place for an inexperienced and untrained doctor. So, the young interns learn to follow the lead of the older, more experienced interns and doctors. When the young intern is sleep-deprived, he will follow robotically.
The late Robert S. Mendelsohn put forward the word "iatrogenocide" in his best seller, Confessions of a Medical Heretic. The meaning, of course, is death caused by the doctor, but in this case, the death of whole ethnic groups caused by the doctor. I suggest that sleep-deprivation, as in brain-washing, is a deliberate teaching technique in our medical schools, for the purpose of implanting rote certainty on the validity of drugs.
Ten years after medical school, as a practicing doctor, it is THAT education which is at the core of his robotic reaction to any suggestions about "alternative health care."
The typical medical doctor has been brainwashed, with all apparent good purpose, into a slave mentality that is unthinking and non-judgmental about what he believes to be true. There is an excellent article on brain washing available, and the Chapter that mentions sleep-deprivation type actions you can find by clicking here.
Here is an example from the news on June 11, 2000:
June 11, 2000
Interns' Long Workdays Prompt First Crackdown
By ROBERT PEAR
ASHINGTON, June 10 -- The authorities who evaluate medical education have, for the first time, begun to crack down on doctor-training programs that force interns and residents to work excessively long hours.
More than 29 percent of training programs in surgery and internal medicine were cited for violations of work-hour standards last year, according to the private group that evaluates and accredits medical education.
Moreover, after years of debate, some experts now say that sleep-deprived doctors are more likely than other physicians to make mistakes, threatening patients' safety. Medical errors are attracting increasing attention, and the government is contemplating new steps to strengthen how they are reported and corrected.
The new data on work-hour violations came from the Accreditation Council for Graduate Medical Education, the body that sets standards for the training of doctors and measures compliance.
Doctors in training often work 36-hour shifts and 100-hour weeks, and experts in the field say that New York is the only state with a law limiting such work hours.
The council has never before disclosed the number of violations. But Dr. David C. Leach, executive director of the council, said: "There has been an increase in the frequency with which this issue provokes a citation. That reflects an increase in the number of programs that are in violation of the standard for work hours."
The council said it reviewed 69 training programs in general surgery last year and cited 25 of them, or 36 percent, for violating its standards on permissible work hours. Reviewers found similar violations at 7 of the 13 programs in pediatric surgery, 54 percent; 28 of the 92 programs in internal medicine, 30 percent; and 20 of the 69 programs in orthopedic surgery, 29 percent.
The council did not identify the teaching hospitals with violations.
Requirements vary from one specialty to another, but reviewers found frequent violations of three standards in particular. The standards state that residents must have off at least one day out of every seven, should not be on duty in the hospital more often than every third night and should not have to work more than a specified number of hours -- say, 80 hours a week, averaged over a one-month period.
Dr. Rachel R. Marcus, a 32-year-old fellow in cardiovascular medicine at Stanford University, fondly remembers her years in training at a major teaching hospital in Boston, but said: "I was chronically fatigued, so tired I felt as if I was operating in a daze sometimes. You go into medicine for idealistic reasons, but by the end of a grueling internship, you see each patient you admit to the hospital as a barrier to getting sleep. That's a horrible way to interact with people."
Dr. Marcus said residents' lack of sleep could affect their decision-making ability. "I remember one night in the hospital when I told a nurse something that was wrong, the exact opposite of what I should have said about giving antibiotics to a patient," she recalled. "Seconds later, when I was more awake, I realized my error, but I still wonder what might have happened if I'd gone back to sleep."
If a teaching hospital does not correct its violations, it can face serious penalties. A training program may lose its accreditation. If that happens, the hospital will lose some of its Medicare money, and residents will shun the program because they cannot be certified as specialists unless they graduate from an accredited training program.
No training program has lost its accreditation exclusively because of work-hour violations.
The effort to restrict work hours comes as Congress is considering legislation to reduce medical errors and as labor unions are intensifying their efforts to enlist doctors.
Strict compliance with the work-hour standards could increase costs for teaching hospitals, which often rely on young doctors as a source of low-cost labor. Dr. Leach said that budget constraints had forced some teaching hospitals to cut back "support staff," including the people who draw blood and transport patients. Some hospitals use residents to perform such tasks, he said.
"It's said that the health care system is broken and has cracks in it, and that residents live in those cracks," Dr. Leach said. "They are the glue that holds the system together. They get things done even though the system is dysfunctional."
For a decade, New York State has had a law that limits most interns and residents to 24-hour shifts and 80-hour workweeks. But in 1998, the State Health Department found widespread violations. Since then, the state has inspected 35 teaching hospitals and fined 26 of them for allowing residents to work hours that far exceed the limits set by state law.
Without explicitly resisting the work-hour limits, many surgeons have expressed skepticism.
Dr. George F. Sheldon, a former president of the American College of Surgeons who is chairman of the surgery department at the University of North Carolina in Chapel Hill, said: "A surgeon has a fiduciary responsibility to care for a patient before, during and after an operation. You can't punch a clock and say, 'My time is up.' We believe in continuity of care. That is not always consistent with working a fixed number of hours."
Dr. Marvin R. Dunn, who coordinates the council's review of residency programs, agreed. "Continuity of care by the same physician is very important, especially in surgery," Dr. Dunn said. "Errors are made when patients are handed over from the care of one physician to another."
But Dr. William C. Dement of Stanford University, a pioneer in the study of sleep, said his research and observations strongly suggested that "sleep deprivation contributes to medical errors," and that "with more hours of sleep, doctors make fewer errors."
A synthesis of the Russian
Textbook on PsychopoliticsMark L. Levy, executive director of the Committee of Interns and Residents, a labor union with 10,000 members, said that teaching hospitals and medical societies had for years opposed limits on residents' work hours. Medical educators are beginning to enforce such limits, he said, because they want to prevent unions from gaining ground.
"Teaching hospitals and accrediting agencies are trying to clean up their act," Mr. Levy said. "They are becoming more systematic in enforcing work standards. They are finally acknowledging that work hours are excessive. They are doing this, in part, to reduce the appeal of and need for unions."
Dr. Richard B. Reiling, who supervises the surgical residency program at Kettering Medical Center in Ohio, said it was inappropriate to set rigid limits on doctors' work hours.
"In this day and age," Dr. Reiling said, "a lot of residents want the time off not because they're tired, but because they want to moonlight to make extra money to pay off their monumental loans."
Moonlighting -- clinical activity outside an educational program -- is not counted in determining how many hours a doctor has worked. But Dr. Dunn, of the Accreditation Council for Graduate Medical Education, said the organization was considering a change in policy to require that such work be counted.
You think this wouldn't happen? How about the University of Virginia?
The University of Virginia's psychology department, who conceived the project five years ago, has been conducting an experiment using the academic activities of unaware students. Told in the fourth year of high school that they had been accepted to the University of Virginia's Engineering School, the students arrived in droves. Deceived into thinking that doing massive amounts of homework, completing pointless projects, and attending mind-numbing classes were the criteria for receiving a "degree," the students have actually been spending their lives working through a plethora of meaningless busywork. The purpose of this workload is to keep the participants awake for countless nights, and even many all-nighters.
So far, the four-year experiment has yielded fascinating results. The subjects have responded mentally with a zombie-like indifference to all things and stunted social skills. Physically, the students have a sickly, pale pallor, and shrunken genitalia.
The results of the study will be released in several months, at which point it is anticipated that many other colleges across the country will also want to conduct the experiment.
Or, try this one:
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Thoughts Of A Medical Student |
Ironically the most healing I did all day was to squeeze the arm of a classmate being beaten down. Everyone's miserable. The whole mentality is if I can't sleep, if I can't have spare time, neither can you. One resident confided in me that she felt real hatred walking home in the morning as she watched kids running around, people smiling. A real hatred, she repeats.
The interns are the sickest looking people on the floor. As the interns experience the worst time of their lives, they forget that it's probably the worst time for the patients too. The same my-life-sucks-so-yours-should-too attitude towards medical students gets directed towards patients. The roots of the word compassion mean "suffering with," but the interns just suffer alone.[36] I bet that my surgical intern could be hospitalized for depression.
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