Dilemmas for Doctors

In the November 5 issue of The New York Review, Dr. Jerome Groopman wrote about his experiences observing interns and residents at Massachusetts General Hospital and the way that new technologies and practices have affected the work of young doctors. He recently talked about the subject with Andrew Martin of The New York Review.

AM: In your review, you wrote about leading a clinical conference at Massachusetts General Hospital, thirty-three years after training there yourself. Could you give a picture of what your experience as an intern there was like when you first began?

JG: It was a very jarring experience to begin as an intern. As it happened, I was on call the first night of my first day as an intern, and in those days, you were supposed to be an iron man, meaning that you were on call alone and you were actually discouraged from asking for backup from a more senior resident.

Everything seemed to be under control, and then in the late evening, a middle-aged man whom I was talking to, just getting a social history, sat bolt upright in bed. His chest started to heave and he was gasping for air. I had been a high-achieving medical student. I had gotten good grades in all my courses. I had thought I was prepared and I completely froze. My mind just went blank. I gave myself an F. And almost deus ex machina, there was a cardiologist who had trained at Mass General years before who was strolling through the wards in some sort of memory lane experience.

And he saw me there, and he saw this man in bed, gasping for air. And he walked up behind me, introduced himself, took the stethoscope out of my pocket, listened to the man’s chest, and said, “He just ruptured his aortic valve and he needs to go for open heart surgery immediately.” And so then I was unglued, rushed to the nurse’s station, and fortunately, the man’s life was saved.

AM: Is there more of an attempt now, do you think, to give young trainees more backup or give them more of a sense of community?

JG: That kind of macho, you know, you’re on alone, hold the fort, baptism by fire, all of those clichés are really quite counterproductive and, frankly, dangerous. And it’s very, very different now. There’s much more backup, much more encouragement at every major teaching hospital to have green interns feel completely comfortable and ready to ask for help when it’s needed.

AM: You mentioned in your article the sleep deprivation being a significant factor in the lives of medical students. There have been attempts to cut down on that. But is that still a major factor in the practice?

JG: Well, there are very strict rules now around length of shift from the point of view of safety. There are a lot of data showing that the more exhausted you are, the more …

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