Spark [Robert_Klitzman]_When_Doctors_Become_Patients(Boo | Seite 290

Improving Education 279
Although they would like to provide ideal care, many factors can sty-
mie these doctors’ best intentions. In the end, physicians were only hu-
man.
In the current, ever-changing health care system, professionalism itself
is in crisis. Many concluded that doctors were often less conscientious,
and that medical education needed to embrace professionalism and a
sense of responsibility more. As Nancy, the endocrinologist with cancer,
observed, ‘‘We should teach not just humanism, kindness, and empathy;
but how to behave professionally.’’
Reduced supervision by overworked attendings can further lower
standards. Nancy complained of physicians becoming ‘‘lax.’’ For exam-
ple, she felt that chief residents no longer reviewed patients’ charts to
check for errors or suggest improvements far less. She added:
There are all kinds of abdication of responsibilities. Residents are
technically not supposed to do things, but it’s sort of ok, and ev-
erybody gets used to this loosey-goosey kind of moral responsi-
bility. A nice chief resident had been doing little procedures for
attendings on the side, unsupervised. He wasn’t supposed to. But
the department had kind of set a tradition. He got caught. I’m sure
he thought: they have been doing it for years. It’s all sort of lack-
adaisical. It’s probably necessary in a hospital, to avoid losing
money while taking care of poor patients. A strength of our pro-
gram is that you are very autonomous.
Nancy herself was ambivalent about the pros and cons of such inde-
pendence as a trainee, citing both advantages to students and costs to
patients, and highlighting the conflicting pressures teaching hospitals
confront.
Some of these doctors urged trainees to collect detailed histories de-
spite increased pressures to do otherwise. However, given the shortened
amount of time physicians have with patients, trainees often resisted
gathering such ‘‘ideal,’’ full medical backgrounds. Harry said, ‘‘I taught
students to do an hour and a half initial history. They said, ‘What are we
going to do with that?’ ’’ Students perceived that such attention was no
longer the norm. Stuart remarked:
I told students how to take a history and a sexual history. They
turned to me as if I were speaking Greek: ‘‘We’ve been in primary
care offices. Nobody does this.’’