Even without long hours, residency training would be stressful. Multiple demands are placed on house of
Libby Zion's death1 has changed residency training forever. The public is outraged that life-and-death decisions are made by residents working 36-hour shifts and 100-hour weeks. The medical community debates the merits of the present system, but the general public overwhelmingly disapproves of it and expects residency reform.See also pp 859 and 889.
No abstract
One summer evening in my youth back in a small midwestern town I watched a street-corner spellbinder show us how his particular brand of " snake oil" would penetrate and disappear when applied to a slab of shoe leather."Ladies and gentlemen, step right up. Let me show you how this magic potion, when rubbed on the skin, will cure migraine headaches, bilious attacks, female disorders, eggzema and pimples. Get 'em while they last, folks, 35C a bottle, two for halfa buck."He was a convincing pitchman, and business was brisk. At that time in my life, 35C took a large chunk out of what I made on my paper route, but this itinerant healer seemed honest; he was charming; and that lotion surely disappeared through the shoe leather, just as he said it would . . . and, I had pimples. I handed over my three dimes and a nickel.This almost forgotten vignette came back to me when I read an editorial in The Western Journal of Medicine titled "Integrity in Medicine."' In that essay Dr Watts cited "dishonesty, plagiarism, and outright fabrication of results at some of the most prestigious research institutions in the nation." He pointed to incidents of fraudulent activities by medical students and dishonesty in billing third parties by practicing physicians.What is happening to our proud profession? Are we by default undermining the public's faith in us, spurring the growth of alternative health care?By coincidence, at about that same time I was invited to sit in on a public forum at a Spokane television station. The subject under discussion was to be "Alternative Health Care Practices."Attending this program was an enlightening experience for me. Among the 60 or 70 members of the audience were perhaps a half dozen physicians representing what was referred to as "traditional medicine." The rest were practitioners of various "alternative" callings and their "clients." The implied assumption was, of course, that there is a crying need for an alternative to the traditional type of health care.Sitting to the left of me was a midwife, behind me an acupuncturist, in front was a homeopathic "specialist," and to the right of me, a "reflexologist." You might say I was well surrounded.As planned, the program was dominated by the alternative health care providers. The "reflexologist" was given time to explain how, after attending several seminars put on by The International Institute of Reflexology in Florida, he was able to treat all areas ofthe body by applying acupressure on specific "zones" ofthe feet.The naturopaths, the homeopaths, and the acupuncturists all followed, telling the television audience of their many therapeutic successes. They brought along their happy, satisfied clients to give glowing testimonials.Under the white heat of the television lights, the outnumbered physicians tried to make calm and rational statements about the scientific practice of medicine, the need for adequate professional training, the requirements for doubleblind crossover studies to prove the efficacy of medicines or treatment modalities, and the desi...
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