The not-so-good old days

Recently I had the opportunity to hear Stephen Bergman, psychiatrist and author of The House of God¹—the classic satire about newly minted physicians—speak at a local hospital. So on Class Day, when it was my turn to address our graduating medical students, I began by sharing a few of the dictums of a key character in the novel—better known as the Fat Man’s Rules:

• At a cardiac arrest, the first procedure is to take your own pulse
• If you don’t take a temperature, you can’t find a fever
• The delivery of good medical care is to do as much nothing as possible.

Perhaps it was my delivery, but there was very little reaction to what I fondly remember as a dark comedy informed by a core of truth. Afterwards, I learned that most of the students had read Bergman’s book, but simply could not relate to the unsupervised care, unbearable workloads, and unthinkable demands that are the cornerstone of the story.

After a bit of reflection, I realized that this makes sense. Residents are no longer expected to work 72 hours in a row, run the emergency room alone, or live 5 minutes from the hospital—or face dismissal. Internship and residency remain rigorous. But the mistreatment of interns and residents is no longer routine, overt demeaning of patients and families is rare, and zero-tolerance policies for drunk attending physicians are in place.

In short, the world in which I trained is long gone, and the excesses of a bygone era seem as anachronistic as Mad Men advertising executives having cocktails at lunch.

Nowhere is the transformation more visible than at VA facilities. Once a bastion of smoking patients, absent attendings, and inadequate resources, Veterans Affairs hospitals have become models of quality improvement, integrated services, and exemplary care.

Indeed, the change is heartening. Now, instead of telling students I remember when we walked 5 miles uphill both ways, I talk about how much medical education has changed for the better. Yes, I understand that today’s trainees don’t get the breadth or volume of experiences that my peers and I did. But the closer I get to the age when hospital care is virtually inevitable, I’m happy that The House of God has gone the way of trephining and rotating tourniquets.

Recently I had the opportunity to hear Stephen Bergman, psychiatrist and author of The House of God¹—the classic satire about newly minted physicians—speak at a local hospital. So on Class Day, when it was my turn to address our graduating medical students, I began by sharing a few of the dictums of a key character in the novel—better known as the Fat Man’s Rules:

• At a cardiac arrest, the first procedure is to take your own pulse
• If you don’t take a temperature, you can’t find a fever
• The delivery of good medical care is to do as much nothing as possible.

Perhaps it was my delivery, but there was very little reaction to what I fondly remember as a dark comedy informed by a core of truth. Afterwards, I learned that most of the students had read Bergman’s book, but simply could not relate to the unsupervised care, unbearable workloads, and unthinkable demands that are the cornerstone of the story.

After a bit of reflection, I realized that this makes sense. Residents are no longer expected to work 72 hours in a row, run the emergency room alone, or live 5 minutes from the hospital—or face dismissal. Internship and residency remain rigorous. But the mistreatment of interns and residents is no longer routine, overt demeaning of patients and families is rare, and zero-tolerance policies for drunk attending physicians are in place.

In short, the world in which I trained is long gone, and the excesses of a bygone era seem as anachronistic as Mad Men advertising executives having cocktails at lunch.

Nowhere is the transformation more visible than at VA facilities. Once a bastion of smoking patients, absent attendings, and inadequate resources, Veterans Affairs hospitals have become models of quality improvement, integrated services, and exemplary care.

Indeed, the change is heartening. Now, instead of telling students I remember when we walked 5 miles uphill both ways, I talk about how much medical education has changed for the better. Yes, I understand that today’s trainees don’t get the breadth or volume of experiences that my peers and I did. But the closer I get to the age when hospital care is virtually inevitable, I’m happy that The House of God has gone the way of trephining and rotating tourniquets.

Recently I had the opportunity to hear Stephen Bergman, psychiatrist and author of The House of God¹—the classic satire about newly minted physicians—speak at a local hospital. So on Class Day, when it was my turn to address our graduating medical students, I began by sharing a few of the dictums of a key character in the novel—better known as the Fat Man’s Rules:

• At a cardiac arrest, the first procedure is to take your own pulse
• If you don’t take a temperature, you can’t find a fever
• The delivery of good medical care is to do as much nothing as possible.

Perhaps it was my delivery, but there was very little reaction to what I fondly remember as a dark comedy informed by a core of truth. Afterwards, I learned that most of the students had read Bergman’s book, but simply could not relate to the unsupervised care, unbearable workloads, and unthinkable demands that are the cornerstone of the story.

After a bit of reflection, I realized that this makes sense. Residents are no longer expected to work 72 hours in a row, run the emergency room alone, or live 5 minutes from the hospital—or face dismissal. Internship and residency remain rigorous. But the mistreatment of interns and residents is no longer routine, overt demeaning of patients and families is rare, and zero-tolerance policies for drunk attending physicians are in place.

In short, the world in which I trained is long gone, and the excesses of a bygone era seem as anachronistic as Mad Men advertising executives having cocktails at lunch.

Nowhere is the transformation more visible than at VA facilities. Once a bastion of smoking patients, absent attendings, and inadequate resources, Veterans Affairs hospitals have become models of quality improvement, integrated services, and exemplary care.

Indeed, the change is heartening. Now, instead of telling students I remember when we walked 5 miles uphill both ways, I talk about how much medical education has changed for the better. Yes, I understand that today’s trainees don’t get the breadth or volume of experiences that my peers and I did. But the closer I get to the age when hospital care is virtually inevitable, I’m happy that The House of God has gone the way of trephining and rotating tourniquets.