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Follow-up on "Gold Medal"...Who wants to be average?

Mike Souter trauma-list@trauma.org
Fri, 21 Jun 2002 21:39:23 -0700

I'm following this thread with interest. I have some sympathy with Dr
Mattox's views, having recently moved from an environment (ie the UK)
where we have seen European legislation limit the working hours of
junior doctors.  The result has been a definite shift mentality with
continuity of care suffering. The short term answer has been an increase
in the workload of already hard-pressed senior staff, to maintain
standards of care.  I frequently would watch with bemusement as the
trainees with whom I had done a full 24 hours on call would go off the
next morning, while I had to stay and fulfill my obligations for that
next day.
At the same time, I know that my most positive educational experiences
were not when dog-tired, and I performed and learnt better when I had
been rested.  I had more time to read, analyze, and use the clinical
experiences I had more profitably.
So I think we need to divorce the teaching and standards argument from
the fulfillment of service requirement argument, and recognize that
there are two partially conflicting issues interacting.  
I do believe that training could be considerably better - on both sides
of the Atlantic.  I have seen nothing here to commend the practice of
exhausted residents operating all throughout the night, and then the
next day.   Their mental acuity is visibly poorer as a result.
The same can be said of senior staff.  In my previous institution I once
had to forcefully intervene and send the operating surgeon off for some
rest, as I saw him falling asleep at the microscope, as we were on hour
22 of what was a difficult 26 hour procedure.  
If I am sick, I want someone well trained looking after me. I do not
want someone exhausted looking after me.  
The most hard pressed environment I have ever been in, was as a serving
officer in the British Navy, on patrol in a nuclear submarine.  The
demands of ability and concentration there exceeded anything I have ever
encountered in clinical medicine, and I have the utmost respect for the
professionalism of the commanders of those craft.  But they knew that
they had to rest, in order to perform efficiently over long periods of
time, and they deployed their team accordingly.  Heroics were
counterproductive, and those who attempted them distrusted.  
So I have always viewed the claims of those who state that the only way
to produce a good service is to be there perpetually, with some
cynicism.  I distrust the egotistical, almost by reflex.  I know there
are alternatives.
There has to be some middle ground, in order to train good residents
efficiently, yet recognizing that there is a service requirement and
commitments of care to be met. 
We just need to be honest about what our motives and goals are.  Doing
otherwise will only confuse the issue and delay resolution of the

Mike Souter.
(steps off his soap-box)...

Dr M J Souter
Associate Professor
Anesthesiology & Neurointensive Care
University of Washington
Harborview Medical Center
Box 359724
325 Ninth Avenue
Seattle WA 98104

> -----Original Message-----
> From: alt-owner-ccm-l@list.pitt.edu
> Sent: Thursday, June 20, 2002 8:44 AM
> To: trauma-l@lists.aast.org; trauma-list@trauma.org;
> Subject: Follow-up on "Gold Medal"...Who wants to be average?
> What does it take to achieve greatness in any field? What are the
> teachings that separate the average practitioner of an art form from
> masters?  The secret is diligent practice followed by more diligent
> practice, to which is added sacrifice.  Whether the art be music,
> athletics, the military, martial arts or surgery...the same holds
> effort. diligent practice and sacrifice lead to mastery.  This all
> requires time.  However, in order to sacrifice and put in the
> effort and time, one must not select a field with one's mind but with
> one's heart, that is, one must have a passion for one's chosen field.
> truly believe that surgery falls into this category.
> I was not trained by average surgeons.  I was not trained to be
> I do not want to train those who want to be average.  I do not want my
> wife and children to be taken care of in the hospital by anyone who
> settled on being average.  Do you????
> If you are concerned about the new regulations on resident work hours,
> then the time to speak up is now or else you and your loved ones may
> cared for by someone who received average training and will deliver
> average care.  I, for one, do not want to settle for average.
> john porter
> university of arizona