Being a doctor is a universally respected vocation. The title of ‘doctor’ that we pin to the start of our names from the day that we leave medical school carries with it connotations of working long, hard hours and making numerous personal sacrifices for the betterment of others. I have always been, to some extent, cynical about this unanimous praise. Firstly, we commit years of our lives towards becoming a doctor, with full awareness of the difficulties it entails, so our situation can hardly be compared to unassuming World War conscripts. Furthermore, as with any job, if it was that bad we could hand in our notice and pursue different professional avenues.
In Matthew Walker’s wonderful book, Why we sleep, he mentions an interesting fact about the origins of intensive medical and surgical training programmes.
Dr. William Halsted was an incredibly dedicated 19th century US surgeon, who is considered the ‘Father of Modern Surgery’. He played a significant role in the many surgical advances that were taking place at the time. He was also deified for certain remarkable feats such as performing one of the first cholecystectomies (gallbladder removal) in US history under suboptimal conditions (operating on his mother on the kitchen table at 2 am).
He is better remembered for setting up the residency training programme in the US. Halsted’s trainees initially began an ‘internship’ of uncertain length, from which, in true Mr. Miyagi fashion, they could only proceed upon Halsted’s approval. The term ‘residency’ was chosen because the hours were so intensive that junior surgeons would, quite literally, have to reside at the hospital. Current residency programmes in the US are notoriously intensive, so we can only imagine the intensity (or insanity) of Halsted’s programme which existed in an era free from the red tape of safe practice regulations. Legend has it that Halsted required that his residents be on call for 362 days per year.
This is, obviously, categorically beyond the functional limits of any human being, so how did Halsted manage to work so much himself?
It was later revealed that Halsted had a voracious appetite for cocaine which fuelled his inhumane level of activity. He had initially been toying with cocaine as a potential anaesthetic agent to use in surgery, but he quickly became hooked on the extra hours of focus and wakefulness that it provided for him.
Such a revelation was too late to change the course of the toxic mentality that had been set in motion and was already being vertically transmitted through generations of doctors at an alarming rate. A lack of sleep has shown, on countless occasions, to have disastrous consequences for patients. A direct violation of the Hippocratic oath that we all proudly recite upon starting and finishing medical school.
Thankfully, things have improved considerably since then, especially in the UK. No doubt, there will be certain rotas that leave little time to engage in other activities, however, it is a far stretch from the cocaine-powered 362 day on calls of days gone by.