ctd Around the turn of the twentieth century as medicine got organized along the Johns Hopkins model, training of graduating doctors started. This consisted of an Internship and residency training. Internship consisted of working in a hospital under practicing physicians, practically 24/7 and living in the hospital. Hence the term 'Intern'. Following that was the choice of going into general practice or continuing further training to specialize as medicine was developing very rapidly. This required a 'residency' the duration of which was two to five years depending on the specialty. The residency was similar to Internship, requiring a stay in the hospital with gradual responsibility and training. Hence the term- Residency.
When I started Internship in the year 1963, it was proportioned into rotation through Surgery, Medicine, Ob-Gyn and Pediatrics. The work hours were every day, alternate nights and alternate week-ends. Week-end was half day Saturday and Sunday. Before the weekend off you had to work Thursday morning through Saturday noon- continuously.
The work consisted of doing History and Physicals and orders on new admissions, drawing blood for lab tests, starting intravenous treatments, taking EKGs, making rounds with the resident then with the attending physician. assisting in Surgery, seeing patients in the outpatient clinic, attending conferences and seminars, answering calls and pages from the nurses and sometimes even transporting patients to O.R. or X-ray. Unbelievable you say- believe it. You can check this with anyone who trained at the time. Residency in Surgery was similar. In a medical specialty the on call became every third night. How did we do it? Everything goes through acceptance then adaptation. Acceptance- it was our choice to train. Adaptation is learnt, and is fast if you have no choice. You learnt to organize your time, eat when you had the time, learn how to be wide awake when called for a problem by the nurse and fall right back to sleep and to ignore the call when the fellow Intern's phone rang- and sleep through it. You learn to take cat-naps whenever you can and find time for some fun. It sounds inhumane and impossible now. It was neither. It was tough and demanding but rewarding. To see a patient with a serious illness or gun-shot wound who you took care of or helped operate on, walk out of the hospital well, is priceless, and its own reward. All this made us who trained in the era- better human beings and physicians-I think. Not anyone can do it. Those who couldn't either dropped out or chose comparatively less demanding specialties. I am not aware of anyone I know of who had a 'burnout' or complained. Training in medicine was hard and difficult but it taught us a lot. To follow an illness closely- recovery from it, the complications and sometimes failure and death. It was an intensely human experience. A patient was not just a disease treated by whoever happened to see him, but a person, a person you followed and cared for. A patient could bond with the doctor who took care of him day in and day out- not just whoever was on call. There was a human touch in medicine, not the impersonal care we see now. This is not just nostalgia but a fact. (to be ctd)
