Journal Questions Doctors Training in Vein

By Jessica Reaves Thursday, Dec. 30, 1999
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For those interested in facing mortality head-on, there are few better routes to grisly self-discovery than medical school. Unfortunately, according to a report in Thursday's New England Journal of Medicine, at least one commonly-used teaching technique may compromise young doctors' ability to see their patients as human beings. For many years, interns and residents have practiced a critical — some say unnecessarily invasive — procedure on patients who have failed to respond to 20 minutes of resuscitation and who are moments from clinical death. It's then that new doctors, who often find themselves under pressure to quickly deliver fluids or medication to critically ill patients, practice threading a tube into the patient's femoral vein. This training maneuver is generally performed without a patient's or family's consent or knowledge, and its proponents argue that performing the same technique on a cadaver doesn't give doctors the same real-life exposure. Of course, as the procedure's detractors point out, cadavers also don't offer the ethical dilemmas posed by experimenting on live subjects.

"It's certainly valid to wonder whether this procedure has the potential to foster some sort of apathy towards patients," says TIME medical contributor Dr. Ian Smith. "But it's difficult to strike a balance between the need to teach residents and interns the procedures they need to know to save people's lives with the need to provide patients with unwavering comfort of care, right to life, empathy and respect." These two positions are neatly represented in Thursday's report; of 234 residents and interns interviewed, two-thirds felt the tube-threading procedure should not be performed. The remaining doctors disagreed, saying the maneuver would help them learn, and treat future patients better. "This process brings up something people are uncomfortable with," one doctor not involved in the study told the New York Times. "Doctors must learn to care for patients and master their skills on patients. Doing it in a responsible and ethical manner is a responsibility of all of us who teach."