Q: What Scares Doctors? A: Being the Patient

What insiders know about our health-care system that the rest of us need to learn

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Harvard's Groopman, who has written three books about the doctor-patient relationship, lived through his own doctor-patient nightmare. It started when his son had a medical emergency in July, which every doctor knows is the worst of all months to go to a teaching hospital. "The new interns and residents begin July 1," he explains. "There's a very morbid joke: don't get sick on the July 4 weekend." But years ago, when he and his wife were new parents, they were visiting her family in Connecticut for the holiday when their 9-month-old son became cranky, ran a fever, got diarrhea. They went to a local pediatrician, who essentially said, 'Oh, it's nothing: you're just neurotic doctor-parents. Give him some Tylenol.'"

By the time they arrived back in Boston, it was clear to both of them that the baby was very sick. "He was flailing and arching his knees to his chest. So we rushed to the emergency room of the Children's Hospital." Their son was seen by a brand-new surgical resident, who diagnosed an intestinal obstruction. "This resident said to my wife--this is now midnight--'Well, in my experience, this can wait until morning.'" Since his experience at that point in his residency amounted to roughly three days on the job, the Groopmans pulled rank. They called someone who called someone who happened to be home on the holiday, and they wound up with a senior surgeon who came in, did an emergency operation at 3 a.m. and, Groopman says, saved his son's life.

That was an extreme lesson in the value of experience; no one recommends seeking out doctors who are brand new on the job, and doctors admit to scheduling elective surgery--even planning childbirth--around the intern calendar. This is not paranoia: the average major teaching hospital typically sees a 4% jump in its risk-adjusted mortality rate in the summer, according to the National Bureau of Economic Research. But there is a larger issue that doctors argue about: which matters more, information or experience? Broadly speaking, a younger doctor is likely to have been trained in the newest surgical procedures, be more up to date on the literature, and be more open to new techniques. Older doctors have had more years to develop the instinctive diagnostic skills that can make the difference in complicated cases and may be skeptical of innovations that are driven more by marketing than medicine.

Older doctors are also worried that rules designed to make young doctors' lives easier may make patients' outcomes worse. Back in the day, grizzled veterans say, a medical resident was called that for a reason: he--and they were all men--actually lived in the hospital. "We were aggressive about our training," recalls a former surgical resident at Boston's Brigham and Women's Hospital. "The only thing wrong with every other night call was that you missed half the good cases." But these long hours of dedication came at a cost: tired doctors made mistakes. Studies showed that long work hours increased stress, depression, pregnancy-related complications, car wrecks and damage to residents' morale and personal life. So now residents' hours are limited to 80-hr. workweeks averaged over a month, in shifts that are limited to 24 hours of patient care, with at least 1 day off in 7. Remaining on call in the hospital is limited to every third night. Hospitals that fail to comply can lose their accreditation.

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