Us against the "system": Troy Madsen's Story

[Krafty]

Here's the story about outing Hopkins IM program for their blatant human rights violations:

Troy Madsen's Story [AMSA.ORG]

Interesting read.

Comments?

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[Fermata]

Working over a 100 hours a week isn't pleasant...but it's a human rights violation?

 

[MacGyver]

Working over a 100 hours a week isn't pleasant...but it's a human rights violation?

Yes, for the PATIENTS.

Only the most egotistical prick would sit there with a smug smile on his face (I'm looking at YOU, Dr. Charles Wiener at Hopkins) and try and claim that working those kinds of ridiculous hours doenst hurt patients.

 

[Fermata]

Yes, for the PATIENTS.

Only the most egotistical prick would sit there with a smug smile on his face (I'm looking at YOU, Dr. Charles Wiener at Hopkins) and try and claim that working those kinds of ridiculous hours doenst hurt patients.

That is a legitimate point. However, it is not a human rights violation.

Btw, if you applied to Hopkins IM back then, then you should have been aware of the intensity of the program.

 

[flighterdoc]

That is a legitimate point. However, it is not a human rights violation.

Btw, if you applied to Hopkins IM back then, then you should have been aware of the intensity of the program.

IIRC, the complaint he made was after the 80-hour rule went into effect, which the IM service was blatently ignoring. Which is why they got decertified (for a week or two).

 

[misfit]

Speaking of the "intensity" of Hopkins IM program -- the residents there have been traditionally known as "Osler's Marines." Intense, indeed.

And, IMHO, absolutely miserable and malignant. What good is dealing with their crap when you can learn IM better in 100 other places without the attitude?

misfit

 

[Old MD]

What good is dealing with their crap when you can learn IM better in 100 other places without the attitude?

misfit

Bash them all you want about their noncompliance with the 80 hour rule. But save the (envy-motivated?) put down. Learn IM better in 100 other places? Stupidest crap I've heard today. There is no place on the whole fuking planet where you get better training. There are 2 or 3 places where you get equal training.

 

[kinetic]

Bash them all you want about their noncompliance with the 80 hour rule. But save the (envy-motivated?) put down. Learn IM better in 100 other places? Stupidest crap I've heard today. There is no place on the whole fuking planet where you get better training. There are 2 or 3 places where you get equal training.

Yeah! Don't all you non-Hopkins people know you're all just a bunch of ******s anyway? OK OK, MAYBE we'll let you Duke guys live because you're just as stuck-up as us Hopkinites. Let's get together and fly into the sky because we're Supermen!!

 

[Homunculus]

from the Johns Hopkins response: "I confess that my aequanimitas faltered after the ACGME investigation."

aequanimitas?? if they talk like that on the wards, it wouldn't take me nearly 30 hours to not understand things

 

[misfit]

Old MD:

You can slur me all you wish, but one does NOT have to endure the machismo of Osler's Marines to learn to be excellent IM physicians.

I believe people often get caught up in dogma and become brainwashed by it; I believe this is the case with the true-believers in the righteousness of Hopkins' program.

I will still stand by my original post and I in no way envy Hopkins residents; I feel sad they got caught up in the fallacy of "being the best."

misfit

 

[The White Coat Investor]

"Hopkins residents are known for the intensity of their work, and our approach has nothing to do with testing endurance limits or being victims of abuse. Rather it is a reflection of our commitment. We believe shift work to be antithetical to the responsible practice of internal medicine and that nothing dehumanizes patient care more than abdicating responsibility for a patient at an arbitrary hour.

I was discouraged by the negative press and concerned that medical students might never learn our perspective on training and medical practice. I hope, however, that word will spread that we do practice the truest form of medicine at Hopkins, and that will never change."

Is it just me, or this the Leggo speaking? "I thought all my boys loved me...." Who the hell would actually want to train in a House of God when you can get training somewhere that would allow you to maintain a life at the same time?

 

[gmonavydoc]

Dr Madsen is a person of character and did a very brave thing while the Hopkins establishment hid behind their elitist name which means nothing to anyone except them. Patients don't even know what an internist is let alone anyone can get into a IM residency somewhere. J-H may have a good IM program but it can be taught anywhere and is without all the elitist BS the Hopkins weasels brought to the party. Haha Weiner!!!!!!!!!!!...looser.

 

[Gleevec]

I can't help but laughing at Hopkins response, which completely ignores all the relevant issues and tries to sell the school's intensity.

The whole 80 hour rule began when an 18 year old girl died of meningitis in NY. A grand jury determined that residents were overworked. Further studies showed that some of these residents had GREATER impairment than someone legally drunk, but that they still had more confidence in their decisions than drunk people-- a very dangerous combination.

I dont think anyone disputes that academically (research), JHU has a fantastic IM department. And if you are one who learns by working 120 hours a week straight with little sleep, and dont really care about if patients are hurt in the process-- well, JHU seems to be up your alley. And honestly, how much more are you going to learn in near-coma hour 110 than you would during barely-awake hour 95? There are diminishing returns, and then there are diminishing gains.

But lets not forget the real reason the 80 hour rule exists. Its to protect the patients. Protecting residents is just a side effect. I like how the response somehow ignores the patient protection aspect completely. Then again, I guess since a lot of the patients residents treat at Hopkins are from the surrounding poor area (since the faculty and fellows probably are the only ones that touch the foreign wealthy patients) patient protection is kind of pushed aside for the sake of "training"

 

[Fabio]

I liked your response, Gleevec.

Can I ask exactly what criteria make JH the "best" IM program in the country? Are we referring to US News and World Report again?

There's gotta be at least ONE JH IM resident who is happy there, right? Was everyone really as miserable as we are painting them out to be? I don't know any medicine residents at JH, so I can't vouch for that.

Does anyone have any info on the fallout as a result of Dr. Madsen's report? For example, did JH get fewer applicants, etc.? Did anyone leave?

Thanks.

 

[theD.O.C.]

In answer to the question of there being at least one happy resident at Hopkins. Well, around Hopkins we have a saying, "Johns Hopkins is a great place to be from". I think that about sums up the atmosphere and training at that place. for good and bad

 

[Gleevec]

I liked your response, Gleevec.

Can I ask exactly what criteria make JH the "best" IM program in the country? Are we referring to US News and World Report again?

There's gotta be at least ONE JH IM resident who is happy there, right? Was everyone really as miserable as we are painting them out to be? I don't know any medicine residents at JH, so I can't vouch for that.

Does anyone have any info on the fallout as a result of Dr. Madsen's report? For example, did JH get fewer applicants, etc.? Did anyone leave?

Thanks.

I know a couple of former JHU residents, they're really great people. Honestly, I dont want to come across as having beef with JHU, because in general the people there are fantastic. Its just the small minority of residents that were in cahoots with the seemingly corrupt administration that have caused all these problems. Im sure 95% of the school had nothing to do with this, but its the 5%, and namely those in the upper levels of managment, that have really irked me on this issue.

 

[purpledoc]

The whole 80 hour rule began when an 18 year old girl died of meningitis in NY. A grand jury determined that residents were overworked. Further studies showed that some of these residents had GREATER impairment than someone legally drunk, but that they still had more confidence in their decisions than drunk people-- a very dangerous combination.:

Just a quick correction. The 80 hr rule in NYC began after the Libby Zion case in 1984, in which this 18 y.o. woman (daughter of a famous newspaper columnist and former DA, Sidney Zion), entered New York Hospital with a high fever. She died in less than a day while under the care of an intern and resident, with an attending available by phone. The death may have been caused by the administration of Demerol while she was taking an MAOI; Ms. Zion might or might not have used cocaine and not told the doctors about other prescription medications. A grand jury investigated and found that both fatigue and lack of supervision in the residency system played major roles in the incident, though it found neither the residents nor the hospital at fault. Sidney Zion did sue, and eventually won $375,000 from 3 of the 4 doctors involved.

At any rate, after this case, the Bell Commission was formed -- a committee appointed by the NYC Commissioner of Public Health and chaired by Dr. Bertrand Bell. The recommendations included a limit of 80 hrs average work per week (averaged over 4 wks), max 24 hrs on call, and minimum of one 24 hr period off work each week. These recommendations were then made into law, known as section 405, which also included rules about supervision. This then became a model for the rest of the country, with similar laws being instituted elsewhere. However, it is not a federal law.

As for studies showing that people overestimate their abilities after lack of sleep, that wasn't related to the residents in this case, though the essential conclusion is correct.

 

[WatchingWaiting]

Here's the thread from last year about the probationary status at Hopkins. There was a Hopkins resident (Linie) who tried to do flak duty for Hopkins, so you can get an insider's scoop:

http://forums.studentdoctor.net/showthread.php?t=80437

 

[Gleevec]

Just a quick correction. The 80 hr rule in NYC began after the Libby Zion case in 1984, in which this 18 y.o. woman (daughter of a famous newspaper columnist and former DA, Sidney Zion), entered New York Hospital with a high fever. She died in less than a day while under the care of an intern and resident, with an attending available by phone. The death may have been caused by the administration of Demerol while she was taking an MAOI; Ms. Zion might or might not have used cocaine and not told the doctors about other prescription medications. A grand jury investigated and found that both fatigue and lack of supervision in the residency system played major roles in the incident, though it found neither the residents nor the hospital at fault. Sidney Zion did sue, and eventually won $375,000 from 3 of the 4 doctors involved.

At any rate, after this case, the Bell Commission was formed -- a committee appointed by the NYC Commissioner of Public Health and chaired by Dr. Bertrand Bell. The recommendations included a limit of 80 hrs average work per week (averaged over 4 wks), max 24 hrs on call, and minimum of one 24 hr period off work each week. These recommendations were then made into law, known as section 405, which also included rules about supervision. This then became a model for the rest of the country, with similar laws being instituted elsewhere. However, it is not a federal law.

As for studies showing that people overestimate their abilities after lack of sleep, that wasn't related to the residents in this case, though the essential conclusion is correct.

Thanks for the more thorough synopsis that I was too lazy too type out.

 

[Old MD]

Old MD:
You can slur me all you wish...

I wasnot "slurring" you. I agree with the new work hour restrictions, and I think Hopkins should have followed them. I thought the ACGME acted appropriately. I think people who voice disapproval of Hopkins not following the rule are quite right: I wrote "Bash them all you want about their noncompliance with the 80 hour rule".

What i disagreed with was denigrating the quality of Hopkins training. You can get better IM training at 100 other places? Don't make me laugh. Yes, there is little objective measure of such things, but by common consent in this country and abroad the Department of Medicine at Hopkins is among the finest in history.

Great training depends not just on mundane things like proper scheduling, it depends on the quality of teachers, the quality of the teaching methods, the research environment, the quality of your peers, the variety of the cases, the patient census, the quality of the other programs and departments... In all of this Hopkins is fabulous.

Sure, I'll bet you could find places that religiously kick their residents out of the hsopital so that they do 60 hours or whatever, and I'm sure these guys will be able to concentrate sooo much better, but that does not mean that their training will be better than at Hopkins, which is what you are implying.

but one does NOT have to endure the machismo of Osler's Marines to learn to be excellent IM physicians.

I like the straw man.

The one and only one point I made was to disagree with the claim that you can get better IM training than Hopkins at 100 other places.

 

[Old MD]

Yeah! Don't all you non-Hopkins people know you're all just a bunch of ******s anyway? OK OK, MAYBE we'll let you Duke guys live because you're just as stuck-up as us Hopkinites. Let's get together and fly into the sky because we're Supermen!!

A little less brain-farting, a little more thoughtfullness. Or, as you like to term it, "Logic".

 

[xmxpro]

Yeah! Don't all you non-Hopkins people know you're all just a bunch of ******s anyway? OK OK, MAYBE we'll let you Duke guys live because you're just as stuck-up as us Hopkinites. Let's get together and fly into the sky because we're Supermen!!

Are you sure you are a doctor? From the sound of it, you are a little kid picking a fight with another 5th grader at the park.. Get a life, and maybe mom and dad will send you to prep school, and you can be a PA or nurse someday.

Have a great day,
MD

 

[kinetic]

Are you sure you are a doctor? From the sound of it, you are a little kid picking a fight with another 5th grader at the park.. Get a life, and maybe mom and dad will send you to prep school, and you can be a PA or nurse someday.

Have a great day,
MD

Wow, you sign your posts "MD"? You penis is really that small? Do you also wear your stethoscope when you go to the park? "Just in case"? Ha ha ha! Oh, I also like how I have to go to "prep school" to be a "PA or nurse". I'm sure you're going somewhere with that -- like, in your puny mind you probably think it's a double whammy by calling me "rich" -- but it doesn't even make sense. Who writes your material? Are you just asking the local prostitutes (i.e., your dad) to come up with some comebacks?

 

[xmxpro]

Wow, you sign your posts "MD"? You penis is really that small? Do you also wear your stethoscope when you go to the park? "Just in case"? Ha ha ha! Oh, I also like how I have to go to "prep school" to be a "PA or nurse". I'm sure you're going somewhere with that -- like, in your puny mind you probably think it's a double whammy by calling me "rich" -- but it doesn't even make sense. Who writes your material? Are you just asking the local prostitutes (i.e., your dad) to come up with some comebacks?

Easy buster... I was just busting your chops. Can't we have any fun... Hard to be serious being post call. MD is my first and last name.

Regards,
MD

 

[Doctor&Geek]

Easy buster... I was just busting your chops. Can't we have any fun... Hard to be serious being post call. MD is my first and last name.

Regards,
MD

I just love it when people go on a tirade, only to find out that it was completely uncalled for.

 

[kinetic]

I just love it when people go on a tirade, only to find out that it was completely uncalled for.

Hope you're not talking to me because all of my ass-kicking is strictly by the book. If you want to poke the dog, you get your hand bitten.

 

[Apollyon]

Hope you're not talking to me because all of my ass-kicking is strictly by the book. If you want to poke the dog, you get your hand bitten.

I have to support kinetic here. I didn't see anything that made me think it was a joke. I did see the humor in his piece that started this little dustup. (I thought he was referring to me with the Duke comment.)

 

[kinetic]

No, this is what I was referring to (and P.S., this post was not in response to anything I said):

Bash them all you want about their noncompliance with the 80 hour rule. But save the (envy-motivated?) put down. Learn IM better in 100 other places? Stupidest crap I've heard today. There is no place on the whole fuking planet where you get better training. There are 2 or 3 places where you get equal training.

 

[Dr Dean]

RARRRRRRRRRRRRRRRRRRRRRRRR It's initiation rites I tell you. RAAAAAAAAAAAAAAAAARRRRRRRRRRRRRRRRRRR