Though this statement is a reference to gambling, I began to think about the hospital as the "house" and what the hospital might be "winning" from us. This analogy is an easy one to make. We are surrounded by "house officers" and "residents", terms which suggest that one lives at the hospital. Interested in this concept, I set about to do some research on where the origins of the term "resident" come from.
- The idea of a resident is based on the medieval European concept of an apprentice. Terms used for doctors-in-training during 1500-1700 include: walkers, dressers, clerks of the house, house physicians, house surgeons, residents, and interns.
- Apprentices had to pay for the privilege of medical training (much like we pay for med school...)
- "Rounds" is a concept that also developed during this time period. Trainees would watch the master at work as he attended to the patients.
- Residents actually resided at the hospital long-term and received room and board.
- Residency was an indentured apprenticeship. They had to pay back time working for the hospital after residency in exchange for training.
- The current length of medical school plus a 3-year general residency is equivalent to the length of indenture by apprentices in the 1600s.
So basically our current model for rounds and residencies dates back to more than 400 years ago - what?! Considering that there have been drastic changes in medicine since that time, it is astounding that we still manage our patients and trainees in the same way. So can a medieval model of physician training still meet our needs in the 21st century? Well, that's a whole other issue.
In our own era, medical students and residents spend so much time in the hospital that it feels like they live there. This makes it hard to separate work life from home life because Work = Home. When these lines blur, one feels that all of one's energy is being consumed by the hospital. And so the hospital eventually wins our time, our money, our effort, and our ability to care. The house always wins.
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