This afternoon, one of the female surgeons who is an authority in the program was scheduled to do a very routine procedure on a person who is a very high authority in the hospital. (You see, I don’t dare be any more specific, even by reversing the details.) The chief, without warning us, sent the two medical students to see her, and scrub in, since the residents have had enough, and too much, of this procedure. The nurse stopped us, saying, “Do you know that this person is ——- ?” So we discreetly sat down at the nurses’ station to wait half an hour for the surgeon to come, so we could ask her opinion/permission, before intruding ourselves upon the august person. (Who could be the pleasantest person in the world; all we know is the nurses guard-dogging the curtain.) The surgeon, when she arrived, shook her head. Perhaps it would be better just to leave her alone on this one. She said, “I almost want to bring you in, so this person will know what it means to be in a teaching hospital; but, s/he also has to meet all of these people every day.”

So the two medical students wandered off, meditating on the nature of insurance/noninsurance/medicaid/important person/street person/medical student in the corner. We ourselves wouldn’t want to be seen by medical students either; so the hypocrisy is not limited to the administrator-patient, or the nurses and surgeon. I have heard of residents who let themselves be operated on, or themselves or their wives delivered by fellow residents; but I can’t imagine it. (I also have to admit that very few laypeople, and not that many even of the nurses and ancillary staff in this hospital, know the difference between a medical student and a resident and a regular doctor; so perhaps it doesn’t make such a difference to them. On the other hand, among ourselves, we know that the difference is not just privacy/prestige, but skill. (Understanding that even if there’s only one private doctor taking care of you, yet the nurses know all about what’s happening, and discuss it, and if it’s interesting enough the house staff will hear about it too.) On yet another hand, most of what happens in surgery will work just as well, whether done by the intern or the attending. When it’s important, like ligating the renal artery directly off the aorta, the attending takes over. As for internal medicine and peds, the residents know more about the newest medicines and the latest standards than the nonteaching attendings do. So perhaps one is better off in a teaching hospital.) And of course, the bottom line is, you can’t have new doctors without teaching hospitals.