To the People of the United States [1944 Film about Syphilis]: 

This film stresses the intensity of the problem of syphilis by numbers of cases and cost in dollars and heartache. Shown are the importance and relative ease of detection and cure, and a comparison to Denmark’s syphilis program. Film also includes exterior shots of the Public Health Service building in Washington, D.C.; Oregon State Hospital; Arizona Hospital for Mental Diseases; and the National Soldiers Home. In addition, it shows the following scenes: the Flying Fortress taking off; children playing; women working at machines in a factory; people bowling, diving into a pool, playing tennis, plowing fields, harvesting crops, Girl Scouts marching, and babies in an infant nursery in an army hospital.
Hospital, Episode 1
Two patients await life-saving surgery at St Mary's in Paddington.

Holby peeps- if you can access iPlayer I highly recommend giving this a watch. It really brings home the challenges facing the NHS when it comes to the lack of beds. 

It’s something we don’t really see on screen- we’re so used to multiple ops being carried out on the same day and all the surgeons, anaesthetists etc being able to get on with their jobs without having to check if there’s a bed for their patient to recover in. 

Also, I would love to see an episode built around this issue. Where there are no free beds in the hospital, and Darwin and Keller spend the morning wrangling over who should get the one ITU bed that may or may not become free. And Sacha wins because his patient’s op has already been cancelled once and they try to avoid multiple cancellations where possible. And then it becomes moot because a trauma call comes in and acute lifesaving surgery has to take priority. So Jac has to tell her patient that his op has been cancelled, Sacha has to tell his patient that her op has been cancelled again, and by the end of the day the only surgeons who have seen the inside of an operating theatre and actually been able to do their jobs properly are Bernie and Serena.

ELI5: Why do many doctors work in crazy 24-36 hours shifts?

The most common answer that was given to me during my training was that working an extended shift allows one to see and understand the evolution of an acute disease process through the patient’s initial presentation and progression through therapy. The more of that illness you are physically present for and participating in, the greater the learning and reinforcement in your mind.

I was never really satisfied with that answer, and it’s partially BS - some of it has some credence. But in reality, the real answers are multi factorial. I’ll list some of the reasons here.

  • Medicine has a very strong sense of tradition. It is a hierarchical structure and is deeply committed to the preservation of standards. I found it to be very much like the military. The “father” of the American medical training system, William Stewart Halsted was known to work exhaustively and expect the same of his trainees - men like Cushing and Dandy. Later on, brilliant surgeons such as Michael Debakey continued to promote the necessity of 100% devotion to the patient in the form of grueling work hours and little to no time off. There are countless war stories of these men and their often brutal treatment of their trainees. I remember one apocryphal story about Debakey taking the new interns to the main hospital lobby doors and telling them they wouldn’t go through those doors for the next year.
  • There is also an ingrained culture of “I trained this way, and you must also in order to be a competent physician”. If I had a dollar for every time during training that I was told the ACGME work hour restrictions were creating terrible doctors, I’d be able to pay of my student loans before the next millenium. Since the dawn of time, old crusty docs have been bemoaning how easy the residents of today have it.
  • Nobody becomes a physician without at least some sense of altruism, even the most craven among us. When there are sick patients to be seen, it’s really hard to mentally justify “going home to go to sleep” when someone or some family is having the worst day of their life. It sounds trite, but when someone is sick and needs my help, I have a really hard time assigning a higher priority to my own rest. (That’s probably partially my Catholic guilt). Human misery is endless and does not rest.
  • Medicine is not a 9-5 job. People will always get sick at odd hours, and someone will always need to be available to do an emergent thoracotomy at 2am. You can’t work shifts as a trauma surgeon. There just aren’t enough of them, and I doubt there ever will be. The training is too long and arduous to ever expect to get to a supply of trauma docs (or Ob-Gyns, or Pediatricians) where every little hospital in the US has enough of them to staff rotating shifts like nurses.
  • There is an enormous amount of work to be done in today’s hospital, and so much of it is clerical. Services need to be covered with residents, call schedules, back up call schedules, vacations, clinic hours, etc. Those 24 or more hour shifts allow residents to have some precious days off once in a while.

-Finally, and I know may people will howl at this point, but I do feel working 28 hour shifts made me a better doctor. I know it did. Specifically, it taught me to think on my feet, prioritize, and overcome (to a degree) fatigue. I am not claiming I am immune to fatigue or that I am as effective after hour 26 as I am after hour 4. The ACGME and many others like to make a big deal about work hour restrictions during residency, but what never gets talked about is that for many of us docs, life after residency can be even harder. And there are ZERO restrictions on the hours attendings work. In my past job (which I quit) after working all day in the office and rounding in the hospital, I was expected to take phone calls for ED admissions and for moronic patient questions all night long, every 4th night. I did that for 5 years.

Explain Like I`m Five: good questions, best answers.

It occurred to me recently that your average hospital is filled with so many great people, that it’s often hard to tell them apart. So here’s a handy guide to some of the people you’ll meet in hospital.

Today’s team is…assorted cool people you might meet on the ward!

I’d of course like to write much more about what these amazing people do, and how great they are, but my comic is wordy enough as it is. Needless to say, hospital wouldn’t be the same without them. I’m still working on more people to include, so it’s not an exhuastive list…

Talk about Aleppo.
Our silence is killing them. They are people, PEOPLE!!!
Are they not important because they’re arabs?
because they’re Syrian?
Do their lives matter less than the life of a French or an American?
People from Aleppo are posting their goodbye messages on the internet as a final massacre is expected to happen any time soon and we are SILENT….

We have been silent for over five years.
Some children in Aleppo don’t know life without war.
Imagine living in a city of ruins and having to fear for your life every instant.
Hospitals,mosques, churches, houses, restaurants are bombed on the daily and hundreds are killed every single day.
Yet we are silent.
Remember them.
Honor them.
We’ve allowed a mass genocide to happen before our eyes for years.
It’s burning is a testament of our moral failure!!!
Talk about Aleppo, please.
Pray for them!