Let Me Heal: The Opportunity to Preserve Excellence in American Medicine by Ludmerer Kenneth M

Author:Ludmerer, Kenneth M. [Ludmerer, Kenneth M.]
Language: eng
Format: epub
Publisher: Oxford University Press
Published: 2014-08-31T14:00:00+00:00

HOUSE STAFF ACTIVISM

The voices of house officers had always been discernible to medical educators. From the beginning house officers had shared their views with their teachers as to what was working in their education and what was not: which rotations were the most successful, which conferences were the most rewarding, which attending physicians provided the most effective teaching, which consulting services offered the most timely and useful help, which nursing and hospital services functioned the most efficiently, and which low-level chores were the most burdensome. Thus, the house staff contributed to the year-by-year improvements that virtually every residency program made. House officers also communicated with fourth-year medical students who were considering applying to their program. This they did directly, through interactions with students appearing for intern interviews, as well as indirectly, by relating their experiences to the dean and personal friends at their medical alma mater. A contented house staff proved instrumental in attracting qualified applicants for the next year, whereas disgruntlement discouraged applicants. In these ways, interns and residents shaped their environment, as their environment shaped them.

Through the mid-1960s, house officers usually expressed their opinions politely. They came largely from middle-class or affluent family backgrounds, and they had little inclination to challenge authority by displaying unconventional attitudes, dress, or behaviors. They felt comfortable in medicine’s button-downed, white-coated, conformist, sometimes dictatorial culture. During or after residency, many of them gladly joined the highly conservative American Medical Association, with its strong free-enterprise, antigovernment, and antilabor positions. When house officers objected, they did so courteously and respectfully.26

Before the mid-1960s house officers also tended to cast their criticisms toward noncontroversial matters, such as the capabilities of particular teachers or the quality of various conferences. The most emotionally charged issue of the era was salary. For instance, in 1964 house officers at the University of California, Los Angeles, engaged in what for the times was considered a “lengthy and acrid debate” with hospital administrators on the subject of their pay.27 In a petition with four pages of signatures, house officers said to the administration, “We the undersigned, and our families, would appreciate knowing why we have been denied a living wage.”28 Before 1965, however, house officers did not make the academic medical center the subject of their scrutiny, much less broader political issues of any sort. Indeed, like most Americans, they were enraptured with the hospital’s image as a charitable, nonprofit institution that provided invaluable services to the community. It was this view of hospitals that justified the low salaries and benefits they traditionally paid their workers. It was also this view of hospitals that allowed them a specific exemption from the Taft-Hartley Act of 1947, which meant that hospital employees could not unionize.29

In the late 1960s, house officers became much more restless. Animated by the fervor of the civil rights movement, the anti–Vietnam War protests, and the in-your-face youth rebelliousness of the period, the voices of house officers, like those of students in general, for the first time became strident, their rhetoric radical, and their methods confrontational.

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