Letters to the Editor - June 14, 2004

In calculating return on investment from educational costs, law and business trump medicine - There is a place for humor in medical crisis situations

In calculating return on investment from educational costs, law and business trump medicine

Regarding "High medical school debt steers life choices for young doctors" (Article, May 17): Your article drew attention to a critical problem, but it contained one major factual error.

The article states that becoming a doctor is a better-paying investment than law or business.

Economic analyses done by William B. Weeks, MD, and Amy E. Wallace, MD, in 1995, and again in 2002 showed that medicine had a lower return on investment than the other professions.

In 1995, specialty care medicine was a better investment than dentistry, but by 2002, even specialty medicine had fallen behind.

Medical education debt is skyrocketing out of control, driven mainly by unrelenting increases in medical school tuition that have exceeded inflation every year for the past two decades.

Numerous studies have shown that these high debts are driving new medical graduates away from primary care and out of medically underserved areas.

The debt burden is falling more heavily onto minority and low-income medical students, decreasing the diversity and cultural awareness of our physician work force.

Organized medicine, legislators, and medical schools must come together to solve this crisis now, before there are no physicians left who will care for America's underserved and underinsured.

--Alik Widge, Pittsburgh, chair, Task Force on Medical Education Debt, American Medical Association Medical Student Section

Editor's note: Our article should not have used the term "return on ... investment." The Assn. of American Medical Colleges used another standard, "net present value" in the study we cited.
We regret the error.
Our wording was intended to reflect a passage in the college association's report that stated, "The calculation [of return] certainly indicates that a medical education is a worthwhile finacial investment."

There is a place for humor in medical crisis situations

Regarding "Exam room comedy best used with caution," (Article, May 24/31): Despite the "rules" given for bedside humor that reject humor in crisis situations, physicians who routinely deal with medical crises know that humor often can help patients, their families and caregivers more calmly handle trying circumstances.

As an emergency physician in a busy university hospital/trauma center, I often have found that patients who are aware of their situation often derive comfort from gentle humor from their own caregiver -- or among caregivers.

"Your wife told me that you really came here for the food!" I might tell someone around whom we are busily scurrying to treat his acute MI. His smile -- or oftentimes a pretty good stab at his own humorous retort -- alters his attitude, as well as that of everyone else in the room.

Humor that acknowledges the situation and includes the patient and family in the joke (rather than making jokes at a patient and family's expense) greatly calms the situation. It emphasizes the team effort -- thus including the patient and family to be a part of the treatment effort -- and often seems to even improve the patient's condition.

Humor often can be vital for staff and trainees. When, for example, senior staff members enter a situation in which residents are in trouble managing a critical patient, self-deprecating or stress-deflating humor helps re-establish resident confidence and often puts a resuscitation or critical procedure back on track.

"I think your only problem here is that there is a full moon" is rather weak humor, but being so innocuous and nonjudgmental, it often achieves the desired goals of restoring resident assurance and smoothing kinks in the resuscitation process.

When medical crises occur, they stress physicians who don't deal with them on a daily basis. To these physicians, they certainly don't appear to be the site for jokes.

For emergency physicians, intensivists and trauma surgeons who routinely deal with these catastrophic events, however, humor is part of our armamentarium and a measure of our savoir faire.

--Kenneth V. Iserson, MD, Tucson, Ariz.