Of no fixed abode: homeless house officers

Many years ago when I was first a ward sister a young house surgeon committed suicide and I became aware of how vulnerable we all are. Last year I had the opportunity to talk individually with 10 house officers in a provincial teaching hospital six months after they qualified. These doctors were caring, able people committed to providing a good service to patients and they were some of the most thoughtful, sensitive, lively, and intelligent human beings I have met. Most of them loved medicine—the challenge, the autonomy, and helping people to get better—and they hoped to be rewarded by belonging to the medical team, practising and learning medicine, and “being the patient's doctor.” Instead they were commonly exhausted, stressed, and frustrated, and they felt themselves to be unproductive; on the whole, as they looked at their seniors, they could not see it getting better. What had gone wrong?

“I never have more patients on one ward than any other … mostly I have patients on over 10 wards, very rarely less than 10. I have no ward … I would not know where to leave a coat if I brought one with me.” All the house physicians, and to a lesser degree, the house surgeons, were homeless; trailing all day throughout the hospital like itinerant travellers. This homelessness was a striking change to the traditional pattern of medical firms attached to designated wards. It was caused by a policy of bed scatter, through which a patient was admitted not to a designated ward but to any …