<p>"1) Do you mean quality of patient care -- perhaps as measured by US News?
2) The maximum number of resident work hours allowed is equal at <em>every</em> hospital, as mandated by national organizations. Either you know this also, or you don't have the background that you claim (or the experience to know the difference).
3) Math 55 at Harvard is tough, and there is a "macho" attitude associated with it too. Yes, I know because I took it. Does that mean that it is also to be "deplored, not celebrated"? If avoiding Hopkins means that medical students are so "smart" as you claim -- should the smart math students also avoid Math 55 or Math 25? Should the smart engineers avoid MIT and Caltech because they're also perceived as rigorous? Please!!!"</p>
<p>1) The US News ranking does NOT meaure the quality of patient care. Just exactly which parameter in the ranking reflect the quality of patient care? And how do you measure the quality? Mortality (but teritary care hospitals get sicker patients)? The percentage of patients in the ER with chest pain who get aspirin or patients with pneumonia symptoms who get started on iv antibiotics soon after arrival? (Yes, there are such statistics but Hopkins is not at the top). Are there any services that Hopkins provides that cannot be provided at MGH? I don't think so. Are there any diagnoses that MGH physicians would miss and Hopkins physicians would get? Don't think so, either. The truth is that it's extremely difficult, if not impossible, to compare the quality of care, unless the difference is very obvious, such as a teritary teaching hospital versus a small community hospital. Anyone else who claims otherwise is lying. The clinical and basic research output can be measured reasonably objectively, on the other hand, and there Harvard well outranks Hopkins.</p>
<p>2) Yes, the work hour rules came into place a few years ago, because of the all the ill effects of excessive work hours I discussed, but it doesn't mean that they are enforced equally at all hospitals. Hopkins is one of the most notoriously noncompliant, if not THE MOST noncompliant, hospitals around and they came very close to losing accrediation several times because of that.</p>
<p>3) I took Math 55 also and incidentally did pretty well (got an A both semesters). I spent close to 20 hours a week on Math 55 problem sets but at no point did I have to skip meals or suffer prolonged sleep deprivation to the extent that I felt exhausted all the time. I could still go to parties and extracurricular activities. The hours I spent on Math 55 problems sets were spent purely exercising my brain and were extremely beneficial. Working 100 hours a week during residency means eating poorly and sleeping poorly to the extent that you cannnot even think properly or drive home safely. Yes, at the beginning, there is a positive correlation between more work and learning but at some point you reach a point of diminishing returns. Working 100 hours a week is at a point where you actually learn less because you are so tired.</p>
<p>To give an example, MGH puts a limit of 5 admissions per night for an intern. Hopkins does not have such a limit. A typical intern on call has to:</p>
<p>1) read the charts of the patient being admitted (which can be hundreds of pages filled with dense information)
2) look up the lab values and radiological study results of the patient being admitted
3) go and talk to the patient and do a "thorough" physical exam on the patient
4) speak to the relatives and visitors if necessary
5) speak to the patient's private physician and if the patient is being transferred from elsewhere, to the physicians from the previous hospital
6) write the orders and request new labs and radiographic studies, enter into the computer, and give specific instructions to the nurses if necessary
7) perform any procedures and draw blood on the patient if necessary
8) call consultant physicians if necessary
9) write a detailed note in the chart about the patients history, physical, and assessment and therapeutic plan
10) teach medical students on call if they are with you
11) do reading on your case if you have time</p>
<p>Even if you are the most talented intern in the world, it takes about 2 hours to do a thorough job on one admission (without cutting corners). If the case is very simple, such as cellulitis or pneumonia, it might take an hour. But on top of this you are also expected to:</p>
<p>1) cover the service for the team, meaning you are in charge of all the patients who are already hospitalized. If something goes wrong, you get paged by the nurse and it could soak up hours of your time.<br>
2) check any important lab values or perform procedures signed out by the interns who left for the night and take any action if necessary
3) answer any codes happening nearby. </p>
<p>There's just no way you can physicially do a good job on more than 5 admissions per night without sacrificing something. To claim that you can take 10 admissions a night without any problem and to think that kind of macho attitude translates into superior training is, well, STUPID.</p>