Why Cocaine Dictates Residencies, and How to Create New Stories

Stories dictate our lives. For proof, I offer this: it’s a well-known fact that medical students in their residences spend more time in the hospital than out. A 100hr week is normal, even though the lack of sleep is very dangerous. But why?

The short term answer, which I found from the book Why We Sleep by Matthew Walker, is cocaine. More specifically, the answer lies in William Steward Halsted, MD, a brilliant physician who founded the Johns Hopkins surgical training program in 1889. Halsted believed that med students needed to live in the hospital – to be residents of the hospital. As Walker says,

To Halsted, sleep was a dispensable luxury that detracted from the ability to work and learn. Halsted’s mentality was difficult to argue with, since he himself practiced what he preached, being renowned for a seemingly superhuman ability to stay awake for apparently days on end without any fatigue.

But Halsted had a secret that only came to light years after this death, and helped explain both the maniacal structure of his residency program and his ability to forego sleep. Halsted was a cocaine addict.

Matthew Walker, Why We Sleep

But the longer answer, and perhaps the more interesting one, is why – knowing this information – residencies are still so onerous? This is where stories come into play.

A history of old stories

Even knowing that sleep deprivation is responsible for raising the risk of medical errors by over 53%, many medical faculty are proponents of intensive residency programs. One surgeon was quoted in the New York Times, saying:

When I trained, good or bad, I worked about 120 hours a week. That was just expected. Today the average resident finishes with around 900 operative cases. I finished with twice as many.

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In other words, “if I had to do it, you should too.”

This is how stories work. The longer we hear them, the more we believe them. Commercials repeat until we are humming “Nationwide is on your side” in our sleep. Fables grow over the years. In a fun (fictional) example, in the recent Marvel movie The Eternals, we learn that the Eternal Icarus is the same Icarus we know from Greek mythology, simply because he has been around for so long that they created stories about him.

The amazing thing about stories is that we can also create new stories to affect change.

Create new stories

When we create new stories, we change the future. Sometimes these stories come from research – and more often from a combination of research and marketing (one need only look at vaccine hesitancy to understand that research alone is not enough). Already, thanks to research over the past few decades and good marketing campaigns, new stories are resulting in changes to residency requirements.

I’ve seen the culture change. There were some early adopters and also some early naysayers who say lack of sleep builds character. But the incorporation of science was a way to get over that hurdle.

Scott Holliday, MD
The Ohio State University College of Medicine

The Accreditation Council for Graduate Medical Education has now limited first-year residents to working no more than an 80 hour week. It’s a small step, but it shows how research and data on sleep deprivation and burnout are having an impact. Maybe if we tell more stories about how much better doctors work when they sleep well, we can make more changes.

What new stories are you telling? How are you creating new stories for your organization, or your industry?

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