Despite AIDS suit, residents feel well trained

On Wed., Jan. 14, the University appealed a New Haven court's decision to award $12.2 million to "Dr. Jane Doe," a former resident at Yale-New Haven, who blamed the University for her infection with the AIDS virus. Doe said she pricked her finger in 1988 while performing a procedure for which she had been inadequately trained. While the case has prompted concerns about safety and training at medical schools nationwide, many residents and students at Yale insist that they are well-prepared to deal with the demands and risks of their job.

Yale legal counsel William Doyle, who filed the appeal, said the infection was accidental, rather than the result of poor training. Doyle had announced that the University intended to appeal the verdict as soon as it was handed down on Thurs., Dec. 18.

Although it was rumored that the University planned to blame the hospital, or Doe herself, for the incident, Doyle said, "We've never said that. We believe it wasn't anybody's fault, it was just an accident."

James Borin, MED '98, described medical school procedure: "We have a protocol we call, `See one, do one, teach one.' First you watch an expert do [the procedure]. Then you do one, usually under supervision so you can ask questions. Then you teach someone who has less experience--that really cements the ideas in your head. I think it's the best way to learn."

In her lawsuit, Doe claimed that although she had seen an instructor do an arterial line procedure once before, she had never performed one herself. When Doe's patient's artery began spurting blood, Doe panicked and attempted to stop the flow with her finger, accidentally pricking herself in the process.

Needle pricks are virtually impossible to avoid in hospital work, but are generally not a source of major concern to doctors and residents. "[Needle pricks] happen, but fortunately they're usually nothing serious. It's always on your mind, working with knives and whatnot, so you take whatever precautions you can," one resident said. " I feel that we are absolutely adequately trained."

A doctor performing an invasive procedure usually knows from a patient's medical chart if the person is infected with AIDS. Even so, doctors are trained to always use universal precautions since AIDS and other diseases often go undetected for several years after infection.

Students say potential exposure to AIDS is a serious concern but one they try not to worry about while working with patients. "[Getting AIDS] is something I think about," Borin explained. "It's very easy to prick your finger by accident. It's always a concern, but you think about it more before and after the fact [of the procedure]. If you get too caught up in fear while you're working, you'll slip up. You always have to be focused and concentrating on the patient."

Although the incident has saddened medical students, they are reluctant to place the blame for Doe's fatal accident on the University. "I feel sympathetic [to Doe], but I don't want to say I think it was Yale's fault," Borin said. "It's hard for anyone to know they haven't prepared someone if that person doesn't speak up."

Another anonymous fourth-year student expressed satisfaction with the level of training she has received. "I feel pretty confident. I've never been asked to do something I didn't know how to do," she said. "It's sad that [Doe] has AIDS, but I don't think that's necessarily anyone's fault."

After four years of medical school, students usually spend two years in residency. This grueling experience prepares would-be doctors for the world of hospital work by long hours of constant hands-on training. It also provides school-affiliated hospitals with a handy, unpaid work force, something critics of the system, including Doe's attorney Michael Koskoff, are quick to point out. Residents traditionally work very long shifts with little or no sleep.

Nevertheless, conditions for residents and understanding of safety procedures have improved since Doe's accident nearly a decade ago. "Medicine has changed a lot in terms of safety in the last 10 years," Borin explained. "The idea that interns have a life and should actually sleep is completely new."

Borin suggested that better communication could further improve conditions for residents. "Maybe there needs to be a better awareness that it's okay to ask for help. It's Yale's responsibility to make sure people feel prepared and confident," Borin commented. "I've always felt confident and supported."

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