Alcohol has always been a part of a medical education, and a very sick liver is no barrier to professional progress
Tuesday 28 January 1997
Perhaps not the best reason for entering the caring professions, but it's true to say that the bar is central to many medical schools. It's a safe place, perhaps the only safe place, for very stressed students to congregate out of the public gaze and indulge in enlightened discussion and rough cider. When I first entered medical school, the bar was run by the students themselves, was often open at very irregular hours and made a monumental loss which the medical school was happy to write off. Indeed, some consultants were proud of the tradition in a "work hard, play hard, drink hard" sort of way. The rugby boys would stand up one end, vomiting against the dart board and clutching lengths of burning lavatory paper between their buttocks in a curious game called "Flaming A's" (Yes, I've still got the burn marks). But most of the year would just drink a reasonable amount and be hearty. It was the closest medical school came to personal development.
Then women arrived, in ever-increasing numbers, followed by a steady trickle of non-Caucasian students whose culture wasn't so deeply rooted in alcohol. Many bars were taken over by professional staff and adhered strictly to the licence laws. Some didn't even manage those, and were only opened on one evening a week in an attempt to discourage heavy drinking. The great hope was that with women occupying half the medical school doctors would become more empathic, better communicators, fine role-players and sensible socialites. Alas, research found that women students were more likely to drink above their safe limits than men. Accepting women into what is predominantly still a male culture didn't make much difference - you have to change the culture itself.
One medical school has now responded to this by deciding not to renew the licence on its bar at all. The school will become an alcohol-free zone and students will now spend their evenings doing macrame and reflecting on what an interesting day of small-group teaching they've had. And monkeys will fly out of my butt. The whole point of being a student, not just a medical student, is to have fun, behave badly and buck the system before turning to a life of tedious professional conformity. Or going on the dole. Many students drink heavily, but those studying medicine tend to stay in during the week and binge drink at weekends. One in 10 of all professionals, not just doctors, is likely to end up with an alcohol problem and for most it will have started as a student. But is this an excuse for banning alcohol from the campus?
There's a puritanical streak in some doctors who believe that we, as a profession, should be setting an example; that doctors who smoke shouldn't be allowed to practise and those that drink should stick within safe limits - or else. With 13,000 doctors addicted to alcohol (or drugs), there's clearly a lot of witch-hunting to be done to rid us of these social deviants and we'd end up with a lot of jobs vacant in very high places. The fact that you can rise very high in medicine with a very sick liver shows that addicted doctors often refuse to acknowledge the problem, are very good at covering up and are virtually never shopped by their colleagues. Or their patients. I know of a GP, now retired, who used to have several safe houses he could go to sleep off a heavy lunchtime session. "Nice to see you again, doctor. Would you like the settee or the zed bed?"
The puritans have suggested that random dope testing for doctors is the only way to sort the problem out and, with pilots and train drivers facing the same fate, it may not be long before individual NHS trusts try to get tough. But I doubt they'd get doctors to test other doctors, so it might have a few teething troubles. I'm not sure what the answer is, other than to make medical training more humane and allowing the development of interests outside alcohol. Starving medical students at source, like banning drugs from clubs, is doomed to fail also because they'll just go elsewhere to unwind. And that could be fatal for the reputation of the medical school. A penis in a pint in the medical school bar is boyish high spirits but one in the lounge bar of the Plume and Feathers is a PR disastern
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