I propose a different slant on Dr. Green's perception that "the primary adverse consequence of prolonged work hours seems to be that overtired house officers develop undesirable and unprofessional attitudes" [1]. Much of medical training teaches physicians how to function compassionately and ethically under various "unnatural" circumstances; we are uniquely granted access to the most private physical and mental aspects of other humans. We address aspects of individuals, societies, and diseases that may be distasteful or repulsive. Nevertheless, the key to our professional soul is maintaining universal humanism in settings from which others may elect to remain exempt.

We must incorporate professionalism and compassion not only when we are comfortable but also when we are stressed, unhappy, or tired. We must be equally compassionate at night and on weekends, regardless of the patient, illness, or setting.

This is not a defense of overtiring housestaff. Rather, part of medical training is deliberately constructed to teach compassion and caring under trying circumstances. It is easy to be a "limousine liberal," an "armchair quarterback," or a well-rested compassionate moralist. This portion of learning comes not from books or sermons but from the trenches, supervised and controlled.

I am unaware that training programs that are not associated with prolonged sleep deprivation (for example, radiology or dermatology) produce more ethical or compassionate physicians. Most physicians recall the stressful periods of their training with greater fondness than they do their quiet rotations [2].

I don't like long hours, but they were as essential in developing my compassion and ethics as were my encounters with vomiting drunks, noncompliant diabetic patients, and babies with meningitis. Indeed, one may ask, How secure are the professionalism, compassion, morals, and ethics of physicians who have not been stressed close to their limits? This subject requires study and data rather than wishful speculation.