Wednesday, March 20, 2013

Duty hour limitations

Latest headline regarding duty hour limitations:
There was no improvement in residents' reported sleep and general well-being in 2011, however, and the proportion of medical trainees who said they'd made a serious error in the past few months rose from 20 to 23 percent. (Desai, JAMA 2013;173(8):649-655)

Well I'm glad we trashed decades long tradition and culture of medicine for that. One of the most important lesson I learned in medical school was from Ron Trunsky, a psychiatrist and medical sage,

"Medicine is not like selling shoes." 

He would say that when ever there was patient care to be done but someone wanted to go home. Medicine is important. Medicine is hard. Medicine requires a commitment not found in regular jobs. Patients' needs do not fall between the hours of 9 and 5 but around the clock. Part of residency is training you to accept that. Part of residency is turning normal people into physicians.

Working insane hours during residency was the forge that allowed me to be cast me into a physician. Like boot camp in the military, long residency hours broke you down and reformed you into a specific type, the physician.

There is a lot to criticize about this system, but it was an important part of the physician ecosystem and it irresponsible to trash one component of that system without doing prospective studies on what will happen. Now, 9 years later what are supposed to do with this data. Apparently working 30 hours in a row was a key part of reducing medical error and made no difference in the hours slept or resident depression.

This agrees with my experience. Reduced duty hour requirements is forcing residents to spend more and more of their time watching the clock, filling out attendance records, missing lectures and skipping rounds. Trading improved fatigue for less investment in patients was a terrible bargain.
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