Work hour restrictions, or the death of professionalism

A case where a patient died due to multiple handoffs. retired doc criticizes the trend:

We seem to be replacing personal physician responsibility with “systems”.
What lessons are being implicitly taught to the house staff? The procedure doc seems to have no post procedure responsibility but is content to delegate care to a NP. In that environment how surprised could you be to learn the intern signs out without seeing the chest x-ray. End of shift-end of responsibility. End of procedure-end of responsibility.

Comments

Anonymous
Not only did the patient not die, but the article states specifically that “the patient probably suffered no long term ill effects.”
Anonymous
Take responsibility is what I say.
Anonymous
Well, at the teaching facility where I work we DID have a death due to poor f/u post procedure. Pt had thoracentesis, no CXR done post procedure, only a CT scan (was tapped to eval for possible underlying CA). Pt wanted to go home – quasi AMA. He was d/c’d – CT scan had not been read yet. Pt died suddenly that nite.
CT scan showed large pneumo on side of tap. Suspect he died due to tension pneumo.
Anonymous
These kinds of problems are going to become more common as we move more toward “shift based” scheduling.
Primary care is dead. The idea of having one person who takes care of you is dead.
Either we expect doctors to manage their own complications and take responsibility or we expect to have enough people around that are responsible for taking sign out. If we expect everyone to leave on time, then we need just as many people present at night as are present in the day time.
That’s never going to happen, so errors will increase in frequency.
Anonymous
No. NO NO NO. I take care of my post operative patients. Not an intern or a resident or an ER doc or a partner or an NP or anyone else. That means that i dont take vacations the week after I have operated and I have to be available. In trainting it was called Frankensteins rule: You make a monster, you take care of it. If I take the responsibility for doing surgery on someone I have the responsibility for seeing that the recover from it.
Chrysalis Angel
I’m so glad to see you follow through anonymous! When I was looking for a surgeon to remove a tumor that may have put the laryngeal nerve at risk, I found surgeons that would operate, and then you were passed of to an N.P. (no offense to any N.P.s). With my surgery, I was going to need further monitoring afterward for calcium levels and such. One surgeon wanted to do it Friday afternoon, and then a resident would take over if I had a problem. (No offense to any residents). I, thankfully, found a surgeon that said “No way, I monitor my post op patients”. I was so grateful and he’s the one I chose. Great outcome too!
Anonymous
“…I take care of my post operative patients…That means that i dont take vacations the week after I have operated and I have to be available.”
You are a true surgeon, but unfortunately, your breed will become rarer and rare with the new flocks that are exiting residency.
Welcome to shift-work surgery.
Anonymous
Perhaps a bit off the topic…but do not confuse lack of overzealous test ordering with “poor follow-up”. This is in response to the third comment above. CXR is NOT indicated after thoracentesis unless the patient is symptomatic post-procedure. Plus, since when did we start using pleural fluid cytology to diagnose lung cancer? Did I fall asleep for seven or eight years?

Work hour restrictions, or the death of professionalism

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