Comments on: Work hour restrictions, or the death of professionalism http://www.kevinmd.com/blog/2007/01/work-hour-restrictions-or-death-of.html medical blog Sun, 22 Nov 2009 14:15:05 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Anonymous http://www.kevinmd.com/blog/2007/01/work-hour-restrictions-or-death-of.html/comment-page-1#comment-73441 Anonymous Fri, 30 Mar 2007 17:44:00 +0000 http://clients.emmense.com/kevinmd/2007/01/work-hour-restrictions-or-the-death-of-professionalism.html#comment-73441 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? 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?

]]> By: Anonymous http://www.kevinmd.com/blog/2007/01/work-hour-restrictions-or-death-of.html/comment-page-1#comment-71021 Anonymous Mon, 29 Jan 2007 01:40:00 +0000 http://clients.emmense.com/kevinmd/2007/01/work-hour-restrictions-or-the-death-of-professionalism.html#comment-71021 "...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."<br/><br/>You are a true surgeon, but unfortunately, your breed will become rarer and rare with the new flocks that are exiting residency.<br/><br/>Welcome to shift-work surgery. “…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.

]]> By: Chrysalis Angel http://www.kevinmd.com/blog/2007/01/work-hour-restrictions-or-death-of.html/comment-page-1#comment-71003 Chrysalis Angel Sun, 28 Jan 2007 01:14:00 +0000 http://clients.emmense.com/kevinmd/2007/01/work-hour-restrictions-or-the-death-of-professionalism.html#comment-71003 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! 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!

]]> By: Anonymous http://www.kevinmd.com/blog/2007/01/work-hour-restrictions-or-death-of.html/comment-page-1#comment-70994 Anonymous Sat, 27 Jan 2007 17:49:00 +0000 http://clients.emmense.com/kevinmd/2007/01/work-hour-restrictions-or-the-death-of-professionalism.html#comment-70994 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. 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.

]]> By: Anonymous http://www.kevinmd.com/blog/2007/01/work-hour-restrictions-or-death-of.html/comment-page-1#comment-70980 Anonymous Sat, 27 Jan 2007 04:26:00 +0000 http://clients.emmense.com/kevinmd/2007/01/work-hour-restrictions-or-the-death-of-professionalism.html#comment-70980 These kinds of problems are going to become more common as we move more toward "shift based" scheduling.<br/><br/>Primary care is dead. The idea of having one person who takes care of you is dead.<br/><br/>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.<br/><br/>That's never going to happen, so errors will increase in frequency. 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.

]]> By: Anonymous http://www.kevinmd.com/blog/2007/01/work-hour-restrictions-or-death-of.html/comment-page-1#comment-70976 Anonymous Sat, 27 Jan 2007 03:42:00 +0000 http://clients.emmense.com/kevinmd/2007/01/work-hour-restrictions-or-the-death-of-professionalism.html#comment-70976 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.<br/>CT scan showed large pneumo on side of tap. Suspect he died due to tension pneumo. 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.

]]> By: Anonymous http://www.kevinmd.com/blog/2007/01/work-hour-restrictions-or-death-of.html/comment-page-1#comment-70973 Anonymous Sat, 27 Jan 2007 02:45:00 +0000 http://clients.emmense.com/kevinmd/2007/01/work-hour-restrictions-or-the-death-of-professionalism.html#comment-70973 Take responsibility is what I say. Take responsibility is what I say.

]]> By: Anonymous http://www.kevinmd.com/blog/2007/01/work-hour-restrictions-or-death-of.html/comment-page-1#comment-70972 Anonymous Sat, 27 Jan 2007 02:27:00 +0000 http://clients.emmense.com/kevinmd/2007/01/work-hour-restrictions-or-the-death-of-professionalism.html#comment-70972 Not only did the patient not die, but the article states specifically that "the patient probably suffered no long term ill effects." Not only did the patient not die, but the article states specifically that “the patient probably suffered no long term ill effects.”

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