Comments on: My take: Selling preventive care, surgeons’ hours, part-time doctors http://www.kevinmd.com/blog/2008/04/my-take-selling-preventive-care.html Tue, 14 Feb 2012 19:56:00 +0000 hourly 1 By: Ian Furst http://www.waittimes.blogspot.comhttp://www.kevinmd.com/blog/2008/04/my-take-selling-preventive-care.html#comment-84786 Ian Furst http://www.waittimes.blogspot.com Fri, 04 Apr 2008 19:58:00 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-selling-preventive-care-surgeons-hours-part-time-doctors.html#comment-84786 Re #2 Kevin -- having been on the wrong end of a 70-hour day the question is really what's the trade off? If the surgeons/ internists are graduating with less experience what is the benefit? We all know the answer is fewer resident errors (which I presume equates to fewer deaths). And, it BS that procedure errors are what kills. The original studies in long-work day errors where done by having the residents diagnose MI's on ECG's. The internists are just as if not more likely to do harm. <br/><br/>One day I saw show where a reporter asked an ER doc "did you save a life today?", he thought for a second then responded "No, but I didn't kill anyone either". I know it's harsh but that's the reality. <br/><br/>We regularly measure the benefit of drugs and procedures by cost per life-year saved so do the same for resident training. Whatever the program is, create a mandate that it can't have an additional death rate of more than 3.4 per million (6-sigma level)? Involve the epidemiologists and statisticians and do it properly. How many errors are allowable before you control the hours? Finally, in this era of full disclosure, do you stand to benefit by having longer resident hours? I don't. <br/><a HREF="http://www.waittimes.blogspot.com/" REL="nofollow">www.waittimes.blogspot.com</a> Re #2 Kevin — having been on the wrong end of a 70-hour day the question is really what’s the trade off? If the surgeons/ internists are graduating with less experience what is the benefit? We all know the answer is fewer resident errors (which I presume equates to fewer deaths). And, it BS that procedure errors are what kills. The original studies in long-work day errors where done by having the residents diagnose MI’s on ECG’s. The internists are just as if not more likely to do harm.

One day I saw show where a reporter asked an ER doc “did you save a life today?”, he thought for a second then responded “No, but I didn’t kill anyone either”. I know it’s harsh but that’s the reality.

We regularly measure the benefit of drugs and procedures by cost per life-year saved so do the same for resident training. Whatever the program is, create a mandate that it can’t have an additional death rate of more than 3.4 per million (6-sigma level)? Involve the epidemiologists and statisticians and do it properly. How many errors are allowable before you control the hours? Finally, in this era of full disclosure, do you stand to benefit by having longer resident hours? I don’t.
http://www.waittimes.blogspot.com

]]> By: alexa-bluehttp://www.kevinmd.com/blog/2008/04/my-take-selling-preventive-care.html#comment-84784 alexa-blue Fri, 04 Apr 2008 18:42:00 +0000 http://clients.emmense.com/kevinmd/2008/04/my-take-selling-preventive-care-surgeons-hours-part-time-doctors.html#comment-84784 other options to improve surgical training:(1) more and better sim labs, (2) less scutwork. other options to improve surgical training:(1) more and better sim labs, (2) less scutwork.

]]>