It seems intuitive that better rested physicians equates to better patient care.
Surgeon Pauline Chen takes a look at the repercussions of further limiting work-hours, saying “even the best attempts at cure do not come without strings attached.”
There’s something to be said for being a patient’s dedicated doctor. Back in the days without work restrictions, Dr. Chen was “able to forge the kind of strong personal and clinical connections that helped me offer them more relevant, sometimes lifesaving, clinical care. I never had to resort to the simulated patients, computer-generated cases or foam rubber suturing set-ups that educators are now using increasingly in order to round out clinical experiences.”
There was never the 78th hour pressure of picking and choosing what educational activity to skip, and after graduating, there was a level of comfort that only comes with time and clinical experience.
No data firmly exists showing that limiting resident hours actually work. In fact, “there have been few, if any, large-scale studies on how strictly residency programs have followed the 2003 mandate; which scheduling adjustments have worked, or have not; how the quality of resident education might have been affected; and, most importantly, exactly how patient safety may or may not have been compromised.”
There is clearly a detriment to tired and overworked residents. I get that. I’m just saying that the we should be careful of the solution, which may make things worse than the initial problem.
Related posts:
- Restricting resident work hours forces doctors to lie, and other unintended consequences of the 80-hour work week
- Resident work hours and sign-out
- Resident work hours: An alternative view
- Restricting resident work hours leads to a shortage of surgeons
- Limiting resident work-hours
- Surgeons don’t receive enough training when resident work-hours are capped
- How work-hour restrictions harms resident surgeon training
{ 12 comments }
Perhaps medical schools should be closed in favor of nursing school and nurse practioner schools. I’m fairly certain the problems of sleep deprivation would be solved.
I can take your point that mandated sleep time may not be the ideal solution to the problem of resident sleepiness, but what alternative solution is there? I can’t think of a way that would help residents get more rest that doesn’t require time limits on shifts and therefore more handoffs, etc.
I’m currently a Med1, so I’m interested in seeing how this all plays out. You thoughts have been enlightening.
i think that if we need to have more rest time, which is fine, although I’m in private practice and I have to work quite a bit more than 80 hours these days.
So fix the problem, give them less hours and make the residency longer.
I’d like to know what data exist regarding the enforcement of training hour restrictions. At least in my experience it is something of an expectation in certain residency programs that the hour requirements will be ignored in the course of residency.
I recall being told flat-out by the director of a surgical residency during an interest group meeting that “it is impossible to meet the case requirements of our program spending only 80 hours a week.”
I’m a third year med student. I am in total favor of limiting work hours. I will always put these three thing first in this order 1) My faith 2) my family 3) my patients. So, my patients will NEVER be placed before my family. And I despise any father or mother who does place their patients first. Thus, work hour are a logical improvement in patient care….screw any evidence otherwise. It doesn’t pertain to me.
I trained in the old days and worked plenty of 140 hour weeks, did some stints of every other night in-house call, and worked a few blocks of several months without a single 24 hour period off.
It ruined my health in ways that have never recovered. I have not slept 8 unbroken hours in the decades since. I remember little of it during the busiest times as severe sleep deprivation impairs memory formation.
I got a lot of experience but it’s utility is limited to implicit memory mostly and at a tremendous price.
I therefore was an enthusiastic supporter of the current workhour restrictions. I think it an adequate boundary within which education and patient care can be accomplished and programs have proven that they will not act with minimal humanity on their own.
The more recent proposal worries me however. I know that I only functioned fully aware when I had at least 5 hours sleep. But I find it harder to imagine how continuity of very ill patients will be maintained if even when on call, people can hand off to someone else and clock out.
I did my resideny right when the 80 hours work week was being implemented. 1/2 way through my residency, my program switched from traditional call to having a night float…personally, I hate night float. I felt that the work ups on my patients were subpar…and further more I had to redo the H&P the next day (when I have less time) in order to understand my patient fully. Also, I found that the night float system lead to the idea that we doctors are shift worked. SORRY I DESPISE THAT. I AM A WHITE COLLAR WORKER not a BLUE COLLAR worker….and people don't get sick from 9-5. We are graduating residents who view patient care as shift work and many of them are quite lazy now. I guess that is OK if you plan to be either a hospitalist or an outpt provider since after 5 you can dump your pts on the ER and have them admitted to the hospitalist. If you want to do the rewarding thing and provide both…your patients will love you for the individual care that you will provide. Its always nice to know your patients. In the real world…you will sometimes work much more than 80 hrs a week and at times sometimes less. If the ACGME wants to limit work hours even more…well then learning will go down and a 3 year resideny should become a 6 year resideny then.
Respectfully, shouldn’t the burden of research proof be on evidence to show that working 30-hour shifts or 100-work weeks does NOT harm patients? I mean, in the rest of the civilized world and white-collar professions, such “training” would be seen as something from another century. Not something that should be continued, ad infinitum, barring more evidence.
The fact is, the human body wasn’t meant to work 30 hours straight with an hour or two of sleep. If it was, we’d all be working 30 work days, and this practice would continue long into a doctor’s regular professional life (which, except in certain specialties, it does not).
It’s time to stop this barbaric practice and bring the medical profession into line with virtually all other modern work standards, and stop hospitals and universities from further taking advantage in abusing their residents.
Anon 1:49
re:”So, my patients will NEVER be placed before my family”.
So following your reasoning you are going to walk out the door on a critically ill patient to go to your kids recital? You have a lot of growing up to do. Though I support the 80 hour rule (I trained before it’s implementation). The reality of (most of) medicine is that in practice you are going to go over the limit. There is no RRC in the real world to hold your hand or wipe your butt for you. Patient’s don’t punch a clock. That’s not arrogance, that’s the truth. If you really feel that way, then I suggest you find anopther career. You will be profoundly unhappy in this one, or you will be a danger to your patients.
Dr John:
Most medical and surgical subspecialists take call. Most primary docs take call. That is to say they may (depending on the field and the night) be up most of the night. This is not a rarity, it is common. Maybe it doesn’t work that way in psychology, but it does in rest of medicine.
i think that if we need to have more rest time, which is fine, although I’m in private practice and I have to work quite a bit more than 80 hours these days.
with all those long hours, i think residents should at least have a higher salary…especially with such a large debt from medical school.
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