Comments on: The consequences of limiting resident work-hours http://www.kevinmd.com/blog/2008/12/consequences-of-limiting-resident-work.html Tue, 14 Feb 2012 22:04:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2008/12/consequences-of-limiting-resident-work.html#comment-89724 Anonymous Mon, 09 Feb 2009 21:33:00 +0000 http://clients.emmense.com/kevinmd/2008/12/the-consequences-of-limiting-resident-work-hours.html#comment-89724 with all those long hours, i think residents should at least have a higher salary...especially with such a large debt from medical school. with all those long hours, i think residents should at least have a higher salary…especially with such a large debt from medical school.

]]> By: lasixhttp://www.kevinmd.com/blog/2008/12/consequences-of-limiting-resident-work.html#comment-88548 lasix Mon, 08 Dec 2008 17:41:00 +0000 http://clients.emmense.com/kevinmd/2008/12/the-consequences-of-limiting-resident-work-hours.html#comment-88548 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. 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.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/12/consequences-of-limiting-resident-work.html#comment-88534 Anonymous Mon, 08 Dec 2008 00:17:00 +0000 http://clients.emmense.com/kevinmd/2008/12/the-consequences-of-limiting-resident-work-hours.html#comment-88534 Dr John:<br/>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. 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.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/12/consequences-of-limiting-resident-work.html#comment-88533 Anonymous Mon, 08 Dec 2008 00:09:00 +0000 http://clients.emmense.com/kevinmd/2008/12/the-consequences-of-limiting-resident-work-hours.html#comment-88533 Anon 1:49<br/>re:"So, my patients will NEVER be placed before my family".<br/><br/>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. 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.

]]> By: DocJohnhttp://www.kevinmd.com/blog/2008/12/consequences-of-limiting-resident-work.html#comment-88529 DocJohn Sun, 07 Dec 2008 23:15:00 +0000 http://clients.emmense.com/kevinmd/2008/12/the-consequences-of-limiting-resident-work-hours.html#comment-88529 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. <br/><br/>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). <br/><br/>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. 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.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/12/consequences-of-limiting-resident-work.html#comment-88528 Anonymous Sun, 07 Dec 2008 23:14:00 +0000 http://clients.emmense.com/kevinmd/2008/12/the-consequences-of-limiting-resident-work-hours.html#comment-88528 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. 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.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/12/consequences-of-limiting-resident-work.html#comment-88523 Anonymous Sun, 07 Dec 2008 22:58:00 +0000 http://clients.emmense.com/kevinmd/2008/12/the-consequences-of-limiting-resident-work-hours.html#comment-88523 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.<br/><br/>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.<br/><br/>I got a lot of experience but it's utility is limited to implicit memory mostly and at a tremendous price. <br/><br/>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.<br/><br/>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 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.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/12/consequences-of-limiting-resident-work.html#comment-88519 Anonymous Sun, 07 Dec 2008 18:49:00 +0000 http://clients.emmense.com/kevinmd/2008/12/the-consequences-of-limiting-resident-work-hours.html#comment-88519 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’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.

]]> By: M. Studenthttp://www.kevinmd.com/blog/2008/12/consequences-of-limiting-resident-work.html#comment-88517 M. Student Sun, 07 Dec 2008 17:05:00 +0000 http://clients.emmense.com/kevinmd/2008/12/the-consequences-of-limiting-resident-work-hours.html#comment-88517 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.<br/><br/>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’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.”

]]> By: Anonymoushttp://www.kevinmd.com/blog/2008/12/consequences-of-limiting-resident-work.html#comment-88495 Anonymous Sat, 06 Dec 2008 01:52:00 +0000 http://clients.emmense.com/kevinmd/2008/12/the-consequences-of-limiting-resident-work-hours.html#comment-88495 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.<br/><br/>So fix the problem, give them less hours and make the residency longer. 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.

]]>