Comments on: An incredible surgery, but would future surgeons be able to accomplish the same feat? http://www.kevinmd.com/blog/2009/04/incredible-surgery-but-would-future.html Tue, 14 Feb 2012 21:09:00 +0000 hourly 1 By: Joseph Sucher, MD FACShttp://www.kevinmd.com/blog/2009/04/incredible-surgery-but-would-future.html#comment-90684 Joseph Sucher, MD FACS Fri, 03 Apr 2009 19:51:00 +0000 http://clients.emmense.com/kevinmd/2009/04/an-incredible-surgery-but-would-future-surgeons-be-able-to-accomplish-the-same-feat.html#comment-90684 Dr. Birdi,<br/><br/>A few points concerning your comments.<br/><br/>1. "There are no work hour limitations on fellow training"<br/><br/>This is not true of all fellows. Some fellowships are outside the ACGME (surgical oncology) and are not subject to their regulations. But many fellowships are (MIS, Vascular, CT, PRS... etc) <br/><br/>2. "I believe much of the responsibility will be shifted on them (fellows)." <br/><br/>Again... you can't shift work to people who are limited as much as residents.<br/><br/><br/>3. "In my opinion, these are some of the hidden side-effects of the new work hour limitations."<br/><br/>There is nothing hidden about the side-effects. The literature is replete with the myriad of unintended consequences. The reality is that work hour limitations in training is here to stay. We need to find better ways to train people with less time.<br/><br/>JFS Dr. Birdi,

A few points concerning your comments.

1. “There are no work hour limitations on fellow training”

This is not true of all fellows. Some fellowships are outside the ACGME (surgical oncology) and are not subject to their regulations. But many fellowships are (MIS, Vascular, CT, PRS… etc)

2. “I believe much of the responsibility will be shifted on them (fellows).”

Again… you can’t shift work to people who are limited as much as residents.

3. “In my opinion, these are some of the hidden side-effects of the new work hour limitations.”

There is nothing hidden about the side-effects. The literature is replete with the myriad of unintended consequences. The reality is that work hour limitations in training is here to stay. We need to find better ways to train people with less time.

JFS

]]> By: Shiva Birdi M.D.http://www.kevinmd.com/blog/2009/04/incredible-surgery-but-would-future.html#comment-90683 Shiva Birdi M.D. Fri, 03 Apr 2009 18:23:00 +0000 http://clients.emmense.com/kevinmd/2009/04/an-incredible-surgery-but-would-future-surgeons-be-able-to-accomplish-the-same-feat.html#comment-90683 Although its true that surgeries of this duration are quite uncommon, they STILL HAPPEN. For example, the recent face transplant was nearly exactly 23hrs long!<br/><br/>These breathrough, "adventurous" procedures will continue to happen. Although I agree that less and less residents are going to be exposed to the entire length of the procedure because of potential work hour violations. However, much like the face transplant - thats what the fellows are for! There are no work hour limitations on fellow training and I believe much of the responsibility will be shifted on them. I think the reality is that we will have more burnout rates in fellows and decreased education with less continuity of care amongst the residents. In my opinion, these are some of the hidden side-effects of the new work hour limitations. <br/><br/><a HREF="http://www.chestjournal.org/content/131/5/1614.full" REL="nofollow">I refer you to a recent article in CHEST.</a><br/><br/>These breakthrough surgeries however will continue to happen at the major centers.<br/><br/><b>Shiva Birdi M.D.<br/>Intensivist/Anesthesiologist<br/>Cleveland Clinic<br/><a HREF="http://www.criticalcareminutes.com" REL="nofollow">www.CriticalCareMinutes.com</a></b> Although its true that surgeries of this duration are quite uncommon, they STILL HAPPEN. For example, the recent face transplant was nearly exactly 23hrs long!

These breathrough, “adventurous” procedures will continue to happen. Although I agree that less and less residents are going to be exposed to the entire length of the procedure because of potential work hour violations. However, much like the face transplant – thats what the fellows are for! There are no work hour limitations on fellow training and I believe much of the responsibility will be shifted on them. I think the reality is that we will have more burnout rates in fellows and decreased education with less continuity of care amongst the residents. In my opinion, these are some of the hidden side-effects of the new work hour limitations.

I refer you to a recent article in CHEST.

These breakthrough surgeries however will continue to happen at the major centers.

Shiva Birdi M.D.
Intensivist/Anesthesiologist
Cleveland Clinic
http://www.CriticalCareMinutes.com

]]> By: Pieterhttp://www.kevinmd.com/blog/2009/04/incredible-surgery-but-would-future.html#comment-90668 Pieter Thu, 02 Apr 2009 18:35:00 +0000 http://clients.emmense.com/kevinmd/2009/04/an-incredible-surgery-but-would-future-surgeons-be-able-to-accomplish-the-same-feat.html#comment-90668 Regardless of time limitations by law... I don't believe that performing such long surgery is beneficial to the patient if the surgeon does not take a break once in a while. Neurosurgical procedures can also take long. Some surgeons do take a break.<br/><br/>It's a different discussion from patient perspective. Do you do one long surgery (20h) or two "short ones" (10h) if necessary? I don't know... Regardless of time limitations by law… I don’t believe that performing such long surgery is beneficial to the patient if the surgeon does not take a break once in a while. Neurosurgical procedures can also take long. Some surgeons do take a break.

It’s a different discussion from patient perspective. Do you do one long surgery (20h) or two “short ones” (10h) if necessary? I don’t know…

]]> By: Anonymoushttp://www.kevinmd.com/blog/2009/04/incredible-surgery-but-would-future.html#comment-90649 Anonymous Wed, 01 Apr 2009 23:07:00 +0000 http://clients.emmense.com/kevinmd/2009/04/an-incredible-surgery-but-would-future-surgeons-be-able-to-accomplish-the-same-feat.html#comment-90649 Give me a break! Like the "old guard" surgeons routinely practiced those big bad 23 hour cases so that when they were out on their own, they could crank them out like nothing.<br/><br/>Besides, the restriction is a 30 hour maximum. How would this have been affected? Give me a break! Like the “old guard” surgeons routinely practiced those big bad 23 hour cases so that when they were out on their own, they could crank them out like nothing.

Besides, the restriction is a 30 hour maximum. How would this have been affected?

]]> By: Eric135http://www.kevinmd.com/blog/2009/04/incredible-surgery-but-would-future.html#comment-90646 Eric135 Wed, 01 Apr 2009 20:32:00 +0000 http://clients.emmense.com/kevinmd/2009/04/an-incredible-surgery-but-would-future-surgeons-be-able-to-accomplish-the-same-feat.html#comment-90646 I am not sure the limitations on resident hours would "prohibit such a procedure." People will do what they have to do, and heroic measures are not usually something professionals "train" for. The physicians that would do such a feat would do it no matter the intensity or restrictions on their training. Those who would/could not wouldn't or couldn't despite any restrictions (or lack of limitations). I've seen heroic measures (by physicians, nurses, families -- priests, electricians, veterinarians, lawyers, whatever) with little preparation or warning. Dr. Kato is a hero; there will still be heroes (and villains and spectators) despite the restriction.<br/><br/>Eric RN<br/>Phoenix AZ I am not sure the limitations on resident hours would “prohibit such a procedure.” People will do what they have to do, and heroic measures are not usually something professionals “train” for. The physicians that would do such a feat would do it no matter the intensity or restrictions on their training. Those who would/could not wouldn’t or couldn’t despite any restrictions (or lack of limitations). I’ve seen heroic measures (by physicians, nurses, families — priests, electricians, veterinarians, lawyers, whatever) with little preparation or warning. Dr. Kato is a hero; there will still be heroes (and villains and spectators) despite the restriction.

Eric RN
Phoenix AZ

]]> By: M. Studenthttp://www.kevinmd.com/blog/2009/04/incredible-surgery-but-would-future.html#comment-90638 M. Student Wed, 01 Apr 2009 16:39:00 +0000 http://clients.emmense.com/kevinmd/2009/04/an-incredible-surgery-but-would-future-surgeons-be-able-to-accomplish-the-same-feat.html#comment-90638 Why was it necessary for one surgeon to operate for 23 hours straight? Is the training and experience to perform a surgery like this really at such a premium that two qualified surgeons could not be involved in such an extraordinary operation? Why was it necessary for one surgeon to operate for 23 hours straight? Is the training and experience to perform a surgery like this really at such a premium that two qualified surgeons could not be involved in such an extraordinary operation?

]]> By: Joseph Sucher, MD FACShttp://www.kevinmd.com/blog/2009/04/incredible-surgery-but-would-future.html#comment-90637 Joseph Sucher, MD FACS Wed, 01 Apr 2009 11:39:00 +0000 http://clients.emmense.com/kevinmd/2009/04/an-incredible-surgery-but-would-future-surgeons-be-able-to-accomplish-the-same-feat.html#comment-90637 Quite frankly, it is extraordinarily rare to perform a 16 hour operation. However, your point about resident work hours in surgery is still noteable. As it stands now, the new limitations are recommendations from the IOM. It is unclear where the ACGME and RRC stand as we await their response. There is some valid debate that work hour limitations should be specialty specific. Surgery is one such specialty where the particular restrictive policies do not match with the practicalities of placing patient care first. Quite frankly, it is extraordinarily rare to perform a 16 hour operation. However, your point about resident work hours in surgery is still noteable. As it stands now, the new limitations are recommendations from the IOM. It is unclear where the ACGME and RRC stand as we await their response. There is some valid debate that work hour limitations should be specialty specific. Surgery is one such specialty where the particular restrictive policies do not match with the practicalities of placing patient care first.

]]>