Restricting resident work hours forces doctors to lie, and other unintended consequences of the 80-hour work week

To his credit, Dr. Thomas J. Nasca, chief executive of the Accreditation Council for Graduate Medical Education, is aware of the many problems in trying to limit work hours for physicians in training.

This topic has been frequently discussed on this blog, but some points bear repeating.

The first are the ethical quandaries that the cap often places on residents. In one example, a doctor wanted to spend time with a dying child she had been caring for during the past 10 to 12 days. “This resident stayed, but there was an unintended consequence,” says Dr. Nasca. “She could tell the truth about breaking the hours rule, and thus jeopardize herself and the residency program. Or she could lie. What could be worse than a training system that encourages doctors to lie because they want to be with their patient? This is the last thing we should be doing, but we’ve done it.”

Next, the mistakes that occur due to more frequent patient hand-offs perhaps negate the improvements in patient safety resulting better rested residents. It’s difficult to know for sure, as I’m not aware of any data showing that capping work-hours improves patient outcomes in the first place.

One point I do agree with, is the “hazing” aspect of grueling training. That should never justify the long hours that doctors in training put in. However, further reducing the amount of hours a resident is able to work does a disservice to both the doctor and the patient.

In the real world, where there are no caps to pamper newly minted attendings, do patients want a physician who’s used to punching out at the clock, or worse, lack the experience necessary to perform a complicated procedure?

The answer is no. But hey, at least they were well rested during residency.

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