Sunday, April 23, 2006

Resident Work Hours

Several bloggers, including Kevin,MD link to the Time Cover Story, "What Doctors Hate About Hospitals".
Part of the cover story discussest the relatively new 80-hour work week regulations for residents:
Studies showed that long work hours increased stress, depression, pregnancy-related complications, car wrecks and damage to residents' morale and personal life. So now residents' hours are limited to 80-hr. workweeks averaged over a month, in shifts that are limited to 24 hours of patient care, with at least 1 day off in 7. Remaining on call in the hospital is limited to every third night.
The reforms made intuitive sense; but the unintended result, older doctors warn, is a 9-to-5 mentality that detaches the doctor from the patient. They fear that young doctors don't get the experience they need or build the instincts and muscle memory from performing procedures so many times that they can do them in their sleep. Even the residents may agree: in a 2006 study in the American Journal of Medicine, both residents and attending physicians reported that they thought the risk of bad things happening because of fragmentation of care was greater than the risk from fatigue due to excess work hours. Other residents say that while they may feel more rested, they sense that they are not learning as much or as fast as they need to.
So, residents are now more rested, but care is more fragmented. I don't think anyone can conclusively state whether the new system currently improves or worsens care in teaching hospitals.
What will happen 20 years from now, when the majority of practicing physicians have trained under the new system??
"I know that I will not like it 20 years from now when I'm 68 and having to be taken care of by these guys," says Dr. Paul Shekelle, a professor of medicine at UCLA. "It's all shift work now. When 5 o'clock comes, whatever it is they're doing, they just sign it all out to the 5 o'clock person. It's eroding the sense of duty, or commitment to being the person responsible for a patient's care."


mchebert said...

I just don't get that complaint. I don't know about you, but I don't work 90 hours a week. What doctor in private practice does? Sure, we all work hard, but a range of 50-70 hours covers about 90% of doctors.

Every time I take a weekend off, and most nights, I turn over care to someone else. No big deal. Is it really a big deal for residents in training?

jason said...

it is a big deal if you are an itinerant doctor.... What kind of doctor counts the work hours??? do you stop operating on a patient if you are over the 80 hours.... do you tell a patient that you can not take care of him/her because you are on your 78th hour....Give me a break! How did such a noble profession stoop to such a low level!.... if you cant take the heat....( you know the rest)!

Anonymous said...

yeah please. The guy that does not want to be taken care of by this generation of doctors 20 years from now can go jump off a bridge. Bottom line is money. The resident program pays too little for that much trouble. And hope no-one tries to give me that "do it for the love of the profession" hippie crap

Anonymous said...

As someone who typically works 80+ hours a week in the acute care settings (ICU, ER) I feel that I have a little more insight than "Jason" who apparently hasn't worked 80+ hours a week for 3 years of his life. So I ask...
Who wants to be taken care of by the resident on their 100th hour of work for the week? We all know that fatigue leads to medical errors, and that's the point behind the 80hr week - patient safety.
Can you honestly say that a patient would rather have the resident taking care of them being exhausted and more prone to errors? Especially when the alternative is to have them sign out 1-2 hours earlier in the day (5 or 6pm instead of 7 or 8pm) and let the night float cover for them.

Griffin said...

This won't have effect in reality, that's exactly what I think.