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Archive for March 14th, 2009

On the 80-hour Workweek Cap – Part 2

Posted by medliorator on March 14, 2009

Pauline W. Chen, M.D. :

I spoke with Dr. Thomas J. Nasca, the chief executive of the council, and asked him about resident duty hours

Q. What have been some of the effects of decreasing duty hours on patient safety?

A. We know there have been a lot of unintended consequences, some of which have not been good for patients. One of these unintended consequences, for example, has been an increased number of handoffs between doctors leaving their shift and new doctors coming on. The handoff period is the most vulnerable period for a patient, not because the people handing off data are not doing their best or because institutions don’t have systems in place. It’s a vulnerable period simply because one cannot predict what will happen when a patient is ill, and the doctors left caring for those patients don’t know them.

Another unintended consequence has been placing residents in certain ethical quandaries. One resident told me about caring for a child who was dying. She had taken care of this child for 10 or 12 days and was on call when it became clear that the child was going to die in the next few hours. But this resident was supposed to go home; her hours limit was up.

This resident stayed, but there was an unintended consequence. She could tell the truth about breaking the hours rule, and thus jeopardize herself and the residency program. Or she could lie.

On Young Doctors and Long Workdays [NYT]

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Posted in Residency | 1 Comment »

On the 80-hour Workweek Cap – Part 1

Posted by medliorator on March 14, 2009

Pauline W. Chen, M.D. :

I finished my general surgery training in 1998, five years before the national accrediting organization for residency programs set a limit of 80 hours per workweek for residents across the country. I worked on average 110 to 120 hours per week and had my share of being on call every other night. Like many of my peers, I know about fatigue so overpowering that the odor from your pores smells not like nervousness or exertion but exhaustion. I have experienced the teeth-chattering chill of the early morning, which never leaves despite two layers of clothing, a sweatshirt and a doctor’s coat. I remember that falling asleep at 5 a.m. for an hour before rounds does more harm than good. And I can tell you that a quick but well-timed morning shower after being up all night is the physiological equivalent of a two-hour nap.

Does More Sleep Make for Better Doctors? [NYT]

Posted in Residency | Comments Off on On the 80-hour Workweek Cap – Part 1