The ACGME report on the new standards for resident work hours raises many interesting questions. We must examine ourselves as a profession. Attendings should consider themselves role models, and reflect on that role. How should a physician balance work and life outside work? How do we keep our moral contract with patients, while maintain our humanity and our personal lives?

I believe that many programs and attendings have lost their way. They mean well, but they haven't considered carefully how changes in health care should change our residencies. My cohort remembers working every third night. When residents work every fourth they assume it is easier. We often forget the many changes which have occurred on the inpatient wards - all make residency more challenging.

The average length of stay during my residency was longer than a week. We admitted less patients per night, and the patients were not as sick. Occasionally we would "get slammed" and get 6 or more admissions, but at least in my program that was unusual. We had time to develop a management plan, and to view the outcome of that plan.

Attending physicians made teaching rounds during the week, but the resident was king (or queen). The attending taught, but didn't direct care. Soon after I first became an attending, we had to start writing very brief notes. As the documentation requirements have increased, so has the attending input on rounds. The challenge we face today is that of balance - how do balance our clinical documentation responsibility with our teaching function. Attendings differ in their approach, not all taking the resident's circumstances into their equation.

Much of the distress in housestaff training comes from how their attendings treat them. As an attending I have to balance the resident's situation and patient care. Teaching becomes secondary to the situation. Or at least it should. We should rethink how we do rounds, when we teach, and how we transmit our expectations. Neverending rounds aren't consistent with housestaff mental health. At the risk of becoming pedantic let me make some modest suggestions:

• Daily rounds need an announced ending time. The housestaff have much to do, as an attending I should give them the certainty of when they can do their work. If I drone on and on, I selfishly impinge on their time.
• Post-call rounds should take into consideration how difficult the night call treated the housestaff. If you come in and they look haggard and tired, then adjust. I call such rounds - "survival rounds". On those days we have minimal teaching, and no longer have complete presentations on each patient. I may have to spend a little extra time after rounds, but the housestaff need time to stabilize the service.
• We should be role models of healthy lives. Let the housestaff know that you have hobbies. Discuss your life with them. Get to know them - what they enjoy - what they do on their days off. I've seen too many physicians burn out; I hope that I can prevent a few from that self-destructive life style.
Be their advocates, not their enemies.