I agree with you 100% on your assessment of this. Having recently finished residency, I can attest that so much learning gets done the day after admissions. If you are gone the next day, you miss exactly what you said: all the results for the tests and studies that you made.

The best way to learn medicine is by follow-up. Overnight, as an intern or a resident, you are making your best assessment of what is going on with a patient. These days, patients have to be pretty sick to get admitted. If you miss the opportunity to see how your patients progress in the first 24 hours, you have missed your opportunity to really see an illness from presentation to resolution. You miss the opportunity to make decisions about the care that is delivered. You miss the opportunity to speak with all the consultants about the case. You miss the opportunity to match up your thoughts with what the specialists say and with how the patient ends up doing.

From a patient care standpoint, I think it is also somewhat ridiculous. The person who knows the patient the best is going to leave. Signouts are fine for safe care, but they are not optimal care. As a resident, when you are working up a patient, you end up talking with a lot of people about the game plan for the patient. You cannot communicate all of that to the next resident. You are going to react differently to a lab result because you are intimately involved with the case than someone else who didn’t have the benefit of talking with a senior, an attending, and specialists.

In this way, optimal care gets delayed. And learning is decreased.

So I really do disagree with the 24+6 thing.

You are all focussing on the professional growth of the physician in training which is certainly an important point but I’m quite sure the motivation for this law was the health of her patients. Is it really in the interest of a patient to be cared for by someone who has been working for over 30 hours in a row-whether they want to or not? Your program seems quite humane with a cap on the number of admits and a substantial commitment to education of residents but other programs may differ and its not in the public interest to have patients cared for by someone who has been running for 30 hours or more.

I certainly agree in theory that if she wants to go to conferences or other educational activities, she should be allowed to do so but I’m not sure how feasible that is as a law.

Lets be HONEST, restricted work hours are NOT because of RESIDENT Medical misadventures. These happen everyday by Residents that just came off 12 hrs of sleep. Restricted work schedules resulted from RESIDENTS being 45% female. This is just more of the FEMALE NOTION of having IT ALL. In RESIDENCY the ONLY thing anyone can have ALL of is PATIENT care. Any person selecting a CLINICAL discipline
should accept that they must do things in RESIDENCY that they can elect not to in PVT. practice.

There is NO (none, zero, zilch) class 1 or class 2 data showing that physicians make more mistakes when they’re tired (actually being that I don’t believe that the bureaucrats that passed the laws can be considered experts there isn’t even Class 3 data). There IS however a good deal of observational (Class 2) data (mostly from the ED) that error rates go up during turnover of a patient’s care from physician to physician. Basically what we’ve done is turn a system with a theoretical possibility of error to one with a definite rate of error based on no actual research in the medical field. Of course mathematicians would consider that a move in the right direction (Ah, now it’s a problem we understand!).
And as a personal note, because you can’t be polite when you’re tired means you’re a jerk, not that the system is bad.