Comments on: Duty hours, patient safety and resident education http://www.medrants.com/archives/4897 Internal medicine, American health care, and especially medical education Sat, 11 Feb 2012 15:15:48 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: Erik http://www.medrants.com/archives/4897/comment-page-1#comment-529307 Erik Wed, 07 Oct 2009 03:09:38 +0000 http://www.medrants.com/?p=4897#comment-529307 I hope Dr. Kirsh has done a few endoscopies at ungoldy hours - in my hospital no one seems to hemorrhage during the daytime. I'd just as soon his training (and mine) included caring for sick people when tired, stressed, and upset about some personal issue. Dr. Centor brings up a good point - residents don't sleep when they leave the hospital. They care for young children and elderly parents. I had a resident who lived with his mother, who was on hospice for end stage lymphoma - his time at home was quite stressful and rarely relaxing. We cannot legislate or force people to relax. There is a point where staying the hospital becomes ridiculous and accomplishes little for the patient or the doc, but every single case does not hit that point when the clock strikes 14, or 24 or 30. Very few jobs as attendings allow for time off after call. If the goal of residency is to make sure doctors are ready to practice without any supervision in their community, then part (but not all) of their training has to include working past the point of exhaustion. I hope Dr. Kirsh has done a few endoscopies at ungoldy hours – in my hospital no one seems to hemorrhage during the daytime. I’d just as soon his training (and mine) included caring for sick people when tired, stressed, and upset about some personal issue.

Dr. Centor brings up a good point – residents don’t sleep when they leave the hospital. They care for young children and elderly parents. I had a resident who lived with his mother, who was on hospice for end stage lymphoma – his time at home was quite stressful and rarely relaxing.

We cannot legislate or force people to relax. There is a point where staying the hospital becomes ridiculous and accomplishes little for the patient or the doc, but every single case does not hit that point when the clock strikes 14, or 24 or 30.

Very few jobs as attendings allow for time off after call. If the goal of residency is to make sure doctors are ready to practice without any supervision in their community, then part (but not all) of their training has to include working past the point of exhaustion.

]]> By: Michael Kirsch, M.D. http://www.medrants.com/archives/4897/comment-page-1#comment-529306 Michael Kirsch, M.D. Tue, 06 Oct 2009 22:47:05 +0000 http://www.medrants.com/?p=4897#comment-529306 It is self-evident to any thinking individual that reform of residency training is in order. I didn't buy in to the specious arguments that working 36 hrs straight was necessary training and preparation to face emergencies at odd hours as a practicing physician, or to follow the natural history of acute disease,. The reasons that this inhumane system has survived has much more to do with $$$, machismo and perpetuating a tradition of abusive training, than is does with actual medical education. As a gastroenterologist, I'm awakened to attend to patients and hope that I perform well on these occasions. I doubt that my training years when I was somnambulating through the hospital corridors was necessary preparation for what I need to do now as a practicing gastro. Did we really need Libby Zion to determine that a physician, an airline pilot or a truck driver performs better when rested? www.MDWhistleblower.blogspot.com It is self-evident to any thinking individual that reform of residency training is in order. I didn’t buy in to the specious arguments that working 36 hrs straight was necessary training and preparation to face emergencies at odd hours as a practicing physician, or to follow the natural history of acute disease,. The reasons that this inhumane system has survived has much more to do with $$$, machismo and perpetuating a tradition of abusive training, than is does with actual medical education. As a gastroenterologist, I’m awakened to attend to patients and hope that I perform well on these occasions. I doubt that my training years when I was somnambulating through the hospital corridors was necessary preparation for what I need to do now as a practicing gastro. Did we really need Libby Zion to determine that a physician, an airline pilot or a truck driver performs better when rested? http://www.MDWhistleblower.blogspot.com

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