Good NY Times article on residency hours he-pha…

The article raises some conflicting points that we’ve struggled with the last month since the rules went into effect. Is the inherent problem sleepy, unsupervised interns, lack of efficient patient handoff, or both? Interestingly, under the new rules, there are more patient handoffs, potentially creating even more patient safety issues.

I also thought it was interesting that the article mentioned something else that’s kind of bothered me about the new rules; that is in the real world, a physician’s day does not end after 16 hours if there is still work to be done. “Stuff” happens at 4am, and you better know how to handle it. At least during residency, now it will hopefully be handled by second year and above physicians who are well-rested, but I still worry about it. If interns are going home at midnight because they’ve reached the limit on their work hours, are they going to be prepared next year, or are they going to be deer in headlights when the code pager goes off? At some point you just have to jump in with both feet. Those of us who teach/supervise are responsible to make sure the physicians who are covering patients overnight are competent to respond appropriately when the “stuff” hits the fan. It’s a tricky balance, one that we are just beginning to understand and deal with.

Fortunately, we had enough lead time to think through all this before the rules went into effect. I think most programs instituted new protocols on their inpatient services to cover the handoff and short shift issues, at the same time insuring the interns get the training they need to function appropriately when they’re unsupervised and working longer hours next year. I truly hope that the changes will ultimately result in better patient care and less medical errors. After all, that’s why we’re here.

Anyway…thanks Shannon for sharing the article. I’m going to forward the link to our new 'terns.

I thought the article was thought provoking, too. It certainly paints a very realistic picture; that the issues surrounding residency hours are not black and white.

Ultimately, as you stated, it all boils down to what is best for patient care.

Someone once told there is a reason physicians are called practitioners. I am anxious to become a practitioner myself and I hope the “practice” of others who precede me will help me get the most appropriate training so I can offer the best care to those who will be counting on me to deliver it. If that means less sleep, so be it! After all, I think most of us who decide to enter medicine know what we are getting in to, but if it’s definitely determined that more hours and less sleep is not best for training new physicians and even for more senior staff, then we must deal with that, too. It appears, if this article is any indication, that the jury may be out on this one for awhile.