November 17th, 2009
Residency work hours
Andrew M. Kates, MD
Apropos of our recent blog on work hours, see this post in the Boston Globe.
What are your thoughts?
If a reputable program goes on probation, how would this effect your willingness to apply?
How do you feel about educational changes — including limiting conferences so that programs may be more compliant?
One Response to “Residency work hours”
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In response to this post as well as the prior post regarding residency work hours, I have to say that I tend to agree w/ Dr. Majmudar about the negative outcomes of these work hour restrictions not only for trainees but also in terms of patient care. It is impossible to place a time rule on resident work hours without affecting continuity of care. Surgical residents are having to operate on patients that they did not do the initial work up on (this hits home for me, as my husband is an orthopaedic surgeon) and internal medicine residents are having to “check out” to the on call team such issues as talking to the family that shows up in the evening about deciding future care of the patient. The mentality is changing to shift work, rather than personal responsibility of his or her patient, and it’s a shame. I am not saying that we should not look out for fatigue ridden trainees who could pose a danger to themselves or patients b/c of their exhaustion. I do, however, completely disagree with situations in where we are required to make the housestaff go home when it would serve both the trainee and patient’s best interest for them to stay and finish a critical work up, have an important discussion w/ a patient’s family, etc. The “rules” should be strong recommendations, not absolutes. We are adults here, and we as physicians should be able to determine what would be in the best interest of the patient, even if it goes beyond the “work hours” rules. In regards to the suspension of the surgical program posted in the Boston Globe, I say that we should not jump to any conclusions about the program. Were these violations b/c of a malignant program or violations due to physicians attempting to maintain continuity? Unless you are part of this program or closely related, I would not venture to guess.