Growing pains worth the effort in reducing resident work hours

LETTER — Posted Aug. 22, 2005

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Regarding "The 80-hour experience: What happens when residents have to leave" (Article, July 25): New work restrictions for residents are an important first step in physicians practicing what they preach (safety, balanced lifestyle, etc.).

However, they also demand a tremendous paradigm shift. For decades, the process of training physicians was unchanged, while the science and practice of medicine evolved rapidly. Physicians who are wary of the changes are quick to point out that the old system worked, but without anything to compare it with, their argument is weak.

Older physicians argue that continuity of patient care suffers as residents turn over their patients to other residents after the required 30 hours (do any residents really leave the hospital after 24?). This, too, is a bogus point. Patient turnover (to oncoming call teams, colleagues or other services) has always been a necessary part of hospital practice.

In my experience, a great deal of the "patient continuity" at 1 p.m. on my post-call day involves mindless administrative work -- such as setting up physical therapy or writing a discharge summary -- that few would describe as a quality learning experience.

I have trained under both the old and new systems and see both sides of the issue. However, I can honestly say that I did not learn more when I was working 120 hours per week than when I work 80. Rather, I have found that, since I am better rested, I am more eager to read and study. I also can concentrate better on rounds and listen more effectively during lectures. Most important, I find myself more eager to spend quality time with my patients.

For many residents, the old system created a degree of animosity toward patients. Residents frequently viewed them as the enemy, something keeping them from sleeping or even just sitting down for a few minutes. I've seen this attitude extend beyond residency and affect attending physicians, often resulting in early burnout and potential attrition from our ranks at a time when a physician shortage is imminent. I maintain that well-rested physicians are more likely to treat patients enthusiastically and compassionately while they relish the profession they set out to master.

Having said that, residents agree that long hours are a necessary evil, and the best way to learn medicine is to see as many patients as possible. Undoubtedly there will be growing pains as programs struggle to replace the work and cases lost by fewer resident hours. And surgical specialties that rely on building caseloads for procedures clearly have the most challenge.

But considering that the rest of the working world wonders how physicians can see an 80-hour work week as an improvement, it's good to see the medical community finally admitting that sleep deprivation is just as harmful for us as it is for an airline pilot or truck driver. After all, what would you say to your patient who works frequent triple shifts, experiences excessive daytime somnolence, has a poor diet, rarely exercises and has no time for any personal pursuits?

Fernando Leyva, MD, Pensacola, Fla.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2005/08/22/edlt0822.htm.

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