Do the possible benefits of limiting resident duty hours for training outweigh the possible benefits of working long hours?
Working long hours helps when you get into practice.
Richard Lander, MD
When I did my residency, the limited duty hour restrictions did not exist. Residents worked every third night, and there were no protected sleep hours. I do not recall, within our program or in other programs, a physician who was so tired that he or she could not function.
Although there is clinical documentation of medical errors made due to residency fatigue, I would be interested to view the reverse. How many lives were saved by residents who worked 36 hours straight, functioned and performed their duties effectively?
A benefit of working long duty hours is that it helps when you get into practice, because there are times when you are going have to wake up three or four times a night to deal with a patient.
In terms of continuity of care, if I was on call Monday overnight and something went wrong with a patient, I was there Monday afternoon to follow-up with that patient, so there was continuity of care.
Richard Lander, MD, is a private practitioner in New Jersey and Chairman of the Section on Administration of Practice Management, Committee Member on the Private Payers Advocacy Advisory Committee of American Academy.
IOM recommendations may help improve patient care.
Michael Rhodes, MD
Working long shifts often causes fatigue and influences your personal mindset. Some of the new IOM recommendations, like protected sleep, could possibly improve patient care.
Having someone else to cover during those five hours would allow the resident to rest while the patient is still treated. Patient care may be affected on late nights when people have been up for 20 hours or so and still have 12 hours ahead of them. A protected time when someone else is helping out could improve patient care as well as the residents’ well-being.
The argument that continuity of care is affected by duty hour restrictions is a somewhat flawed argument, because unless you work 168 straight hours, which are the hours in a week, there will always be some loss of continuity.
There are always going to be handoffs, especially in the real world. Doctors working 12-hour shifts is common, and seeing a higher numbers of rotations and working more hours results in learning more, but it would be more beneficial to work 80 hours spread out rather than the 30 or more hours consecutively.
Michael Rhodes, MD, is a first-year resident at the University of California, in San Diego.