More on medical house staff work hour restrictions

I evoked a good deal of rather strong comments when I wrote about the ACGME mandated resident work restrictions. Let me go on the record and say I am not an advocate of having residents perform important medical tasks while in effect stoned from sleep deprivation. Sleep deprivation is a bad thing and when folks have to make decisions when they are fatigued and sleep deprived bad things will follow.

Medical educators all of whom have thought more and more deeply about it than I have expressed some of the same concerns that I did in a previous post. Simply put-will there be unintentional consequences and will some of those consequences not be a good thing. This would included errors involving hand offs, less educational opportunities for house staff, disruption of the typical work routines for other hospital personnel,even more fragmented patient care .

Two articles and an editorial in the recent issue of the Annals of Internal Medicine provide some reassurance for the older generation of physicians who in the twilight of their careers live mainly to ensure that the current generation of medical trainees suffer at least as much as they did during training. These two investigations found no evidence of significant harm to patients and while saying there is no evidence of harm is not equivalent to saying there is no harm, the editorial writers seemed convinced that the Hippocratic oath maxim of doing no harm had not been violated.

The editorial mentioned a new "ist" that I had not previously heard about. The term is "noturnalist". This seems to refer to attending hospitalists and moonlighting senior residents who fill in at night on the teaching service to make up for the restricted work hours of the house staff. This development is one probably of many to come as the residency programs and the institutions continue to adapt and make the new ACGME rules work better for all concerned.