Wednesday, September 02, 2009

Do resident work hour restrictions transform professionals to shift workers?

The answer according to Dr. John D. Rybock,from Johns Hopkins School of Medicine, is "yes". Dr. Rybock in a letter to the editor published in the August 27,2009 issue expresses the opinion that the duty-hour rules of 2003 have "taken away their(residents) control" and prevent them from making decisions that characterize a professional.

In regard to limiting work hours he says:
"We now force them to leave a patient with whose treatment they are intimately involved or to cease the observation of an instructive surgical procedure midstream.It did not take long for this system to produce residents who would either walk away when their time" had expired or else lie in order to violate the rules.Although we added "professionalism" as a training goal, we began giving our trainees the choice between abandoning a patient and lying."

As pointed out in another letter to the editor in the same issue of NEJM: It has now been six years since the implementation of the 2003 ACGME regulations and there still is no consensus or clear cut evidence on whether the work-duty hours changes have improved safety and the debate continues on the effect on residents' medical education.

I continue to be amazed at how much impact the pronouncements of the IOM have and how there seems to be so little questioning and criticism of their recommendations.The IOM recommendations regarding further limitation of work hours seems to be taken seriously by ACGME.

An editorial in the NEJM presented the voice of reason.(Blanchard,MS, et al, To nap or not to Nap.Residents' work hour revisted .NEJM 2009,360,2242-4). That editorial recommended careful studies on the impact on the new IOM recommendations regarding patient safety and other relevant end points before widespread implementation of further restrictions.

1 comment:

Anonymous said...

Rybock proposes a brilliant solution:
schedule residents for 75 hrs of a work a week and let them decide what to do with the extra 5 hrs.

That way the resident would not be forced to leave when the clock strikes twelve; she could stay for the surgery/family meeting/lecture/whatever.

So simple, so effective - brilliant! Why didn't I think of that??!!