Just Another Twenty-Seven Hours?
It's a bit of a catch-22. You want the very best care when you're sick, so you go where the best doctors are. So do the best-doctors-in-training. That means you all end up at a cutting-edge teaching hospital, staffed with exceptionally bright residents who will be exceptionally skilled physicians-if they survive their residencies.
The Institute of Medicine (IOM), a non-profit organization that provides advice to policymakers and health care professionals, recently issued recommendations for limiting the number of hours worked by residents. At least partially.
The IOM did not recommend a change to the 80-hour limit per workweek currently in place for residents. But, they did recommend shortening the number of consecutive hours residents can work from 30 - sort of. The IOM recommends residents work no more than 16 consecutive hours without a break for sleep, which they think should be for five uninterrupted hours. The remaining hours of their shift should be used for transitional duties, such as shifting patient care to others in an efficient manner, and for education.
Currently, residents can work 30 straight hours, while admitting patients during the first 24-hour period. The remaining six hours are then used for transition and education.
There are other changes as well, dealing with limiting the number of consecutive days a resident may work, and assuring that all moonlighting hours - not just internal moonlighting hours, but those worked elsewhere as well - are counted against the maximum 80 hours in a given week.
The issue, of course, is safety - for both the patient and the resident. And, while we certainly want these exceptional doctors-in-training to forge brilliant medical careers, there's only so much risk we're willing to take.
So, in a world filled with catch-22s, let's step back and take a new look at residents' excruciatingly long hours. Better yet - let's sleep on it...