Patient safety advocates say even more reforms are needed — stat!
As of July 1, the Accreditation Council For Graduate Medical Education has decreed that first-year hospital residents (a.k.a. interns) can work no more than 16 hours in a shift.
Second- and third-year residents, however, are still allowed to work a grueling 28 hours without sleep.
Common sense tells most of us the value of 40 winks, but there are actually forces vehemently opposing any further changes. Hospital administrators view the long hours as a necessary part of a well-rounded education, even though dog-tired residents must constantly relearn the basics, such as referring to those little wooden sticks as tongue depressors and not as “eyelid-holder-upper thingies.”
Oh, it’s quite easy to find residents who, like good-natured fraternity pledges enduring hazing—wander around gamely upholding tradition. They’re in denial about sleep deprivation affecting their mental focus.
(“Ha! I’m just getting my second wind…Who has seen the wind? Neither you nor I…The rain is Tess, the fire Joe, and they call the wind Mariah…I think we’re in for a blustery day, Piglet…”)
Do we really encourage a good bedside manner when we make doctors think they’re invulnerable?
(“Whew! Biggest operation since I removed a rib from Adam to create a woman!”)
I’ve read comments from seasoned doctors who are absolutely heartbroken over attempts to shorten resident hours. They consider it to be degradation, dumbing down and a kowtowing to the lowest common denominator. It’s like these macho types are channeling the spirit of Dana Carvey’s Grumpy Old Man character from Saturday Night Live.
(“Fiddle-dee-dee! Back in my day, we worked all summer without sleep. And we pulled a beating heart out of the chest to listen to it, instead of fooling with those newfangled sissified stethoscopes that the whippersnappers are so dependent on nowadays…”)
We are told that residents must be toughened up so they’ll be able to handle real emergencies. This apparently involves their someday being in a clinical setting when a natural disaster strikes – and a film crew is short an extra to play a zombie.
Bean counters warn that giving residents shorter shifts will make health-care costs increase. Of course “shorter shifts” will have to fall in line behind the other things that make health-care costs increase: Republicans in office, Democrats in office, the price of rice in China, a butterfly in Sri Lanka contemplating fluttering its wings.
Residency program directors who try to take a Big Picture approach to the problem seem a bit shortsighted to me. They imply that you have to break a few eggs (the unfortunate patients who succumb to the mistakes of punch-drunk residents) in order to produce an omelet (a crop of well-tested physicians). But this flies in the face of research about the long-term effects of chronic sleep loss on the heart and other organs. Where is the long-term glory in producing doctors who burn out or die before retirement age?
Let’s keep tweaking our residency programs to make them as safe and productive as possible. But be prepared for more muttering.
“Y’know, it’s odd for me to say ‘fiddle-dee-dee’ and ‘whippersnapper,’ since I’m only 37 years old.
Okay, dagnabbit it — maybe the hours DO age you a little.”
(Danny Tyree is distributed exclusively by Cagle Cartoons newspaper syndicate. His e-mail address is firstname.lastname@example.org.)