www.hourswatch.org

It's a website set up by the AMSA/Committee of Interns and Residents about resident hours reforms.

Personally, I don't want a doctor who has the equivalent of a blood alcohol level of 0.1 in charge of my life!

I am a faculty physician and have found it extremely ironic that rules are now in place for the residents' hours but not the faculty's. At our program the faculty take more frequent call than the residents and it is us whom they call at 3 AM, when they need direction and advice about the ICU pts suddenly crumping. Then, we get to work a FULL day the next day, with or without sleep on call; often giving advice as preceptors in the office where we have to stay until EVERY pt leaves the office and every resident/student has discussed EVERY case with us and we have signed EVERY chart (or at the latest, in order to be "compliant," sign them all within the next 24 hours). We aren't gonna graduate in 3 years...some of us are planning to be in those postions for decades.

Now, all of that having been said, I DO advocate placing reasonable limits on physician hours. For far too long, in our egotistical male-dominated profession, physicians have neglected their families, their own health and mental well being, and been slaves to their jobs in the name of doing something noble and service-oriented. I believe and support nobel causes and service to others (those are some of the major reasons why I am a doc in the first place), but there needs to be a reasonable balance and it's PAST time that our profession, which preaches moderation and healthy lifestyles to everyone else, begin to be role models for setting appropriate limits and balancing our lives. We are not machines; if that is what is needed, I'm sure that a computer/robot will soon be albe to replace all of us and we can finally get our rest! To be an effective healer (or honestly, an effective HUMAN BEING), we need to heal ourselves. I have found that one's practice, whether in an academic or private setting (I've done both) can become all-consuming. I am a multi-faceted individual and I refuse to swallowed whole by a career tract that I chose for myself, or be made to feel less than what I should be by some guy who looks down on my desire to go home at a reasonable hour and refuse to support the idea of a Saturday clinic, etc... Let's stand up for what is right for our patients, our families, our profession and ourselves!

Young Doctors Working Too Many Hours

A new article about compliance with the resident work hours.

Wow, that guy really had some courage! Good for him!

A subject close to my heart...

The attitude I get from attendings, as well as some of my senior residents, is that we (the newbies) have it so much easier. They imply that we are lazy slackers because we are concerned about "lifestyle", and because of the 80 hour workweek. And I am quite tired of hearing, "Well when I was an intern...". I feel like responding that just because that is they way it was, does not mean that is the way it should be. I am also tired of the implication that I am somehow deficient as a physician because I am not working the 120 hour weeks my predecessors did.

I work hard. I do the scut. I write the notes. I dictate the cases. I triage the patients. I am the one who is up writing labor or Mag notes. That's my job as the intern, whether I like it or not. And I really can't agree that taking 8 calls a month, many of them q2, is slacking.

What this residency process often feels like to me is ole fashioned hazing. The "I did this, now you have to do it," mode of thinking. As if there is nobility in the suffering. That somehow we should gladly place ourselves, our families on the alter of medicine.

I love what I do. My family and I have made many sacrifices so I could be where I am today. And I don't regret the choices I have made. But I am more than a physician. I am a mother, a wife, a sister, a woman.

I know I'm rambling on a bit... my apologies.

An aside (and a clarification)... the 80 hour week is based on an "average" over four weeks. So some weeks you can do 100 hours, and some weeks 60. The call is also not supposed to be more frequent than q3, but that too is "averaged." So it doesn't matter if I take 3 every other night calls, as long as my average is q3. Our on call days are also usually more like 30 or 31 hours, not 24. The reason is that while we should only have patient care for 24 and then do paperwork or continuity of care for a max of 6 more. That's not what happens. We work, taking care of patients for those 6 hours.

My purpose is not to whine, but to emphasize that changes are happening within medicine, and that they have to take place. My own chosen specialty, OB/Gyn, can't fill their spots with US seniors anymore. And it is not just the liability issues that have med students running from the surgical specialties. It really is a matter of "lifestyle". And threats (that exist) from these specialties to lengthen training programs will have even more people choosing other careers or specialties.

To (poorly) paraphrase the famous quote about democracy... Residency is the worst form of training doctors, but it is the best one we have so far. I'm for us finding a new and hopefully a better way of doing it.

Linda
PGY-1, OB-Gyn

Am about to go to bed, s/p 30 hour cardiology/CCU shift (would have been 36 except for new RRC rules), agree that I wouldn't want someone as delirious as myself taking care of my loved one. That being said, the solution to the work hour problem is increasing numbers of physician hand-offs. There are numerous studies in medicine relating errors to hand-offs, and none relating physician sleep-deprivation to errors (though numerous case reports). In this case, I think we can all agree despite the absence of literature that physician sleep-deprivation is dangerous. However, the patients I admitted overnight to the CCU were being managed this afternoon by someone who just briefly heard about them on rounds. We all need to be careful in the ways that we attempt to rectify the situation, that we don't actually worsen patient outcomes.