Duty hour limitations

Latest headline regarding duty hour limitations:

There was no improvement in residents’ reported sleep and general well-being in 2011, however, and the proportion of medical trainees who said they’d made a serious error in the past few months rose from 20 to 23 percent. (Desai, JAMA 2013;173(8):649-655)

Well I’m glad we trashed decades long tradition and culture of medicine for that. One of the most important lesson I learned in medical school was from Ron Trunsky, a psychiatrist and medical sage,

Medicine is not like selling shoes.” 

He would say that when ever there was patient care to be done but someone wanted to go home. Medicine is important. Medicine is hard. Medicine requires a commitment not found in regular jobs. Patients’ needs do not fall between the hours of 9 and 5 but around the clock. Part of residency is training you to accept that. Part of residency is turning normal people into physicians.

Working insane hours during residency was the forge that allowed me to be cast me into a physician. Like boot camp in the military, long residency hours broke you down and reformed you into a specific type, the physician.

There is a lot to criticize about this system, but it was an important part of the physician ecosystem and it irresponsible to trash one component of that system without doing prospective studies on what will happen. Now, 9 years later what are supposed to do with this data. Apparently working 30 hours in a row was a key part of reducing medical error and made no difference in the hours slept or resident depression.

This agrees with my experience. Reduced duty hour requirements is forcing residents to spend more and more of their time watching the clock, filling out attendance records, missing lectures and skipping rounds. Trading improved fatigue for less investment in patients was a terrible bargain.

2 Replies to “Duty hour limitations”

  1. You seem pretty certain of your opinion, would you believe a RCT which showed similar results:

    Results The study included 560 control, 420 Q5, and 140 NF days that interns worked and 834 hospital admissions. Compared with controls, interns on NF slept longer during the on call period (mean, 5.1 vs 8.3 hours; P = .003), and interns on Q5 slept longer during the postcall period (mean, 7.5 vs 10.2 hours; P = .05). However, both the Q5 and NF models increased handoffs, decreased availability for teaching conferences, and reduced intern presence during daytime work hours. Residents and nurses in both experimental models perceived reduced quality of care, so much so with NF that it was terminated early.

    Effect of the 2011 vs 2003 Duty Hour Regulation–Compliant Models on Sleep Duration, Trainee Education, and Continuity of Patient Care Among Internal Medicine House Staff

    You have any evidence that awrecking decades long tradition has done anything besides giving residents more time to moonlight?

  2. I'll have to refute this. As someone who does these sorts of hours regularly, there is really no difference in tiredness between working 67 hours and 63. None at all. That is an insignificant change in working hours.

    And yet with a change of a mere 1/2 per day, suddenly people made "substantially more errors"? What a load of crap. This wasn't even genuine errors, this was self-reported fear of errors!

    What has changed, however, is that rules have come in that were resisted by the resident doctors. And what you are seeing is their psychological perception.

    It's interesting that medicine is the only profession where being tired leads to "less errors".

    Terrible methodology here, and definitely not in line with the medical experience outside America.

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