Resident Work Hours

I was pretty disappointed with the responses Dr. Thomas J. Nasca, the executive director of the ACGME (Accreditation Council for Graduate Medical Education), made in a recent interview with Pauline Chen from the New York Times about resident work hours.

Dr. Nasca's point is that physicians in training need to put their patients' needs over their own, being prepared to suffer extended work hours. Of course professionalism dictates that the patient's well being is paramount but not at the expense of the doctor's safety. Doctors' incidence of needle sticks and motor vehicle accidents increase after extended work hours.

Furthermore, we know that someone who is excessively tired cannot make good judgments, and lack of sleep has been likened in psychological studies to intoxication. Yes, pass offs are a high risk time, but two alert physicians can communicate clearly with one another. If I were a patient, I would always prefer a new physician who had slept well over an original one who was debilitated with fatigue.

Dr. Nasca highlights a resident who was put in the position to either leave her dying patient or stay and lie about the hours she had worked. From my experience, the lies have been in the other direction: One friend at a New York program told me that one resident schedule was created for public consumption (demonstrating that the residents were working within the work hour limitation guidelines) while the real schedule was followed.

Furthermore, Dr. Nasca reports that teaching hospitals have been shown to give better care than private hospitals, but that is in spite of the long resident hours, not because of them. I recall a surgical resident who told me that on his service, after being on call, the residents were rewarded by being allowed to operate the next day. Would you want your family member to be a reward for an exhausted doctor?

A surgical colleague told me of the time she left work after extended hours, was driving home during daylight and next found herself on the side of the freeway in the dark. Apparently, she had fallen asleep at the wheel, but not before she drove her car to a safer spot. Pretty creepy.