Dr. Pauline Chen has written a great article on Workload for Doctors in Training, a topic I have been thinking about lately. From being feeling overworked to being on call by youself, it really makes you wonder if there is a better way to structure residency. The comments from the article are worth a read too as many residents, staff and the public weigh in on this heated topic.
Much of the recent kerfuffle arises from an article published in JAMA on Duty Hour Reforms. A lot of medical bloggers that I follow regularly have commented on it more elegantly than I can - Sims and Choppers, Precious Body Fluids, Med Rants.
In Canada, at least at my institution, we don’t have a 80 hour work week limitation. Our contracts states that call shifts are to be a max of 26 hours, though I have stayed longer many times post-call. We don’t have a night float system yet. There are still some vestiges of traditional work hours and I really don’t mind them. I guess I can consider myself lucky?
But based on my experience as a medical student and resident, I believe that work hours are not the main issue to be addressed. Medical errors are more likely to be made when processes are rushed and when you have to make clinical decisions for patients you are not familiar with. More handovers leads to more chances for errors to occur. Lack of supervision can be an issue too, as quoted from the NYT comments, “young docs left to make immediate decisions, only to be berated for their mistakes a day or two later when attending (supervisory) rounds were made. The mistakes, of course, were patient care.” Though for the most part newer attendings are more involved (JAMA article co-authored by Dr. Abraham Verghese) and I’ve had good experiences with academic staff.
How this all will play out - I’m not entirely clear and sure if it will benefit or disadvantage residents and patients. I think we will start having work hour restrictions here in Canada soon, some provinces have already adopted them.
To my regular readers - I am alive, eating, sleeping and getting by but not much more. I have not had time to write much. A string of multiple calls in a row can really be draining and can really sap all the remaining energy and motivation out of you. I”m on call five more times in the next two weeks… I can’t wait for the next block.
To those who applied to be a co-blogger, I haven’t forgotten. I’ve gotten a great response and getting back to everyone has taken longer than expected. I’ll try to finalize things by the end of April.
(Photo Cred: Ghz from Flickr)
[…] aren’t getting enough time with patients, leading to errors in patient safety. However, in a post responding to a recent New York Times Well article by Pauline Chen, MD, this Canadian internal medicine […]