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The Tired Trainee

Wed, 07/07/2010 - 7:45am
Amanda McGowan
One of my close friends recently moved to a new city to take a job at a large company. The job, it seems, is a perfect stepping stone for her as she builds her career. Still, when I receive calls from her at 8:30 or 9 pm while she is on her way home, just leaving work after being there since the wee hours of the morning, I know she questions if all the hard work and long hours are worth it.

One of my close friends recently moved to a new city to take a job at a large company. The job, it seems, is a perfect stepping stone for her as she builds her career. Still, when I receive calls from her at 8:30 or 9 pm while she is on her way home, just leaving work after being there since the wee hours of the morning, I know she questions if all the hard work and long hours are worth it.

I understand the need for young professionals in any job to have to “pay their dues” and work extra hard the first few years to establish themselves and learn what they need to know. When I talk to her, I tell her it will get better soon, that surely these first few months are the worst. I can tell, though, what she’s thinking in her head about how she’s tired, she’s getting burnt out and the pressure not to make a mistake.

Talking to her, it gets me thinking about the often-debated work-week “cap” implemented for medical residents and interns. Since 2003, medical interns and residents have been limited to 80-hour work weeks and 30-hour shifts.

The argument for instituting this rule is rooted in patient safety and the idea that tired doctors make more mistakes. To support this argument, a study in the New England Journal of Medicine reported a year after the rule was implemented that doctors made significantly more errors when they worked frequent shifts of 24+ hours.

Still, arguments against the work-week cap are multiple. According to a USA Today column written by Kevin Pho, limiting resident and intern hours has possible negative effects, such as:

  • More "patient handoffs" between doctors, which could introduce the potential for errors.
  • Hampered training—some argue 80 hours per week is not sufficient for doctors-in-training to learn all they need to know.
  • Increased costs—less hours being worked means more staff needed to fill the shifts, which equals increased costs for hospitals.

Still, it doesn’t take more than a little common sense to understand that tired doctors are prone to making more mistakes. I think about myself when I’m tired—I get more emotional and less rational, I forget things more easily, I have a hard time concentrating. I have no doubt that surgical residents and interns feel these similar effects of fatigue.

In his article, Pho suggests that flexibility is key in order for the work-week limit to do what it is supposed to do. Mandating that a physician be at the hospital or at home at certain times is not always going to help the doctor learn. There may be times they need stay for emergencies or valuable learning cases that come in. Additionally, Pho says, how to adequately communicate during patient handoffs needs to become part of the standard curriculum for medical trainees as shorter shifts are to be worked.

While it’s clear that the medical community is still figuring out how to exactly make this rule work as it should without risking the negative side effects, the work-week limit overall has the potential to be a good thing for the medical facilities, their residents and interns, and most importantly, their patients.

The work-week rule was instituted in order to keep patients safer while in the care of a doctor who is alert and well-rested rather than simply a tired trainee, and when it’s implemented with the flexibility, education and understanding required, that is what it will accomplish.

What’s your take on the work-week limit? Is it improving patient safety or are the negative effects of the rule overpowering the benefits? E-mail  me at Amanda.McGowan@advantagemedia.com

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