Did You Know that the Doctor Treating You May Not Have Slept in Over 30 Hours?
In 2003, the Accreditation Council for Graduate Medical Education adopted guidelines to limit the amount of hours that residents could be required to work. The guidelines stated that residents could work no more than 80 hours a week with no more than 30 hours of consecutive work. The Institute of Medicine (IOM) has recently moved to further alter these guidelines and asserts that while the 80 hour limit should be maintained, residents should be provided with at least 5 hours of uninterrupted sleep per every 16 hour shift. Other groups advocating for a reduction in hours argue that further guidelines should be put in place that further reduce the 80 hour week to a 60 hour week and that residents are still too tired to do their jobs properly.
Doctors fear that increased work caps may hinder residents' ability to see enough patients and practice enough procedures to become competent doctors. They also worry that patients will suffer as they are passed back and forth between different residents everytime a shift ends. Doctors assert that this "baton-passing" may lead to increased mistakes as one resident may not have all the information needed to properly care for the patient. Furthermore, for the first time ever, residents are actually sneaking around so that they can stay after their shift is over to watch procedures that they find interesting fearing that they will get in trouble if they go over the work cap.
However, these doctors and residents should fear not. Residents may continue to be overworked to save hospitals money. A new report published in the New England Journal of Medicine, "Cost Implications of Reduced Work Hours and Workloads for Resident Physicians", argues as determined that it will be more profitable for hospitals to continue overworking residents than to hire the extra staff of nurses and doctors they would need with reduced resident hours. The study, initiated in response to the IOM's recommendations, the new guidelines would cost teaching hospitals upwards of $1.7 billion dollars extra in labor costs to comply with the IOM guidelines. The study also estimated that teaching hospitals would have to employ an additional 7,600 specialty residents per year to cover their needs.
I am personally torn between the need for residents to get the required hours needed to learn the procedures and techniques required and the need for residents to get enough rest to be able to perform their duties properly. However, I support any new guidelines that will make the practice of medicine safer. I do not think working residents to the bone is the solution to safer medicine. I think that if residents are careful when they "pass the baton" to another resident, there won't be many mistakes made. I also think that if residents are forced to stay up for 30 hours just so that the patient just has one physician, I think that serious medical mistakes will continue to happen. I think that the medical community should really think about new guidelines that will ensure that residents get the training they need, but aren't sleep deprived during the process. Although I don't have all the answers, I am confident that with some brain power, a solution could be reached. Unfortunately, the new study in the New England Journal may slow any progress being made towards reducing resident hours or issuing any new guidelines as hospitals may use any pull they have to stop reforms from being made.
When you are at the hospital, as your attending physician whether he is a resident and how long he has been up for. If you are not confident that he is aware and awake enough to properly attend to you, you have the right to request another doctor. You have the right to proper care, and do not have to be treated by a doctor that can hardly stay awake. Perhaps if enough patients request well rested residents, the medical community will continue to find ways to train residents while also getting them the sleep they need.