Blog | Thursday, September 26, 2013

Strict work hours are not the right solution


Lisa Rosenbaum has described the problem well: Why Doesn’t Medical Care Get Better When Doctors Rest More?

We have a classic conundrum in medical training. We want our trained doctors to care deeply for their patients and to have superb bedside manner, to have excellent diagnostic skills, and generally to put patient care as the highest priority.

But we hamper education and tell our trainees that we must put their sleep as a higher priority than patient care.

We do need to have reasonable work hours, but we have become a bit too draconian in the prescription of work hours. Most residents that I know want to provide the best care for their patients. They often “cheat” on the work hours to achieve that.

Some residency programs demand that residents leave at an appointed time. What does that teach about professionalism?

Some residency programs have creatively designed their new work hours to limit hand-offs and still meet the “requirements.”

Residents do not seem to sleep more when given the work hours adjustments. They seem to learn less about the natural history of disease.

I am in favor of work hour restrictions, but would prefer that residents have more flexibility. I would prefer that we put patient care first over strict resident work hours.

Whenever you create strict rules you have inevitable unintended consequences. The rush to make rules without studying the implication of those rules flies in the face of our evidence based profession.

Residents need sleep and they need to become excellent physicians. We need a bit more flexibility to achieve both goals. We can do it, but not if rules are rigid.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Associate Dean for the Huntsville Regional Medical Campus of UASOM. He also serves as a frequent ward attending at the Birmingham VA Hospital. This post originally appeared at his blog, db's Medical Rants.