Proposed Duty Hour Limits for Residents Met with Scrutiny

Joe Cantlupe, for HealthLeaders Media , March 17, 2011

"This is especially urgent since the current private-sector regulating organization, ACGME, has continued to abdicate its responsibility to adequately protect resident physicians," Wolfe stated.

The ACGME opposes the petition, noting: "The interests of residents and patients are served by maintaining an approach that is comprehensive and that is designed to weigh and balance in an integrated manner the full spectrum of different interests and considerations applicable to graduate medical education."

"The ACGME does that now; and the petition, if granted, would seriously disrupt the effectiveness of that system by establishing regulation of resident duty hours within the exclusive purview of the OSHA," it adds.

The current debate can be traced to the death of Libby Zion in 1984, which prompted the New York legislation to adopt regulations regulating working conditions of physicians.

The 18-year-old college freshman was admitted to New York Hospital with a high fever and mysterious jerking movements, Barron H. Lerner, MD, wrote two years ago in the New York Times.

Lerner, who was a medical student at the time, wrote that the "only doctors who had seen her were in training, that such doctors routinely worked 36-hour shifts with little or no sleep and that the attending physicians had never come into the hospital." Zion's father worked feverishly for reform, stated Lerner, a professor of medicine and public health at Columbia University Medical Center, and author of "When Illness Goes Public: Celebrity Patients and How We Look at Medicine."

After Libby Zion's death, medical students looked into their own education, and themselves, as budding physicians, in a world of intensity, and exhaustion, as they tried to retrace her care, and what went wrong.

"Would we have ordered restraints and not seen her? Would we have sent her to the intensive care unit? Would we have known about a potentially toxic interaction between drugs in her body?

Ultimately, they concluded there was a "for the grace of God go I," he wrote. "We knew what it was like to stay up for 36 hours straight, first as medical students and later as residents. It was in, a word, insanity."

In Reed's survey report, a mention was made of Libby Zion's death. It still looms large as the debate continues over physician "duty hours."

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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1 comments on "Proposed Duty Hour Limits for Residents Met with Scrutiny"

Ken Murphy, MD, FACS (3/17/2011 at 10:14 PM)
This is ridiculous, as it has been since inception. The education of prospective physicians depends upon understanding how disease develops and responds to treatment over time. This can only be obtained by being available to the patients we care for precisely when they are ill. Increased supervision by attendings and upper level residents, I believe, is highly desirable; why would we not take advantage of those who have gone before? I certainly agree that fatigued residents are more prone to errors and that patient safety is our prime consideration ("first do no harm"), and I vivdly recall every-other-night call as Chief Resident in Surgery, but illness does not assume a holding pattern after business hours and on weekends/holidays. In the real world of medicine it will be critical that physicians have as-complete-as-possible knowledge of the disease processes with which they will deal. I do not recall a single time when I was "too tired" to attend a patient. I will admit that I am a dinosaur (30 yrs solo practice) but I say let's get the more experienced physicians much more involved in education of trainees, including those in private practice. Just as an aside, there is a wealth of education available in private practice, and we have yet to take adequate advantage of it in our training programs. Perhaps that is a direction which training programs should consider? Thanks. Ken Murphy, MD, FACS (Ret.) Medical Director, CRPHO UR Physician Advisor, CRMC Conway, Arkansas




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