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Karl Bilimoria

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Residents’ work-hour limits may be backfiring


As Slate notes,  “In 2003, the Accreditation Council for Graduate Medical Education, the nonprofit that oversees residency programs, followed New York’s lead and barred residents from working more than 80 hours a week or spending more than 24 straight hours on duty caring for patients. It also guaranteed them the relative luxury of one day off every week.”

“Yet by the time this new round of reforms was solidifying, researchers had already started to notice something discouraging: Although the 2003 rules seemed to have made life more bearable for residents — several papers found physicians were suffering less burnout—a pair of major studies concluded that they still weren’t improving patient outcomes. There were a few theories why, including the possibility that hospitals were simply ignoring the rules. But as Darshak Sanghavi explained in a lengthy 2011 New York Times Magazine article, many suspected another problem was at play: While doctors might have been better rested, the new rules prevented them from overseeing their patients’ care from start to finish. ”

“The surgical community in particular is concerned about this and feels duty hour restrictions have impaired continuity of care,”   Karl Bilimoria, M.D.,  a professor at Northwestern University’s Feinberg School of Medicine, told Slate, which paraphrased him as saying  that “young doctors find themselves forced to hand off patients in the middle of urgent situations—in the middle of an operation, for example, or while trying to stabilize them in the intensive care unit. Senior doctors, of course, get to stay on the case. But interns and older residents have to switch off, ”and it’s simply because their clock is up and they have to leave.”

Slate added that: {T}here are some signs that interns themselves may not be benefiting much from the latest changes. A 2013 study found that interns who started training after the 16-hour rule went into effect were statistically no less likely to experience depression and no more likely to feel a sense of well-being. They were also more likely to report feeling concerned about having made a serious medical error.”

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