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Murray Epstein

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Limits on residents’ hours called dangerous

Murray Epstein, M.D., argues that residents’ work-hour limits can dangerously disrupt continuity of patient care. He concludes:

“…. My contention is that the ‘lesion that we must extirpate’ is not solely the extended duration of being on call. Rather, I believe that the major defect is the glaring absence of continuity of care and the lack of ownership that once was the norm in postgraduate medical education.

“I would not argue the point about fatigue and long hours being detrimental to cognition, good clinical judgment, and performance. Unfortunately, much of the link to continuity includes long hours. I am convinced that the curtailing of hours and the proliferation of ‘shifts’ has hurt continuity of care and, in all probability, collegiality. Where once we had overtired zombies, we now have robotic assembly-line medicine, where the entity responsible for a patient’s care is the system and rarely a single doctor.”

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