July 2002 • Volume 8 • Number 7 |
It's
3 a.m., you're not even halfway through this shift, and you're already well
on your way to what you and your fellow residents have dubbed a "major exhaustive
episode."
That ratty old couch in the docs' lounge is looking mighty tempting, but -- *%##@! -- there goes your pager. Car meets bridge abutment. Car loses. And you're on your way to the ER.
Been there? Done that? Then perhaps you'd like to share your views on long duty hours with your colleagues at this year's National Conference of Family Practice Residents and Medical Students. You'll have that chance during an Aug. 1 town hall meeting on the topic.
Arguments on each side of the ideological fence have merit and command attention.
Clinical research has shown that lack of sleep impairs both cognitive function and motor skills. A recent study in the journal Nature reported that staying awake for 24 hours results in cognitive deterioration equivalent to that associated with a blood alcohol level of 0.1 percent -- the level at which operating a motor vehicle would be illegal.
At potential risk are not only the patients exhausted residents care for, but also the residents themselves, say members of a coalition lobbying for adoption of H.R. 3236, introduced late last year by Rep. John Conyers, D-Mich. The resolution calls for shorter resident work hours and other work environment changes and is supported by the American Medical Student Association, the Committee of Interns and Residents/Service Employees International Union, and the consumer watchdog group Public Citizen.
But, say others, learning to provide safe and effective patient care despite long hours is a key part of the training experience, and the issue certainly doesn't merit federal intervention.
In a recent e-mail discussion group posting, Robert Bowman, M.D., of the family practice residency at the University of Nebraska, Omaha, pointed out that in light of present fears of domestic terrorism, physicians must be capable of responding to stress with skill and surety. "Disaster drills are good preparation," Bowman said, "but they do not train the body. Call is what trains the body."
And for call to succeed as a training tool, certain factors need to be taken into account, he added. "All of these components need to be present: long hours, responsibility for patients, ability to do things and excellent available supervision.
"We want physicians who can serve. We need training programs that balance hours and training and quality. We need leaders to lead and direct programs. We need residents to be direct and communicate with program directors about conditions."
News flash: The Accreditation Council for Graduate Medical Education's directors last month OK'd proposed requirements on resident duty hours. Your comments are invited; go to http://www.acgme.org to find out how to access the report of the ACGME resident duty hours work group and enter your input by Aug. 1.
FP Report is published by the
AAFP News Department.
Copyright © 2002 by
American Academy of Family Physicians.