I was reading a column by Pauline Chen on the New York Times about resident work-hour reform, and I have to say that I’m very stunned and somewhat outraged at a doctor’s claim that resident work-hour reform is a bad idea:
I spoke with Dr. Thomas J. Nasca, the chief executive of the Accreditation Council for Graduate Medical Education, and asked him about resident duty hours, patient safety in teaching hospitals and the implications of further duty hour changes to the doctor-patient relationship.
Q. What have been some of the effects of decreasing duty hours on patient safety?
A. We know there have been a lot of unintended consequences, some of which have not been good for patients. One of these unintended consequences, for example, has been an increased number of handoffs between doctors leaving their shift and new doctors coming on. The handoff period is the most vulnerable period for a patient, not because the people handing off data are not doing their best or because institutions don’t have systems in place. It’s a vulnerable period simply because one cannot predict what will happen when a patient is ill, and the doctors left caring for those patients don’t know them.
Handoffs are when most errors occur, and most of the potential reductions of error based on fatigue have been replaced by an escalation of errors related to handoffs.
Really? And this guy is responsible for making trade-off decisions that affect patient’s lives? Let’s ignore just for a moment that incumbents never want change (after all the people who went through hazing processes oftentimes become the biggest advocates of said hazing processes), but I think most patients would agree with my take:
- I strongly prefer a resident who is rested and slightly unfamiliar with my case over a resident who is half-asleep and is probably not all that familiar with my case anyways given that he/she is probably dealing with many other patients and was probably half-awake/running-on-adrenaline during those patient visitations as well.
- Really? Handoff errors are occurring at such a high rate that they are compensating for decrease in fatigue-related errors? I find that really hard to believe.
- Even if handoff error rates are close to fatigue error rates, it suggests that we aren’t training doctors correctly at all. After all, while fatigue error is practically impossible to control (if you’re tired, your brain doesn’t think properly — there’s not much you can do about that one), handoff errors are. I fail to see why training doctors to communicate more effectively, to learn to collaborate with other doctors more effectively, and to take better records (Obama is committing $19B to developing better healthcare IT) is something that is unfeasible or undesirable or an unnecessary burden.