Hazing by any other name

I read a WSJ piece today about some of the backlash towards proposals to reduce the bone-crushing hours that medical residents (doctors-in-training) need to endure. Having written a previous post on the subject attacking the crazy hours as “hazing”, I was eagerly awaiting some brilliant doctor to point out why I was wrong.

I was not impressed. The WSJ article cited three unconvincing arguments against resident hours reform:

1. Lack of improvement in patient care from reduced hours
2. Hospitals may need to hire more residents, and this will be expensive
3. Patient hand-off increases medical errors

The first argument asserts that the reduction in hours is not a good thing because there hasn’t been a significant improvement in patient care. This makes absolutely zero sense to me. In the business world, if I could achieve similar results but with much lower worker burnout and hourly commitment, I’d call that a great victory. Odd that these doctors think the exact opposite?

The second point sounds convincing at first glance, but has two big problems with it. First, the estimated cost of hiring additional residents (~$1.6 billion) is a tiny drop in the ocean of total healthcare spend ($2.2 trillion in 2007). To argue that this is a ridiculous burden is to argue that $5.33 per person in a year or an increase of 7 cents on every hundred dollars of healthcare spend is an unconscionable amount to spend to reduce resident burnout and fatigue-related error. Secondly, this point assumes that we currently don’t need/want additional doctors. Given the shortage of doctors in the US, you’d think that hiring more residents could actually be a good thing. Again, to use business as an example, if all our clients could fix their staffing shortage and morale/fatigue problems by increasing their budget by 0.07%, my job would be very easy.

Lastly, the same tired argument is rehashed about hand-off errors. I’m too lazy to come up with new points, so I’ll simply re-quote what I said before:

1. 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.
2. 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. 
3. 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.