Utah Med Law

Assume you are admitted to the hospital for the removal of your appendix.  You wake up in the wee hours of the morning after surgery and have a stabbing pain to your left side and call the nurse.  The nurse evaluates you and gives you some pain medication.  An hour later you wake in a cold sweat with more severe pain in your left side and you call the nurse.  The nurse comes in and says "Um - your incision line is a little red and oozing - I will call the doctor to come and have a look at you."  You drift off to sleep waiting for the doctor but about half an hour later you awake clutching your side and cry out in pain.  The nurse again responds but this time has a doctor you have never seen in tow.  The doctor has greasy hair, looks disheveled, has ten pens in her pocket, small books protruding from her pocket and says to you "Hello Mr. Jones I was called by the nurse to look at you."  You do not care much that the doctor has called you Mr. Jones even though your name is Mr. Smithers because you are in terrific pain.  The doctor looks at your wound and you overhear the doctor say to the nurse, "What a night - five cases in the ER and I have been awake now for thirty hours straight - I am exhausted - so what is the problem here..."

Let me ask you a question. Do you have confidence in this doctor to care for you properly?  I imagine not.  I can not begin to tell you how common the above scenario is - it happens all the time in teaching hospitals.  Doctors, especially residents, interns and medical students are worked long hours in intense situations challenging their skills and endurance.  Is that any way to run a hospital?

The New York Times reported that a rift in the medical profession exists over restricting resident hours.  In 2003, the Accreditation Council for Graduate Medical Education told hospitals to adhere to an 80-hour workweek for their residents.  Before the 2003 guidelines, residents in some specialties would work more than 100 hours a week, compared with a 60-hour workweek common in parts of Western Europe. Ever since the 2003 guidelines were implemented, however, no conclusive evidence has emerged that the shorter workweek leads to a reduction in patient harm, according to an editorial in this week's New England Journal of Medicine. The NEJM editorial -- headlined "To Nap or Not to Nap" -- comes on the heels of a government-funded 2008 report that recommends further limits to the residents' workload, such as a maximum 16-hour shift without sleep, or a five-hour nap for shifts lasting longer.

Studies conducted to date are not conclusive and my guess is they are not conclusive because even 80 hours per week over a four week period with a maximum shift of 24 hours plus six hours involved in "transitional duties" is still too much work.  Let's face it - a decrease from 100 hours per week to 80 hours per week is hardly a basis to determine whether 20 hours off decreases mortality.  Eighty hours is simply still too long and any improvements would be marginal at best supporting the cadre that want to work resident physicians even harder.  For those proponents of longer resident hours let's ask them the same question I asked at the beginning of this post.

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