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Time To Care
PREFACE: How many hours should a doctor work? How much sleep is important for responsible decision making? How important is learning by marathon on-duty hours? These issues hit the headlines in recent years after some notorious mistakes by physicians in residency, subsequent lawsuits, and eventually a 2003 regulation by the Accreditation Council for Graduate Medical Education (the body that governs residency training) that residents can work no more than eighty hours a week—a foreshortened workweek for many. Today, residents are unarguably more rested, but handoffs from one resident to another in hospitals are more frequent and confusing. Liz Gaufberg, an internist, psychiatrist, and professor, writes of her life as a resident before the duty-hour restrictions were put in place and provides a vivid picture of hazards of the Herculean workday. Janet Gilsdorf, an academic pediatrician at the University of Michigan, reflects on the damage done to patient care, physician learning, and a hospital’s workforce (and finances) by the circumscribed hours. Their debate—and insights—go to the heart of what it takes to build a physician.
THE FIRST-YEAR RESIDENT wore a sour expression and a rumpled white coat as he presided over my husband’s recent admission for a serious illness. With the faint blush of sunrise just visible though the hospital window, I suspected that our brusque young doctor hadn’t been horizontal for many hours. Was he eyeing my husband’s bed jealously? Perhaps. But with the morning sun he was sure to find respite and a bed of his own.
Residents like this one are now limited to working no more than eighty hours a week. In any given shift they may work
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