From: sean+@andrew.cmu.edu (Sean McLinden)
Newsgroups: sci.med
Subject: Re: Doctor's hours
Date: 9 Sep 92 00:12:21 GMT
	<1992Sep8.140132.6109@midway.uchicago.edu>
Organization: Carnegie Mellon, Pittsburgh, PA

>Perhaps you should look up the Libby Zion case, and the subsequent legislation
>in New York that restricts interns and residents to a maximum of 80 hours per
>week. 

Or any legislation, for that matter. And then think to yourself, how close
is the parallel between what legislators do and what makes sense to any
rational person. Puhleeeze...like many other legislative actions what resulted
from the Libby Zion case was reactionary at best.

>Having spent 36 hours awake working in the hospital, I can say (at least
>for myself) that while I'm not an acute threat to anyone's safety, I'd hate
>to be on the receiving end of ANYTHING from me during those last few hours
>(i.e., the receiving end of a syringe, IV, cathether, etc.).

Then given that in your particular state of the Union, there exists no
legislation to keep you from being employed to work for more than 18 hours
continously, perhaps out of regard for your patients you should voluntarily
withdraw from patient care. Or are you saying that your responsibility to
your patients only extends to that which is defined by the law?

>Of course, the large boulder that is the medical establishment in this
country >is VERY difficult to move. 

I'm not a big defender of political medical organizations but this comment
is a non-sequitur. Almost everyone who has complained to this group over the
years about the hours of house officers is either 1) a house officer, 2)
contemplating being a house officer, 3) a former patient of a fatigued house
officer, or 4) a family member who misses their house officer. The "medical
establishment" seems always to blame. The truth of the matter is that the
individual department chairmen of who comprise the various clinical colleges
for graduate medical training set their own rules for house officer call and
they don't conspire to "fix" hours or prices. There is no conspiracy.

There is also very little science in this argument. Sure, studies of human
performance and fatigue exist. Those studies typically do not look at clinical
decision making. Furthermore, as I am sure others will mention, the purpose
of night-call is not merely one of hazing or economics (though the latter is
a significant concern) but also one of education. Patients do not go home at
night. Their problems do not disappear when they sleep. Disease progresses,
sometimes as you watch, and learning about that, first hand, is an invaluable
part of a clinician's training. Diabetic ketoacidosis, the management of
edema following hemorrhagic cerebral infarction, septic shock, are but a
few examples of conditions whose treatment may take many hours and there is
no replacement for the knowledge that comes from following the course of
illness and treatment as it unfolds in a single patient.

>Perhaps the guy from the U.K. who's words I'm responding to could tell us a
>bit about the work actions taken by some of the jr. doctors in England (it 
>surprises me that interns and residents in the U.S. don't stand up for them-
>selves more - comments, anyone?)

Yeah, find something else to squawk about, like the fact that hospital
compensation for graduate medical training is constantly decreasing. Or
come back to this issue with some facts.

Sean McLinden