Saturday, March 11, 2017

Is your doctor awake?


A trip to the hospital is often the result of a medical emergency and when you get there you are treated by the resident staff. A new rule from the Accreditation Council for Graduate Medical Education will now allow first year residents to work 24 hour shifts along side more experienced residents who are already allowed to do so.
In setting the new standard, which goes into effect on July 1, officials at the Accreditation Council for Graduate Medical Education said on Friday that they hoped to avoid confusion and disruptions in care that can result when a patient is handed off to one doctor from another whose shift is ending.

The rules do not change for residents after the first year, who have been permitted to work 24-hour shifts if necessary. The new rules also leave in place a requirement that all residents work no more than 80 hours a week.

But the new guidelines roused the ire of critics who say that exhausted and inexperienced residents will be working too many hours to remain alert and focus on the critical decisions they make. The issue has been a focus of controversy for at least 30 years, after a patient named Libby Zion died under the care of residents in a New York hospital.

“We know sleep-deprived people can have impaired motor skills and their memory can deteriorate,” said Dr. Michael A. Carome, director of health research at Public Citizen, an advocacy group.

Accreditation officials said they once believed as much, too, and had tried to protect first-year students from working too many hours. In 2011, the council required that first-year residents, unlike more experienced residents, work no longer than 16 hours in one stretch.

The hope was that shorter shifts would improve patient care. Those hopes, the group wrote in a new report, “have not been realized.” Instead, the council said, patient care was disrupted when residents’ shifts ended after 16 hours.

First-year residents do not have to work for 24 hours straight — their shifts can be shorter — but if needed they may be asked or may choose to continue to work for that length of time.

Whether a longer shift can be better for patients, and for the training of young doctors, has been rigorously studied in two randomized trials, the accrediting council noted — one involving surgeons in training, and the other involving specialists in internal medicine.

The study involving internal medicine residents is still underway, but the study of surgical residents, published last year in the New England Journal of Medicine, found that shorter shifts had no effect on patient care.

Continuity of care was also better with the longer shifts.
So as long as your doctor does not start snoring in the middle of the procedure you will benefit from working with the same medico through the completion of your treatment. And they will have plenty of years ahead to sleep late and rest on the golf course while another resident takes care of you until they finish the back nine.

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