To the Editor:
Re “Napping During Hospital Shifts” (editorial, Dec. 9):
Further shortening hospital doctors’ workweeks will only increase the mistakes patients endure. The all-too-frequent errors my patients encounter when hospitalized are almost always caused by doctors who don’t know them well enough, not by doctors who are too sleepy.
My conversations about patients with hospital staff members almost always begin with, “I don’t know this patient well — I’m just covering.” This problem began with the decrease in residents’ workweeks in the 1980s. It will only get worse with yet another increase in the number of “handoffs” to which each patient is subjected.
Every patient should have a doctor who is in charge throughout the entire hospital stay. Internet technology should make that resident available 24 hours a day, 365 days a year, through real-time audiovisual links — even if the doctor is at another hospital, at home or vacationing in the Poconos.
Error rates would drop, the quality of care would improve and doctors in training could experience the emotional rewards of actually shepherding someone through an illness. And the length of the on-site workweek could be reduced.
Jack Resnick
New York, Dec. 9, 2008
The writer is an internist.
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To the Editor:
How do you feel at the end of a “normal” eight-hour day? Do you really want someone making decisions that affect whether you live or die after working twice as long?
Sixteen-hour workdays are ridiculous for anyone.
Elizabeth Barrett
New York, Dec. 9, 2008
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To the Editor:
Here’s medicine’s dirty little secret: brutal hours do not end with residency training.
As the cost of medical education increases and reimbursement to practitioners and hospitals drops, many community doctors work hours that make training look like a picnic. Add to that the nursing shortage that leads to mandated double shifts, and the potential for mistakes is staggering.
Let’s not limit the scrutiny of working hours to training programs.
Madeline Waid
Peru, N.Y., Dec. 9, 2008
The writer is a doctor.
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To the Editor:
While a good start, the regulations that put in place the 80-hour workweek for residents resulted in patient-care responsibilities being shifted to physician assistants. Under current laws, physician assistants have no equivalent regulations.
Making matters worse, it is common practice for physician assistants to work back-to-back shifts at different hospitals, thus making it difficult to track their hours.
Congress should demand comprehensive regulations to ensure that all front-line health care providers are well rested, including physician assistants, nurses and pharmacists. Perhaps then we will begin to see a significant improvement in patient safety.
Jason Adelman
Bronx, Dec. 9, 2008
The writer, an internist, is associate director of medicine for physician assistants at Montefiore Medical Center and the patient safety officer.