Thursday, October 29, 2009

Hours per week worked by (young) surgeons

In Britain as in the United States, there is considerable debate about the hours worked by physicians and surgeons, and what these mean for patient safety. Convincing data are lacking, but the Royal College of Surgeons of England has just weighed in with a new report, saying that limiting the hours of surgeons endangers patients: Patients are being harmed by working time limits, finds new study

The report argues that frequent handoffs allow patient information to be lost, as doctors have less chance to observe changes in a patient's condition.

"Surgeons across the country say patients are much less safe in the NHS since the August introduction of European Working Time Regulation (EWTR) 48 hour working limits as continuity of care for patient collapses, this is the damning assessment of a survey of NHS surgeons. Services are only being held together by a ‘grey market’ of doctors willing to covertly breaking the legislation to maintain care for patients."

..."The College surveyed 900 surgeons - almost an eighth of the UK surgical workforce – with responses from more than 360 consultants and more than 500 trainees to see how surgical services were faring under the new working time restrictions. It found some alarming results:
"A third say handover arrangements are inadequate in their hospital and 23 per cent say they cannot stay involved in all stages of individual patients clinical care that require their expertise."
"Patients are being lost and at increased risk of dying as a direct result of so many shift changeovers and rotas which leave no time available to handover. Trainee surgeons across the country are staying on unpaid after the hours limit because they want to see through care for patients. They are also taking on additional paid locum work in the hope of gaining the training opportunities they cannot get in their formal working week. Meanwhile hospitals are relying on this goodwill because they know they couldn’t stay open without them. As a result there is an emerging grey market in hospital cover with doctors true working hours being kept off the books."

On the other side is the argument that sleepy doctors endanger patients. We don't let airline pilots work long hours, why should the doctors who staff emergency rooms and operating rooms be different? In the United States, the 1984 death of Libby Zion led to new legislation in her name to limit the working hours of medical residents: A Life-Changing Case for Doctors in Training


dWj said...

"We don't let airline pilots work long hours, why should the doctors who staff emergency rooms and operating rooms be different?"

The sarcastic response is that patients are not airplanes. (The really snarky response is to point out the comma splice.) The point, though, is that, as with any analogy, it goes so far and no further. It seems reasonable to me that handing off a patient creates bigger problems than handing off an airplane.

It also seems reasonable to me that tired doctors would do a worse job than fresh ones. I'm not opposed to limits on doctors' hours to nearly the degree that I'm opposed to idiotic comparisons, especially with particularly inane trailing rhetorical questions. (One can "argue" that a doctor is a flying piece of cheese with the question, "If a doctor isn't a flying piece of cheese, what is he?" Man, I hate that.)

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