Wednesday, January 12, 2011

Changing great expectations

From AMSA On Call:

Post #4 of the "Back to the Wards" series focusing on the transition from research years back to the medical school and clinical rotations.

When I started medical school, there was substantial debate swirling about changing residency work hours, particularly for interns who were putting in untold hours at the hospital clearly to the detriment of their personal wellbeing, and potentially to the detriment of patient care.  These arguments sparked discussions of the best way to train physicians to work independently, how to maintain continuity of care without endless work hours, and even how to measure progress on these issues.  Ultimately, resident work hours were limited to 80 hours per week and shifts limited to 30 hours.  AMSA helped to draft the legislation that implemented these first changes, and continues to advocate for better conditions for residents and students. 

As I’m preparing to return to the wards, the controversy has flared again, though this time regulations have already passed.  The 80 hour work week remains in place, but first year residents (interns) may only work 16 consecutive hours.  (In addition, as detailed in news articles here and here, stricter rules for how residents should be supervised were added, and other regulations to improve patient care and resident safety were also included.)  On the whole, I’m happy to see medicine becoming a safer and more user-friendly profession, and hope that reduced physician burn-out will be a additional consequence of these regulations. 

In spite of these hopes, I nonetheless struggle with what a friend recently termed “competitive suffering.”  We’ve all experienced it before.  It’s what happens when you moan that you didn’t get enough sleep because you were writing a paper or studying for a test, and a colleague counters that he/she hasn’t slept in a week because of all of the work that needed to be finished.  Similarly, it occurs when one med student complains about an overnight shift on an OB/GYN rotation, and someone immediately pipes up that their transplant surgery rotation has required an unendingly flexible schedule and many sleepless nights.  Lately, I’ve noticed that it also happens when I express trepidation at the nights of call and night float I’ll be expected to work as a medical student, and my friends remind me that when they were in medical school, they were frequently in the hospital overnight, and that call expectations for medical students were much greater.  This often follows with exclamations of how much they learned at night because no one else was there, or of how amazing the patient was that they admitted in the morning and followed for a full 24 hours.  How is a returning student to deal with this, as medical student expectations are shifted with those of residents?  Certainly stepping back and saying “Wow, you had a rough go of it.  They sure do things differently now!” rarely feels like the right option, but most of the time, I think it is.  I try to remind myself that I learn more when I’m awake, and that my retention is laughable when I haven’t been able to sleep.  If that’s not enough, I think about the friends I’ve been lucky enough not to lose to drowsy driving accidents, or patients they’ve been lucky enough not to lose because of a sleepless error, and remind myself that these regulations mean that I’ll need to rely a little less on luck.

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