Doctors spend an average of 14 years training for their job. School is stressful; fellowship hours are long and the learning curve is steep. From the training emerge the best minds in medicine – but is there a dark side to the white coat? Extended training and fellowship hours threaten the health of doctors in residency and the patients in their care, and the problem could be getting worse.
A new proposal by the Accreditation Council for Graduate Medical Education, which oversees residency training, could allow first-year residents to work up to 28 hours in a row, which is up 12 hours from the current limit of 16. But, according to WBUR, this could increase health risks for both doctors and patients.
Effect on doctors and patients
The doctors who take part in these fellowships are still in training. Lack of experience combined with long working hours and sleep deprivation do not bode well for safety. One doctor in training admitted that she accidentally stuck herself with a needle from an HIV-positive patient after a regular pattern of only three to four hours of sleep per night.
When fellowship interns do not get enough sleep, they pass the risk onto patients too. Doctors are more likely to misdiagnose or misread an EKG or an X-ray when subject to sleep deprivation. The rate of serious errors was 22 percent higher for interns on a traditional residency schedule, according to the New England Journal of Medicine.
Problems and accountability
According to WBUR, institutional inefficiencies put residents into a precarious position of either obeying the rules or working long enough to get work done. If they work shorter hours, it forces the organization to admit more residents to the hospital, which creates more paperwork and slows down the system.
Residents are then forced to work longer than the current limit of 16 hours and misrepresent the numbers on their timesheets. Increasing the limit as proposed would at least allow the ACGME to better account for resident hours spent on the job. Better accountability could give the council a clearer indication of the number residents needed to administer safer care for patients and residents alike.
How to reform care
According to the NEJM, a reduction in intern work hours could lead to a drastic reduction in medical errors – but what can those in need of medical care do to ensure safety in the meantime?
The answer could be found in civil courts through a medical malpractice lawsuit. Instead of a top-down approach to training policies, civil litigation gives patients the bottom-up power they need to drive reform in medical care.