Work-hour anecdotes battle it out head to head!

Sandeep Jauhar, writing in Slate, has an introduction to the controversy around work-hour regulation for medical residents

1. One assumption made by opponents of work-hour regulations is that these regulations are only justified if there is a proven connection between longer work hours and more medical errors. But why is the burden of proof on those who want to change the established order? Why must we assume that the more hours doctors work, the better? Do we know that 120-hour work weeks make better doctors than 80-hour weeks, or do older doctors - who tend to be most vocal in their opposition to work-hour regulations - merely harbor nostalgia for their training days?

Would another helping profession expect its practitioners to work more hours (consecutive or total) as proof of their seriousness? Yes there is overlap between quantity and quality, but anyone who's spent time in a residency knows that an extra hour does not necessarily mean an extra hour of learning or patient care. Sometimes - often - it means an extra hour of drawing blood, doing paperwork, transporting, finding a working EKG machine . . .

2. Jahuar writes:
Work limits have troubling consequences [...] including interruption of
resident learning, fracturing of traditional hospital teams, and the creation of
a kind of shift-work clock-watching mentality among young doctors.
Notice how none of these consequences are referenced to the literature, and in fact each of them could argue, properly understood, for work-hour regulations.

For example, resident learning is "uninterrupted" by fatigue (or lack of concentration) when proper balance between work and other parts of life is ensured.

"Fracturing of traditional hospital teams": I suppose Jahuar is referring here to night-float interns or residents, people who don't work in teams. Or to "orphan" interns, coming in on the weekends when the rest of their team is off, so that someone can be around to admit patients. But how "traditional" is the intern-resident arrangement really? It can't be older (at least in the U.S.) than the teaching hospital, which itself isn't older than a hundred years or so. "Tradition" in medicine changes every few decades anyway - why shouldn't it change now?

"A clock-watching mentality among young doctors" links to a sidebar referencing not a study or review but . . . a conversation the author appears to have had with some young doctors who don't like work-hour regulations. But my colleagues - conscientious, hard-working, caring doctors - like and accept these regulations as a rule. They "watch the clock" only in the sense that every shift worker respects their own commitments whether at work or outside. Martyrdom is not our measure of compassionate, effective care or of professional devotion.

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