Monday, June 28, 2010

Work Hours Ctd.

Th ACGME has come out with new and improved recommendations for resident work hour restrictions. Some highlights:

*Interns have to inform patients of their role in patient care (i.e... Although I'm wearing a white coat and a stethoscope around my neck, I'm a pretty green neophyte at this whole doctoring business. Just thought you'd like to know. Enjoy your chicken broth and cold coffee.)

*Interns cannot work more than 16 consecutive hours. Fortunately, the ACGME chose not to co-opt the Institute of Medicine's (IOM) recommendation that residents are allotted time for a five hour nap period after 16 hours or work. Because that's just, you know, sort of embarassing. Because then you have to assign blankies and pillows to all the fresh faced interns and make sure snackies are available in the call rooms and it just becomes a logistical nightmare for residency program directors.

*According to the wording of the ACGME report, it appears that interns are not allowed to do anything involving patient care without "level 1 or 2a supervision". That means the attending physician either has to be standing right next to the young doc or at least somewhere on the premises. So all those central lines and chest tubes and code blues that happen in the middle of the night have to be handled by older residents.

Ah, the slow death of general surgery....

4 comments:

Frank Drackman said...

Buckeye, you would be the most awesume Training Program Director...
For the whole 20 minutes you'd last...
Dating myself here, but I remember MY first Central Line as a 3rd Year....
3rd year Med Student, but hey it was towards the end of 3rd Year, cause thats when I did my Surgery Rotation...
Got Supervised by an Intern if you consider "Supervision" him drinking Coffee at the Nursing Station(you could do that back then)
He did come by to check my work, and wasn't concerned about the missing Guide Wire, "Thats what the X-rays for" he said as he hurried back to whatever Interns did back in 1986...
and that was the last time I got supervised doin a Central Line...
Still don't know where that guide wire went...

Frank

Anonymous said...

Does this mean that this duty no longer falls on nursing? (yippeeee)

Buckeye, you know you have an extra binky or two in your pockets.

-SCRN

Anonymous said...

Actually that's not exactly what the supervision requirement says. "For many aspects of patient care, the supervising physician may be a more advanced resident." http://acgme-2010standards.org/pdf/Proposed_Standards.pdf

MedZag said...

It worries me. No call!?! I've maintained for a while now that the difference between the training an MD undergoes and the training of a mid-level provider isn't really about years or hours of training... it's about learning how to be the end of the hierarchy. How to make decisions, potentially dangerous ones, on your own without anyone to consult or back you up. To learn how to do it yourself, because you can't always trust someone to do it for you. That's the responsibility the degree is supposed to represent. Sure call sucks, and most of the time its simply busy work and sleep deprivation. But I remember standing with my general surgery intern on call during the first month of his training/my third year... looking at a post-op patient with a BP of 210/160 with chest pain, looking at a post-op patient with a rigid abdomen, looking at a post-op patient with sudden onset dyspnea. We had no f***in clue what to do... so we went and looked it up. And tried things. And they worked. That's what intern year is supposed to be about. Not hand-holding and learning how to master paperwork (which is all the intern really does during the day) before learning how to be an actual flippin' doctor.

I'll be part of the first intern class these new rules will supposedly affect, so I guess I'm supposed to be happy I'll have more time for reading classical books and windsurfing and UpToDate. But I'm not happy, I can see this seriously affecting my growth as a physician and surgeon and I worked too damn hard to get to anything but the best training.