St. Paul, Minn. -- We're all familiar with the stories of medical residents and doctors in training putting in 80-plus hours a week and grabbing naps in the hospital lounge. So, the thinking goes, efforts to reduce that grueling workload would make a difference in the quality of medical care.
That may not be so, according to a new report in the British Medical Journal. The BMJ reviewed the research and is inconclusive on whether the reduction of hours made a difference in quality of care.
Dr. Jon Hallberg is here now with more on this issue of tired doctors.
Tom Crann: When you read this report, did it surprise you?
Dr. Jon Hallberg: Not really. It seems a little counterintuitive. There has been so much effort in trying to limit the amount, the overworking, or the perceived overworking, that's going on with residents. I think there is so much more to the story. It really makes me realize that there's so much more to the delivery of health care than just simply doctors making decisions.
Crann: So, when we think of doctors as pilots, that it's all on their shoulders, it's not always the case?
Hallberg: I think in some cases it is. Certainly, surgery is a good exception, and intensive care work might be another exception, but a lot of people aren't having that kind of care. It's important to realize that there is a whole spectrum of work at play.
Crann: Why these sorts of schedules or marathon hours in the first place? When this issue comes up [many] will say that it's good training.
Hallberg: I think there are two ways to look at this. One way is sort of the high road, and that is that the more time you put in with patients, you really get to know those patients and you see them through. You might admit them to the hospital, you might assist in their surgery, and you're following their labs. There's a wonderful continuity of care. That's the positive side.
The bad side is that, and a lot of people don't really want to talk about this, there's a labor issue at play. Interns, residents and fellows are relatively cheap labor to have at a hospital. It's not seen exactly that way, and there's so much more to it than that. But that's always been kind of the negative piece: that you are working these people like crazy because you can. It's not a wise idea to do that.
Crann: Is there actually a downside to reducing the hours for residents and doctors-in-training?
Hallberg: A lot of behind-the-door conversations, and certainly many physicians who went through this years ago, feel that the new generation of physicians are sort of missing that continuity. They're just not getting to know their patients' care that well. There might be a limit to how well we really understand their needs. I think all of us feel that way.
I'm not in the hospital anymore; I am just a clinic doctor. There are some doctors who are only in the hospital, so we're sort of portioning off medicine.
It used to be that we do everything, and there's a certain nostalgia for that. I honestly think that it wasn't the best way to practice medicine. It was great because you could sort of see this person through, but I'm not always sure that it was the best way of practicing. We did a lot of unnecessary testing; I think that a lot of things got missed; people were in the hospital much longer than they needed to be. There's a lot that we have to think about.
Crann: What are the lessons learned for you and your colleagues in the clinic for whom these residency years [are] in the past?
Hallberg: I don't have a lot of nostalgia for that time ... This is true for I think for anybody in any kind of job, is this: if we're not well rested we're going to be less good at what we do. We're not thinking as clearly. We have less compassion, and we're going to be less likely to dot the Is and cross the Ts. But to have it so strict that you have to leave when the clock ticks a certain point and walk out of a case because you can't scrub in that surgical case; it seems like there should be some latitude at work.
Crann: Dr. Jon Hallberg is our regular medical analyst on All Things Considered. He is a physician in family medicine at the University of Minnesota and medical director at the Mill City Clinic. Jon, thank you very much.
Hallberg: My pleasure, Tom.