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Follow-up on "Gold Medal"...Who wants to be email@example.com firstname.lastname@example.org
Mon, 24 Jun 2002 11:06:33 EDT
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Let there be no misunderstanding. In none of my posts have I advocated that we have a slash and burn type of endless hour type of "educational" experience. I have pointed out that the solution to one perceived problem (work hours, exhaustion, patient safety) is to restrict hours by regulation. That restriction of hours has secondary impacts which have NOT been adequately anticipated or addressed. Sometimes the solution to one problem creates 4 times as many new problems. I have also indicated that surgeons exist that work long hours, but do not have the same exhaustion described by others. Thomas Edison was such a person, who virtually never felt tired and took intermittent "cat naps." We should not by legislation, regulation, or practice guideline limit the productivity of those that are of this nature by genetics or inclination, but remain safe and productive. To do so is forcing a "reverse lifestyle" on those who have chosen to live a full and busy professional life. We have a very very big problem here. The issues of work hours is only one small part of a multifaceted ecosystem, involving nursing shortages, fiance of education, interaction of research, allied health, technologists, quality of care, required numbers of procedures prior to setting for boards, etc. This one action on restriction of hours will cause a domino effect which will markedly increase the cost of health care delivery. It may also alter the willingness of hospitals to be involved in graduate medical education. It also is already leading to discussions of federalization of health care in America under a single payer. I am not taking any sides on this issue right now, but recognize these movements. We all must be careful what we ask for, because we just may well get it (and the new problems that request brings with it). This last week I have seen medicine from the side of a consumer, rather than a provider. Different perspectives exist. Granted, I have some options open to me that the HMO patient does not have in that I know the system, I want a single doctor to take care of me (not a committee), I want transferability, I want my doctor to be well trained and technically capable, I do not want that doctor to stop working in the middle of my care because his/her shift is over, and I want continuity of care, not intermittent relearning about my case by each hand off. I have learned other things germane to this discussion which will be the subject of later posts. I still believe that no single solution exists and that the Robert Wood Johnson Foundation should commission a 5 year study of Health Manpower much like the Flexner Commission studied Medical Education 100 years ago. The focus of our energies should not be reactionary against differing views, but to get to the bottom of a national solution which will continue the professionalism of the guild of medicine. Otherwise, in 5 short years we all will be mere tradesmen and tradeswomen. k