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Follow-up on "Gold Medal"...Who wants to be average?

trauma-list@trauma.org trauma-list@trauma.org
Mon, 24 Jun 2002 11:06:33 EDT

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.