List Archives

Thu May 7 15:49:05 BST 2009

My Dear Sheldon,
I am not criticizing our younger colleagues, merely pointing out the facts.  As to the rest of your comments, please show the rest of us that there are or will be any less
" victims of Substance abuse, broken marriages and even suicide or mental illness" in the younger surgeon population that we have seen over the last few hundred years.  I suspect that what you will find is that our ilk have about the same number of each group as ANY other work environment, and that is not going to improve as we continue to follow the rules of the new order, be it disingenuously or not.  Having my name on that ATOM book might lend some credibility to that fact that I DO ENDORSE reform in how we train our surgeons, but I DO NOT endorse the abdication of responsibility that we have so sadly endorsed in the process.

Just my 2 cents.

Ron

OBTW - I have and feel not ONE iota of shame for being the dinosaur that I am and that I always will be.  And I would be willing to bet my next year's salary that you would probably choose one of us over someone with 5 years @ 80 hours per week experience coming out of a residency.........and those required TEN index trauma cases tucked proudly under their belts.

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Teperman, Sheldon
Sent: Thursday, May 07, 2009 10:30 AM
To: 'trauma-list at trauma.org'
Subject: RE: trauma-list Digest- Doc Holiday

"Fire makes steel strong in
> the
> same way challenges toughen a person"..

         It is precisely comments like this that required the NYState legislature to pass a law requiring stiff penalties for breaking ( the all ready passed) law regarding resident hours.  Leaders in surgery in this state were disingenuous with following the new rules.  They would have two sets of "books" ( if you will) with the real and then the "doctored" call schedule. Gentleman( ladies), get real.  Reflect for a moment how many of your colleagues have become victims of Substance abuse, broken marriages and even suicide or mental illness. I can think of many examples of each of these in my fellow residents from the " good old days". Where is the virtue and the "true calling" in that???

        These were young, bright people whose lives were ruined by the crushing and completely unnecessary work burden of Residency.  We shame ourselves, for suggesting that only we have the commitment and that young people lack the drive or will to be surgeons. Think of the patients never served and the operations never performed by those of us unfortunate enough not to have survived those grueling times. Rather than carrying forward with the torch of bravado, we should move on. Programs, that address the changes necessary to adapt to these different times should be where words on these pages lye.  For example, Len Jacobs' ATOM course or the simulations labs cropping up all over the country address the issue of decreased resident exposure to clinical material.  These are constructive programs of real value, rather than the "Brutane" of old.

          I suggest we look to ourselves, before criticizing  our younger colleagues. We are to blame for those lost lives and lost careers. How many of those broken homes and mental break downs are we responsible for with our "Dinosaur" like attitudes?  In the words of Gomar Pile,  ...For Shame, For Shame , For Shame.!   Sheldon

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of trauma-list-request at trauma.org
Sent: Thursday, May 07, 2009 7:00 AM
To: trauma-list at trauma.org
Subject: trauma-list Digest, Vol 71, Issue 10

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Today's Topics:

   1. RE: to Doc Holiday-DELAYED response (Gross, Ronald)
   2. RE: Blunt CCA injury ina stable YOUNG pt (Gross, Ronald)
   3. Re: Blunt CCA injury ina stable YOUNG pt (Ante ?ori?)
   4. Re: to Doc Holiday-DELAYED response (Jose Luis Danguilan)
   5. Re: to Doc Holiday-DELAYED response (Andre Carneiro)
   6. Re: to Doc Holiday-DELAYED response (jduchesn at tulane.edu)
   7. Re: to Doc Holiday-DELAYED response (Tidewater001)
   8. RE: to Doc Holiday-DELAYED response (Gross, Ronald)
   9. RE: to Doc Holiday-DELAYED response (Gross, Ronald)

----------------------------------------------------------------------

Message: 1
Date: Wed, 6 May 2009 07:26:56 -0400
From: "Gross, Ronald" <Ronald.Gross at baystatehealth.org>
Subject: RE: to Doc Holiday-DELAYED response
To: "'Trauma and Critical Care mailing list'" <trauma-list at trauma.org>
Message-ID:
        <FD2BE6867A90F543AAD02E429F878633013B1FBC0BC6 at bhsexc11.bhs.org>
Content-Type: text/plain; charset="us-ascii"

And when you finally finish your truncated 5 year surgical residency, with protected educational time, sleep time and no more that 80 hours per week, and you have to go out into the REAL world, will your patients understand that you need to go home now 'cause you're sleepy, and someone they have never seen will be caring for them?

Athletes learn endurance by working harder and longer in their workouts then they have to do in the "real deal".  Our stakes are FAR higher than any athletes' stakes, and yet we are failing to teach our residents the expanse of knowledge they will need, and we are failing to prepare them for the real world, where there isn't protected education time, and guaranteed sleep time.

I know, my wife has told me on several occasions that I am a dinosaur.  She is probably right.....but this dinosaur has been true to his calling, and will never stop being fully responsible for the care of his patients - all the time!

(OOPS, need to take a nap now.  Worked too long.........)

Best to you all,
Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of khumar huseynova
Sent: Tuesday, May 05, 2009 4:50 PM
To: trauma-list at trauma.org
Subject: to Doc Holiday-DELAYED response

Dr Holiday, sorry for retarded response-just read your note on resident hours (March). Thanks and yes, you are right, there is evidence that long hours result in reduced effciency and eventual harm to the patient. I dont think I will ever agree witht eh 48hr/wk schedule for SURGERY residents-it has to be MORE than that. Am not saying 120hrs, but should be reasonable enough to get suffucuent experience and not to feel 'dead' at the end of the day. Maybe someone needs to design a study to determine the cutoff...
And you are right, there are perhaps other ways of increasing the quality of residency without making the hours too long as well. The problem is, given how conservative the health care system is, it will take decades to change it.
Cheers. KH

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------------------------------

Message: 2
Date: Wed, 6 May 2009 07:36:39 -0400
From: "Gross, Ronald" <Ronald.Gross at baystatehealth.org>
Subject: RE: Blunt CCA injury ina stable YOUNG pt
To: "'Trauma and Critical Care mailing list'" <trauma-list at trauma.org>
Message-ID:
        <FD2BE6867A90F543AAD02E429F878633013B1FBC0BC7 at bhsexc11.bhs.org>
Content-Type: text/plain; charset="us-ascii"

How about an image or two?  Before I respond to this very complex issue that has, to my knowledge, no real definitive answer in the surgical or neurosurgical literature, why did you scan the patient in the first place?  "Post-blunt trauma" is a pretty broad category....trauma where?  Was the c-spine injured?  Was the blunt trauma directly to the neck?  Was this a seatbelt across the neck?

And lastly - is the really an injury, to refer to a phrase coined by Ken Mattox, is this just VOMIT?

Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of khumar huseynova
Sent: Tuesday, May 05, 2009 4:53 PM
To: trauma-list at trauma.org
Subject: Blunt CCA injury ina stable YOUNG pt

24M w post-blunt trauma. Stable. Has intimal dissection of common carotid art w 50% lumen obstruction. Asymptomatic from injury currently. No other injuries. What would you do-anticoagulate w LOW-dose heparin; give ASA only; stent; or operate?
KH

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------------------------------

Message: 3
Date: Wed, 6 May 2009 15:00:57 +0200
From: Ante ?ori? <ante.coric85 at gmail.com>
Subject: Re: Blunt CCA injury ina stable YOUNG pt
To: Trauma and Critical Care mailing list <trauma-list at trauma.org>
Message-ID:
        <edddfb3e0905060600t5e9a462aid63e78b889df0f67 at mail.gmail.com>
Content-Type: text/plain; charset=ISO-8859-1

if the lesion is withdrawing by time l see no need for anticoagulation, instead l would repeat ultrasound and see the situation, but if in any doubt, or unable to do any diagnostic test in short period of time, l would anticoagulate him for a while, if otherwise healthy  young person... but l don't think there is a great chance of him stroking because even in this situation 50% lumen is more then sufficient to provide enough blood flow, and if no major turbulence risk for endothelial injury thrombus genesis is practically 100% not happening if lumen doesn't spread on its own, then would consider intervening, surgically or radiology intervention Ante

2009/5/6 Gross, Ronald <Ronald.Gross at baystatehealth.org>

> How about an image or two?  Before I respond to this very complex
> issue that has, to my knowledge, no real definitive answer in the
> surgical or neurosurgical literature, why did you scan the patient in the first place?
>  "Post-blunt trauma" is a pretty broad category....trauma where?  Was
> the c-spine injured?  Was the blunt trauma directly to the neck?  Was
> this a seatbelt across the neck?
>
> And lastly - is the really an injury, to refer to a phrase coined by
> Ken Mattox, is this just VOMIT?
>
> Ron
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org] On Behalf Of khumar huseynova
> Sent: Tuesday, May 05, 2009 4:53 PM
> To: trauma-list at trauma.org
> Subject: Blunt CCA injury ina stable YOUNG pt
>
> 24M w post-blunt trauma. Stable. Has intimal dissection of common
> carotid art w 50% lumen obstruction. Asymptomatic from injury
> currently. No other injuries. What would you do-anticoagulate w
> LOW-dose heparin; give ASA only; stent; or operate?
> KH
>
>
>
> __________________________________________________________________
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>
> http://www.flickr.com/gift/
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>
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------------------------------

Message: 4
Date: Thu, 7 May 2009 04:23:31 +0800
From: Jose Luis Danguilan <jdanguilan at gmail.com>
Subject: Re: to Doc Holiday-DELAYED response
To: Trauma and Critical Care mailing list <trauma-list at trauma.org>
Message-ID:
        <17d66fd60905061323u38c6dacaqef3a8f7e97be68c2 at mail.gmail.com>
Content-Type: text/plain; charset=ISO-8859-1

I fully agree with Dr. Gross. We seem to baby the new generation of surgical residents. Hard work has never killed anyone. Fire makes steel strong in the same way challenges toughen a person or did I get my metaphors mixed up?

A fellow triceratops,

Jose Luis J. Danguilan, MD
Manila, Philippines

On Wed, May 6, 2009 at 7:26 PM, Gross, Ronald < Ronald.Gross at baystatehealth.org> wrote:

> And when you finally finish your truncated 5 year surgical residency,
> with protected educational time, sleep time and no more that 80 hours
> per week, and you have to go out into the REAL world, will your
> patients understand that you need to go home now 'cause you're sleepy,
> and someone they have never seen will be caring for them?
>
> Athletes learn endurance by working harder and longer in their
> workouts then they have to do in the "real deal".  Our stakes are FAR
> higher than any athletes' stakes, and yet we are failing to teach our
> residents the expanse of knowledge they will need, and we are failing
> to prepare them for the real world, where there isn't protected
> education time, and guaranteed sleep time.
>
> I know, my wife has told me on several occasions that I am a dinosaur.
> She is probably right.....but this dinosaur has been true to his
> calling, and will never stop being fully responsible for the care of
> his patients - all the time!
>
> (OOPS, need to take a nap now.  Worked too long.........)
>
> Best to you all,
> Ron
>
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org] On Behalf Of khumar huseynova
> Sent: Tuesday, May 05, 2009 4:50 PM
> To: trauma-list at trauma.org
> Subject: to Doc Holiday-DELAYED response
>
> Dr Holiday, sorry for retarded response-just read your note on
> resident hours (March). Thanks and yes, you are right, there is
> evidence that long hours result in reduced effciency and eventual harm
> to the patient. I dont think I will ever agree witht eh 48hr/wk
> schedule for SURGERY residents-it has to be MORE than that. Am not
> saying 120hrs, but should be reasonable enough to get suffucuent
> experience and not to feel 'dead' at the end of the day. Maybe someone needs to design a study to determine the cutoff...
> And you are right, there are perhaps other ways of increasing the
> quality of residency without making the hours too long as well. The
> problem is, given how conservative the health care system is, it will
> take decades to change it.
> Cheers. KH
>
>
>
>
> __________________________________________________________________
> Get a sneak peak at messages with a handy reading pane with All new Yahoo!
> Mail: http://ca.promos.yahoo.com/newmail/overview2/
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
> ----------------------------------------------------------------------
> CONFIDENTIALITY NOTICE: This email communication and any attachments
> may contain confidential and privileged information for the use of the
> designated recipients named above. If you are not the intended
> recipient, you are hereby notified that you have received this
> communication in error and that any review, disclosure, dissemination,
> distribution or copying of it or its contents is prohibited. If you
> have received this communication in error, please reply to the sender
> immediately or by telephone at (413) 794-0000 and destroy all copies of this communication and any attachments.
> For further information regarding Baystate Health's privacy policy,
> please visit our Internet web site at http://www.baystatehealth.com.
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>

------------------------------

Message: 5
Date: Wed, 6 May 2009 21:38:13 +0100
From: Andre Carneiro <a.carneiro at enflurane.com>
Subject: Re: to Doc Holiday-DELAYED response
To: Trauma and Critical Care mailing list <trauma-list at trauma.org>
Message-ID:
        <5e8268ac0905061338o731c8db2t77e625c354456e15 at mail.gmail.com>
Content-Type: text/plain; charset=ISO-8859-1

Whilst I completely agree that we trainees are not being exposed to enough workload (48 hours! Are they mad??), I would also like to remind you that no athlete trains 80 hours a week (no matter how serious they are about their
performance) and high performing athletes are well aware of the risk of overtraining.
Meaning that surely there must be a happy medium that doesn't mean we live in a complete state of tiredness which, I believe, has been proven time and again to lead to incidents of varying degrees of severity.

Best wishes from across the pond

Andre de Castro Carneiro
Specialist Registrar
Anaesthetics and Critical Care
The Leeds Teaching Hospitals NHS Trust

2009/5/6 Jose Luis Danguilan <jdanguilan at gmail.com>

> I fully agree with Dr. Gross. We seem to baby the new generation of
> surgical residents. Hard work has never killed anyone. Fire makes
> steel strong in the same way challenges toughen a person or did I get
> my metaphors mixed up?
>
> A fellow triceratops,
>
> Jose Luis J. Danguilan, MD
> Manila, Philippines
>
> On Wed, May 6, 2009 at 7:26 PM, Gross, Ronald <
> Ronald.Gross at baystatehealth.org> wrote:
>
> > And when you finally finish your truncated 5 year surgical
> > residency,
> with
> > protected educational time, sleep time and no more that 80 hours per
> week,
> > and you have to go out into the REAL world, will your patients
> > understand that you need to go home now 'cause you're sleepy, and
> > someone they have never seen will be caring for them?
> >
> > Athletes learn endurance by working harder and longer in their
> > workouts then they have to do in the "real deal".  Our stakes are
> > FAR higher than
> any
> > athletes' stakes, and yet we are failing to teach our residents the
> expanse
> > of knowledge they will need, and we are failing to prepare them for
> > the
> real
> > world, where there isn't protected education time, and guaranteed
> > sleep time.
> >
> > I know, my wife has told me on several occasions that I am a dinosaur.
>  She
> > is probably right.....but this dinosaur has been true to his
> > calling, and will never stop being fully responsible for the care of
> > his patients -
> all
> > the time!
> >
> > (OOPS, need to take a nap now.  Worked too long.........)
> >
> > Best to you all,
> > Ron
> >
> >
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org [mailto:
> > trauma-list-bounces at trauma.org] On Behalf Of khumar huseynova
> > Sent: Tuesday, May 05, 2009 4:50 PM
> > To: trauma-list at trauma.org
> > Subject: to Doc Holiday-DELAYED response
> >
> > Dr Holiday, sorry for retarded response-just read your note on
> > resident hours (March). Thanks and yes, you are right, there is
> > evidence that long hours result in reduced effciency and eventual
> > harm to the patient. I
> dont
> > think I will ever agree witht eh 48hr/wk schedule for SURGERY
> residents-it
> > has to be MORE than that. Am not saying 120hrs, but should be
> > reasonable enough to get suffucuent experience and not to feel
> > 'dead' at the end of
> the
> > day. Maybe someone needs to design a study to determine the cutoff...
> > And you are right, there are perhaps other ways of increasing the
> > quality of residency without making the hours too long as well. The
> > problem is, given how conservative the health care system is, it
> > will take decades to change it.
> > Cheers. KH
> >
> >
> >
> >
> > __________________________________________________________________
> > Get a sneak peak at messages with a handy reading pane with All new
> Yahoo!
> > Mail: http://ca.promos.yahoo.com/newmail/overview2/
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> > --------------------------------------------------------------------
> > -- CONFIDENTIALITY NOTICE: This email communication and any
> > attachments may contain confidential and privileged information for
> > the use of the designated recipients named above. If you are not the
> > intended recipient, you are hereby notified that you have received
> > this communication in
> error
> > and that any review, disclosure, dissemination, distribution or
> > copying
> of
> > it or its contents is prohibited. If you have received this
> > communication
> in
> > error, please reply to the sender immediately or by telephone at
> > (413) 794-0000 and destroy all copies of this communication and any
> attachments.
> > For further information regarding Baystate Health's privacy policy,
> please
> > visit our Internet web site at http://www.baystatehealth.com.
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
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> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
>

------------------------------

Message: 6
Date: Wed, 6 May 2009 20:53:41 +0000
From: jduchesn at tulane.edu
Subject: Re: to Doc Holiday-DELAYED response
To: "Trauma and Critical Care mailing list" <trauma-list at trauma.org>
Message-ID:
        <379830282-1241643222-cardhu_decombobulator_blackberry.rim.net-395344921- at bxe1135.bisx.prod.on.blackberry>

Content-Type: text/plain

How can we set a time schedule for the PRIVILEDGE of being trained as a SURGEON?
The field of Surgery needs full time commitment not part time effort.
Duchesne
CharityOne- New Orleans
Sent via BlackBerry by AT&T

-----Original Message-----
From: Andre Carneiro <a.carneiro at enflurane.com>

Date: Wed, 6 May 2009 21:38:13
To: Trauma and Critical Care mailing list<trauma-list at trauma.org>
Subject: Re: to Doc Holiday-DELAYED response

Whilst I completely agree that we trainees are not being exposed to enough
workload (48 hours! Are they mad??), I would also like to remind you that no
athlete trains 80 hours a week (no matter how serious they are about their
performance) and high performing athletes are well aware of the risk of
overtraining.
Meaning that surely there must be a happy medium that doesn't mean we live
in a complete state of tiredness which, I believe, has been proven time and
again to lead to incidents of varying degrees of severity.

Best wishes from across the pond

Andre de Castro Carneiro
Specialist Registrar
Anaesthetics and Critical Care
The Leeds Teaching Hospitals NHS Trust

2009/5/6 Jose Luis Danguilan <jdanguilan at gmail.com>

> I fully agree with Dr. Gross. We seem to baby the new generation of
> surgical
> residents. Hard work has never killed anyone. Fire makes steel strong in
> the
> same way challenges toughen a person or did I get my metaphors mixed up?
>
> A fellow triceratops,
>
> Jose Luis J. Danguilan, MD
> Manila, Philippines
>
> On Wed, May 6, 2009 at 7:26 PM, Gross, Ronald <
> Ronald.Gross at baystatehealth.org> wrote:
>
> > And when you finally finish your truncated 5 year surgical residency,
> with
> > protected educational time, sleep time and no more that 80 hours per
> week,
> > and you have to go out into the REAL world, will your patients understand
> > that you need to go home now 'cause you're sleepy, and someone they have
> > never seen will be caring for them?
> >
> > Athletes learn endurance by working harder and longer in their workouts
> > then they have to do in the "real deal".  Our stakes are FAR higher than
> any
> > athletes' stakes, and yet we are failing to teach our residents the
> expanse
> > of knowledge they will need, and we are failing to prepare them for the
> real
> > world, where there isn't protected education time, and guaranteed sleep
> > time.
> >
> > I know, my wife has told me on several occasions that I am a dinosaur.
>  She
> > is probably right.....but this dinosaur has been true to his calling, and
> > will never stop being fully responsible for the care of his patients -
> all
> > the time!
> >
> > (OOPS, need to take a nap now.  Worked too long.........)
> >
> > Best to you all,
> > Ron
> >
> >
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org [mailto:
> > trauma-list-bounces at trauma.org] On Behalf Of khumar huseynova
> > Sent: Tuesday, May 05, 2009 4:50 PM
> > To: trauma-list at trauma.org
> > Subject: to Doc Holiday-DELAYED response
> >
> > Dr Holiday, sorry for retarded response-just read your note on resident
> > hours (March). Thanks and yes, you are right, there is evidence that long
> > hours result in reduced effciency and eventual harm to the patient. I
> dont
> > think I will ever agree witht eh 48hr/wk schedule for SURGERY
> residents-it
> > has to be MORE than that. Am not saying 120hrs, but should be reasonable
> > enough to get suffucuent experience and not to feel 'dead' at the end of
> the
> > day. Maybe someone needs to design a study to determine the cutoff...
> > And you are right, there are perhaps other ways of increasing the quality
> > of residency without making the hours too long as well. The problem is,
> > given how conservative the health care system is, it will take decades to
> > change it.
> > Cheers. KH
> >
> >
> >
> >      __________________________________________________________________
> > Get a sneak peak at messages with a handy reading pane with All new
> Yahoo!
> > Mail: http://ca.promos.yahoo.com/newmail/overview2/
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> > ----------------------------------------------------------------------
> > CONFIDENTIALITY NOTICE: This email communication and any attachments may
> > contain confidential and privileged information for the use of the
> > designated recipients named above. If you are not the intended recipient,
> > you are hereby notified that you have received this communication in
> error
> > and that any review, disclosure, dissemination, distribution or copying
> of
> > it or its contents is prohibited. If you have received this communication
> in
> > error, please reply to the sender immediately or by telephone at (413)
> > 794-0000 and destroy all copies of this communication and any
> attachments.
> > For further information regarding Baystate Health's privacy policy,
> please
> > visit our Internet web site at http://www.baystatehealth.com.
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
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Message: 7
Date: Wed,  6 May 2009 22:07:26 -0400
From: Tidewater001 <tidewater001 at aol.com>
Subject: Re: to Doc Holiday-DELAYED response
To: "Trauma and Critical Care mailing list" <trauma-list at trauma.org>
Message-ID: <54261d19.b463.4432.b629.8f13e4b82c2e at aol.com>
Content-Type: TEXT/plain; charset=us-ascii

I just got home from my TYPICAL day of seeing patients in the office, operating, rounding, teaching, administrative responsibilities, seeing consults, teaching, responding to the emergent needs of my colleagues caring for their patients, rounding, operating and finally...more paperwork. I just sat down to open my e-mails at 2145...my day started at 0600. Typical day for me and I enjoyed most all of it. Do the residents training today (most of whom will be joining the ranks of private practice like myself) honestly think their work week will only be 80 hours!!!?? In these days of ever worsening reimbursement and ever increasing business costs...you have to work LONG and HARD to make a living and to be available to your patients and the physicians who need your help and expertise as a WELL TRAINED SURGEON. My program director beat that into us and I am a FIRM believer that the patient comes first and last and really does not care if you are tired when they are the ones in need

 of your help!!

Gregory T. Squires, MD FACS
Clinical Assistant Professor of Surgery
Medical University of South Carolina
Director of Trauma
Trident Regional Medical Center
Charleston, SC

In a message dated 05/06/09 16:56:04 Eastern Daylight Time, jduchesn at tulane.edu writes:
How can we set a time schedule for the PRIVILEDGE of being trained as a SURGEON?
The field of Surgery needs full time commitment not part time effort.
Duchesne
CharityOne- New Orleans
Sent via BlackBerry by AT&T

-----Original Message-----
From: Andre Carneiro <a.carneiro at enflurane.com>

Date: Wed, 6 May 2009 21:38:13
To: Trauma and Critical Care mailing list<trauma-list at trauma.org>
Subject: Re: to Doc Holiday-DELAYED response

Whilst I completely agree that we trainees are not being exposed to enough
workload (48 hours! Are they mad??), I would also like to remind you that no
athlete trains 80 hours a week (no matter how serious they are about their
performance) and high performing athletes are well aware of the risk of
overtraining.
Meaning that surely there must be a happy medium that doesn't mean we live
in a complete state of tiredness which, I believe, has been proven time and
again to lead to incidents of varying degrees of severity.

Best wishes from across the pond

Andre de Castro Carneiro
Specialist Registrar
Anaesthetics and Critical Care
The Leeds Teaching Hospitals NHS Trust

2009/5/6 Jose Luis Danguilan <jdanguilan at gmail.com>

> I fully agree with Dr. Gross. We seem to baby the new generation of
> surgical
> residents. Hard work has never killed anyone. Fire makes steel strong in
> the
> same way challenges toughen a person or did I get my metaphors mixed up?
>
> A fellow triceratops,
>
> Jose Luis J. Danguilan, MD
> Manila, Philippines
>
> On Wed, May 6, 2009 at 7:26 PM, Gross, Ronald <
> Ronald.Gross at baystatehealth.org> wrote:
>
> > And when you finally finish your truncated 5 year surgical residency,
> with
> > protected educational time, sleep time and no more that 80 hours per
> week,
> > and you have to go out into the REAL world, will your patients understand
> > that you need to go home now 'cause you're sleepy, and someone they have
> > never seen will be caring for them?
> >
> > Athletes learn endurance by working harder and longer in their workouts
> > then they have to do in the "real deal".  Our stakes are FAR higher than
> any
> > athletes' stakes, and yet we are failing to teach our residents the
> expanse
> > of knowledge they will need, and we are failing to prepare them for the
> real
> > world, where there isn't protected education time, and guaranteed sleep
> > time.
> >
> > I know, my wife has told me on several occasions that I am a dinosaur.
>  She
> > is probably right.....but this dinosaur has been true to his calling, and
> > will never stop being fully responsible for the care of his patients -
> all
> > the time!
> >
> > (OOPS, need to take a nap now.  Worked too long.........)
> >
> > Best to you all,
> > Ron
> >
> >
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org [mailto:
> > trauma-list-bounces at trauma.org] On Behalf Of khumar huseynova
> > Sent: Tuesday, May 05, 2009 4:50 PM
> > To: trauma-list at trauma.org
> > Subject: to Doc Holiday-DELAYED response
> >
> > Dr Holiday, sorry for retarded response-just read your note on resident
> > hours (March). Thanks and yes, you are right, there is evidence that long
> > hours result in reduced effciency and eventual harm to the patient. I
> dont
> > think I will ever agree witht eh 48hr/wk schedule for SURGERY
> residents-it
> > has to be MORE than that. Am not saying 120hrs, but should be reasonable
> > enough to get suffucuent experience and not to feel 'dead' at the end of
> the
> > day. Maybe someone needs to design a study to determine the cutoff...
> > And you are right, there are perhaps other ways of increasing the quality
> > of residency without making the hours too long as well. The problem is,
> > given how conservative the health care system is, it will take decades to
> > change it.
> > Cheers. KH
> >
> >
> >
> >      __________________________________________________________________
> > Get a sneak peak at messages with a handy reading pane with All new
> Yahoo!
> > Mail: http://ca.promos.yahoo.com/newmail/overview2/
> > --
> > trauma-list : TRAUMA.ORG
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> > http://www.trauma.org/index.php?/community/
> >
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------------------------------

Message: 8
Date: Thu, 7 May 2009 06:49:20 -0400
From: "Gross, Ronald" <Ronald.Gross at baystatehealth.org>
Subject: RE: to Doc Holiday-DELAYED response
To: "'Trauma and Critical Care mailing list'" <trauma-list at trauma.org>
Message-ID:
        <FD2BE6867A90F543AAD02E429F878633013B1FBC0BCB at bhsexc11.bhs.org>
Content-Type: text/plain; charset="us-ascii"

You got 'em spot on!

Ron
-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Jose Luis Danguilan
Sent: Wednesday, May 06, 2009 4:24 PM
To: Trauma and Critical Care mailing list
Subject: Re: to Doc Holiday-DELAYED response

I fully agree with Dr. Gross. We seem to baby the new generation of surgical
residents. Hard work has never killed anyone. Fire makes steel strong in the
same way challenges toughen a person or did I get my metaphors mixed up?

A fellow triceratops,

Jose Luis J. Danguilan, MD
Manila, Philippines

On Wed, May 6, 2009 at 7:26 PM, Gross, Ronald <
Ronald.Gross at baystatehealth.org> wrote:

> And when you finally finish your truncated 5 year surgical residency, with
> protected educational time, sleep time and no more that 80 hours per week,
> and you have to go out into the REAL world, will your patients understand
> that you need to go home now 'cause you're sleepy, and someone they have
> never seen will be caring for them?
>
> Athletes learn endurance by working harder and longer in their workouts
> then they have to do in the "real deal".  Our stakes are FAR higher than any
> athletes' stakes, and yet we are failing to teach our residents the expanse
> of knowledge they will need, and we are failing to prepare them for the real
> world, where there isn't protected education time, and guaranteed sleep
> time.
>
> I know, my wife has told me on several occasions that I am a dinosaur.  She
> is probably right.....but this dinosaur has been true to his calling, and
> will never stop being fully responsible for the care of his patients - all
> the time!
>
> (OOPS, need to take a nap now.  Worked too long.........)
>
> Best to you all,
> Ron
>
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org] On Behalf Of khumar huseynova
> Sent: Tuesday, May 05, 2009 4:50 PM
> To: trauma-list at trauma.org
> Subject: to Doc Holiday-DELAYED response
>
> Dr Holiday, sorry for retarded response-just read your note on resident
> hours (March). Thanks and yes, you are right, there is evidence that long
> hours result in reduced effciency and eventual harm to the patient. I dont
> think I will ever agree witht eh 48hr/wk schedule for SURGERY residents-it
> has to be MORE than that. Am not saying 120hrs, but should be reasonable
> enough to get suffucuent experience and not to feel 'dead' at the end of the
> day. Maybe someone needs to design a study to determine the cutoff...
> And you are right, there are perhaps other ways of increasing the quality
> of residency without making the hours too long as well. The problem is,
> given how conservative the health care system is, it will take decades to
> change it.
> Cheers. KH
>
>
>
>      __________________________________________________________________
> Get a sneak peak at messages with a handy reading pane with All new Yahoo!
> Mail: http://ca.promos.yahoo.com/newmail/overview2/
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
> ----------------------------------------------------------------------
> CONFIDENTIALITY NOTICE: This email communication and any attachments may
> contain confidential and privileged information for the use of the
> designated recipients named above. If you are not the intended recipient,
> you are hereby notified that you have received this communication in error
> and that any review, disclosure, dissemination, distribution or copying of
> it or its contents is prohibited. If you have received this communication in
> error, please reply to the sender immediately or by telephone at (413)
> 794-0000 and destroy all copies of this communication and any attachments.
> For further information regarding Baystate Health's privacy policy, please
> visit our Internet web site at http://www.baystatehealth.com.
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------------------------------

Message: 9
Date: Thu, 7 May 2009 06:55:25 -0400
From: "Gross, Ronald" <Ronald.Gross at baystatehealth.org>
Subject: RE: to Doc Holiday-DELAYED response
To: "'Trauma and Critical Care mailing list'" <trauma-list at trauma.org>
Message-ID:
        <FD2BE6867A90F543AAD02E429F878633013B1FBC0BCD at bhsexc11.bhs.org>
Content-Type: text/plain; charset="us-ascii"

>no athlete trains 80 hours a week<

Correct....and no athlete is responsible for anyones' lives but their own.

We are growing a new breed of physician - and they are apparently happy to accept the shift work mentality.  Along with that goes the concept that once they leave the hospital they have given up all of their responsibilities until they return.

Sad.  Very sad.  And scary, 'cause that same person is going to be caring for YOU and ME one day, but only 8 hours at a time..........IF we are lucky enough!

Signed,
The Dinosaur

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Andre Carneiro
Sent: Wednesday, May 06, 2009 4:38 PM
To: Trauma and Critical Care mailing list
Subject: Re: to Doc Holiday-DELAYED response

Whilst I completely agree that we trainees are not being exposed to enough
workload (48 hours! Are they mad??), I would also like to remind you that no
athlete trains 80 hours a week (no matter how serious they are about their
performance) and high performing athletes are well aware of the risk of
overtraining.
Meaning that surely there must be a happy medium that doesn't mean we live
in a complete state of tiredness which, I believe, has been proven time and
again to lead to incidents of varying degrees of severity.

Best wishes from across the pond

Andre de Castro Carneiro
Specialist Registrar
Anaesthetics and Critical Care
The Leeds Teaching Hospitals NHS Trust

2009/5/6 Jose Luis Danguilan <jdanguilan at gmail.com>

> I fully agree with Dr. Gross. We seem to baby the new generation of
> surgical
> residents. Hard work has never killed anyone. Fire makes steel strong in
> the
> same way challenges toughen a person or did I get my metaphors mixed up?
>
> A fellow triceratops,
>
> Jose Luis J. Danguilan, MD
> Manila, Philippines
>
> On Wed, May 6, 2009 at 7:26 PM, Gross, Ronald <
> Ronald.Gross at baystatehealth.org> wrote:
>
> > And when you finally finish your truncated 5 year surgical residency,
> with
> > protected educational time, sleep time and no more that 80 hours per
> week,
> > and you have to go out into the REAL world, will your patients understand
> > that you need to go home now 'cause you're sleepy, and someone they have
> > never seen will be caring for them?
> >
> > Athletes learn endurance by working harder and longer in their workouts
> > then they have to do in the "real deal".  Our stakes are FAR higher than
> any
> > athletes' stakes, and yet we are failing to teach our residents the
> expanse
> > of knowledge they will need, and we are failing to prepare them for the
> real
> > world, where there isn't protected education time, and guaranteed sleep
> > time.
> >
> > I know, my wife has told me on several occasions that I am a dinosaur.
>  She
> > is probably right.....but this dinosaur has been true to his calling, and
> > will never stop being fully responsible for the care of his patients -
> all
> > the time!
> >
> > (OOPS, need to take a nap now.  Worked too long.........)
> >
> > Best to you all,
> > Ron
> >
> >
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org [mailto:
> > trauma-list-bounces at trauma.org] On Behalf Of khumar huseynova
> > Sent: Tuesday, May 05, 2009 4:50 PM
> > To: trauma-list at trauma.org
> > Subject: to Doc Holiday-DELAYED response
> >
> > Dr Holiday, sorry for retarded response-just read your note on resident
> > hours (March). Thanks and yes, you are right, there is evidence that long
> > hours result in reduced effciency and eventual harm to the patient. I
> dont
> > think I will ever agree witht eh 48hr/wk schedule for SURGERY
> residents-it
> > has to be MORE than that. Am not saying 120hrs, but should be reasonable
> > enough to get suffucuent experience and not to feel 'dead' at the end of
> the
> > day. Maybe someone needs to design a study to determine the cutoff...
> > And you are right, there are perhaps other ways of increasing the quality
> > of residency without making the hours too long as well. The problem is,
> > given how conservative the health care system is, it will take decades to
> > change it.
> > Cheers. KH
> >
> >
> >
> >      __________________________________________________________________
> > Get a sneak peak at messages with a handy reading pane with All new
> Yahoo!
> > Mail: http://ca.promos.yahoo.com/newmail/overview2/
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> > ----------------------------------------------------------------------
> > CONFIDENTIALITY NOTICE: This email communication and any attachments may
> > contain confidential and privileged information for the use of the
> > designated recipients named above. If you are not the intended recipient,
> > you are hereby notified that you have received this communication in
> error
> > and that any review, disclosure, dissemination, distribution or copying
> of
> > it or its contents is prohibited. If you have received this communication
> in
> > error, please reply to the sender immediately or by telephone at (413)
> > 794-0000 and destroy all copies of this communication and any
> attachments.
> > For further information regarding Baystate Health's privacy policy,
> please
> > visit our Internet web site at http://www.baystatehealth.com.
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
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