List Archives

Thu May 7 18:16:49 BST 2009

As a PA for almost 30 years, I have pulled my share of 24 hour shifts and
really do appreciate the learning experience that cam with the brutal "stay
awake" edict. Still, as our community hospital changed to 10 hour shifts
(yay!) and residency requirements are down-sized, I too-- applaude.

Some important life-saving decisions are made under those stressful
conditions-- and you yourself: would you want someone rested and with full
acuity-- or a bleary-eyed clinician "doing their best"

Remember: sleep deprivation is one of the most effective torture techniques,
because it works.

cmm

On Thu, May 7, 2009 at 10:30 AM, Teperman, Sheldon <
Sheldon.Teperman at nbhn.net> wrote:

>
>
>
> "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
>
> Send trauma-list mailing list submissions to
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>
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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
>
>
>
>      __________________________________________________________________
> 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 <http://trauma.org/>
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> http://www.trauma.org/index.php?/community/
>
> ----------------------------------------------------------------------
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> contain confidential and privileged information for the use of the
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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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>
> http://www.flickr.com/gift/
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>
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> visit our Internet web site at http://www.baystatehealth.com.
>
>
> ------------------------------
>
> 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
> >
> >
> >
> > __________________________________________________________________
> > Looking for the perfect gift? Give the gift of Flickr!
> >
> > http://www.flickr.com/gift/
> > --
> > trauma-list : TRAUMA.ORG <http://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 <http://trauma.org/>
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
>
>
> ------------------------------
>
> 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 <http://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 <http://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 <http://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 <http://trauma.org/>
> > > To change your settings or unsubscribe visit:
> > > http://www.trauma.org/index.php?/community/
> > >
> > --
> > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > 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 <http://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: 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 <http://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 <http://trauma.org/>
> > > To change your settings or unsubscribe visit:
> > > http://www.trauma.org/index.php?/community/
> > >
> > --
> > trauma-list : TRAUMA.ORG <http://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/
> --
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> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
>
> ------------------------------
>
> 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 <http://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 <http://trauma.org/>
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> --
> trauma-list : TRAUMA.ORG <http://trauma.org/>
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
>
> ------------------------------
>
> 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 <http://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 <http://trauma.org/>
> > > To change your settings or unsubscribe visit:
> > > http://www.trauma.org/index.php?/community/
> > >
> > --
> > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> >
> --
> trauma-list : TRAUMA.ORG <http://trauma.org/>
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
>
> ------------------------------
>
> --
> trauma-list : TRAUMA.ORG <http://trauma.org/>
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
> End of trauma-list Digest, Vol 71, Issue 10
> *******************************************
> -----------------------------------------
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>
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-- 
The one important thing I have learned over the years is the difference
between taking one's work seriously and taking one's self seriously. The
first is imperative and the second is disastrous.
Margot Fonteyn

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