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trauma-list Digest, Vol 71, Issue 12-Doc Holiday
André de Castro Carneiro a.carneiro at enflurane.comThu May 7 19:28:22 BST 2009
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Professor McSwain I must humbly point out that your comments are exactly what I was referring to in my previous post. If one of your trainees walks out half way through a procedure then I agree that you'd be entirely justified to question their motivation and maybe even their professionalism. However, I would like to believe that sort of attitude is the exception rather than the norm. It certainly is where I work! I am not disputing (and neither is anyone else) that patient care is the top priority. And it is exactly because exhausted doctors are dangerous that the restrictions to working hours have come into force. At which point do you say it's enough? What exactly IS 100% 80 hours? 100 hours? 150 hours? It not about the hours "per se", it's about exposure, training and their quality. That was my point. DOI: A fierce critic of the Europen Working Time Directives. André de Castro Carneiro Specialist Registrar Anaesthetics and Critical Care The Leeds Teaching Hospitals NHS Trust McSwain, Norman E Jr. wrote: > The bottom line is that to provide proper and complete patient requires a strong fund and dedication to use that knowledge when and wherever and for however long it is required to provide proper medical care. It does not mean walking out in the middle of a surgical procedure with the statement saying "sorry I am post call, someone else must finish this operation". I am not talking about in training but in your practice when the training is complete and you are in practice and yo have all of the responsible to care for the patient. The training component is to use the hours not in the hospital (above the 80 hour duty limit) to study and learn ALL the knowledge. I do not want a surgeon taking care of me who believes that the knowledge above 70% is wasted. I do not want the surgeon to believe that the end all and be all, is to pass the examination with 70%. The most important examination is the patient lying on the OR table in front of you. Or in the bed in the ICU. You sh ould give 100% to this patient and not 70%. You should have 100% of the knowledge required to provide excellent patient care. Not partial care at the 70% level. > > Patient care is the business that we should be committed to. Patient care comes first, all else is secondary. The patient believes that, we should believe it too. > > Norman > > Norman McSwain MD > Professor, Tulane School of Medicine > Trauma Director, Charity Hospital Trauma Center > norman.mcswain at tulane.edu > 504 988 5111 > > -----Original Message----- > From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of André de Castro Carneiro > Sent: Thursday, May 07, 2009 1:02 PM > To: Trauma and Critical Care mailing list > Subject: Re: trauma-list Digest, Vol 71, Issue 12-Doc Holiday > > Dear all: > > I admire and respect the amount of experience the so-called "dinosaurs" > have accumulated. > > Whether we like it or not, we don't have that option any more. > > What we seriously don't need, as trainees, is to be looked at in a > derogatory fashion by our seniors just because we haven't got the > "battle scars". > We (well, many of us anyway) are not overly enthusiastic about the > working hours restrictions either, but we can also see that there can be > a more balanced approach to training that doesn't mean abdicating from > your life (you only have one, after all. Supposedly.) > > We need your support more than ever, and instead time and again we get > your contempt. > Remember, we are you a few years ago. Just as keen to learn and eager to > help. > > Ron, seems like you're adressing the issue of reduced hours and I'm > grateful for your efforts. I don't know how long a training programme is > in the US, but a full training programme in Anaesthesia is a MINIMUM of > 9 years post graduation. A year on top of that if you're doing the dual > speciality with Intensive Care Medicine. > Perhaps it's time we extended the training programmes even more? > > Best wishes > > André de Castro Carneiro > Specialist Registrar > Anaesthetics and Critical Care > The Leeds Teaching Hospitals NHS Trust > > > Teperman, Sheldon wrote: >> Hey Ron, >> If your salary is anything like what they pay over here in the Bronx, your bet aint worth that much:) All kidding aside, its incumbent upon us to help our colleagues adapt to the new training regimen. I applaud your role in the ATOM course. But these things are slow to pick up. My colleague ( Jody Kaban), a disciple of Len Jacobs, and I are running the only ( that's right) ATOM course in all of NY State! >> BTW our annual Symposium is next week. Our Key note speaker is Fred Moore- WWW.Jacobitrauma.com . If any Surgeons on the list are gonna be in or near town (NYC that is)- Shoot me an email- I will have you as my guest. Far too many ER docs and not enough Surgeons at our show.... I guess its cause they are all too exausted:) 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 11:24 AM >> To: trauma-list at trauma.org >> Subject: trauma-list Digest, Vol 71, Issue 12 >> >> Send trauma-list mailing list submissions to >> trauma-list at trauma.org >> >> To subscribe or unsubscribe via the World Wide Web, visit >> http://list.mistral.net/mailman/listinfo/trauma-list >> or, via email, send a message with subject or body 'help' to >> trauma-list-request at trauma.org >> >> You can reach the person managing the list at >> trauma-list-owner at trauma.org >> >> When replying, please edit your Subject line so it is more specific >> than "Re: Contents of trauma-list digest..." >> >> >> Today's Topics: >> >> 1. Re: trauma-list Digest- Doc Holiday (Krin135 at aol.com) >> 2. Re: trauma-list Digest- Doc Holiday (Krin135 at aol.com) >> 3. Re: trauma-list Digest- Doc Holiday (Andr? de Castro Carneiro) >> 4. RE: trauma-list Digest- Doc Holiday (Gross, Ronald) >> 5. RE: trauma-list Digest- Doc Holiday (Gross, Ronald) >> 6. RE: trauma-list Digest- Doc Holiday (Gross, Ronald) >> >> >> ---------------------------------------------------------------------- >> >> Message: 1 >> Date: Thu, 7 May 2009 10:49:00 EDT >> From: Krin135 at aol.com >> Subject: Re: trauma-list Digest- Doc Holiday >> To: trauma-list at trauma.org >> Message-ID: <d05.55dbcf8c.37344edc at aol.com> >> Content-Type: text/plain; charset="UTF-8" >> >> for those of you who might not be familiar with the ATOM course, here's a >> link: >> >> http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2009-May/_http://atomcourse.com/find.php_ (http://atomcourse.com/find.php) >> >> I'll admit to being disappointed at the paucity of programs here in the >> US...even if I'll never qualify to take the course. >> >> I am also aware of a program at St Louis University Hospital Medical Center >> in coordination with the US DoD where medical teams rotating to combat >> zones go to 'brush up' on operative simulators. Jeff Bailey is doing a >> dynamite job with that program. >> >> ck >> Charles S. Krin, DO >> >> >> In a message dated 5/7/2009 08:31:46 Central Standard Time, >> Sheldon.Teperman at nbhn.net writes: >> >> 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. >> >> **************Big savings on Dell?s most popular laptops. Now starting at >> $449! >> (http://pr.atwola.com/promoclk/100126575x1222382499x1201454962/aol?redir=http:%2F%2Fad.doubleclick.net%2Fclk%3B214663472%3B36502367%3Bg) >> >> >> ------------------------------ >> >> Message: 2 >> Date: Thu, 7 May 2009 10:54:40 EDT >> From: Krin135 at aol.com >> Subject: Re: trauma-list Digest- Doc Holiday >> To: trauma-list at trauma.org >> Message-ID: <c23.5edba44e.37345030 at aol.com> >> Content-Type: text/plain; charset="UTF-8" >> >> OK, Ron...hows come Pret's got an ATOM course up at Maine Medical Center, >> but Baystate isn't represented? or do you go across town to Hartford >> Hospital? >> >> ck >> Charles S. Krin, DO >> >> >> In a message dated 5/7/2009 08:50:16 Central Standard Time, >> Ronald.Gross at baystatehealth.org writes: >> >> 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. >> >> >> **************Big savings on Dell?s most popular laptops. Now starting at >> $449! >> (http://pr.atwola.com/promoclk/100126575x1222382499x1201454962/aol?redir=http:%2F%2Fad.doubleclick.net%2Fclk%3B214663472%3B36502367%3Bg) >> >> >> ------------------------------ >> >> Message: 3 >> Date: Thu, 07 May 2009 15:59:26 +0100 >> From: Andr? de Castro Carneiro <a.carneiro at enflurane.com> >> Subject: Re: trauma-list Digest- Doc Holiday >> To: Trauma and Critical Care mailing list <trauma-list at trauma.org> >> Message-ID: <4A02F74E.7030808 at enflurane.com> >> Content-Type: text/plain; charset=ISO-8859-1; format=flowed >> >> Dr. Gross, I would be genuinely interested in knowing on what evidence >> you base your assumption that more hours equals better training. >> >> The works based on the Airline industry have given us plenty of evidence >> that human behaviour is a core component of error (with or without fatal >> consequences) and as such has looked deeply at human factors suchs as >> exhaustion for a LONG time. >> >> We like to feel more than human. We all do. It's only... errrr... human. >> >> But we're not. We're not machines. We have limitations and we have to >> discover them and accept them, and then modulate them and mitigate them. >> >> Pretending it doens't exist doesn't solve the problem. >> >> We have to reduce working hours. It's law and it's not open to >> discussion, whether we all like it or not. >> I agree that there is a potential for training to suffer as a >> consequence, but there are so many different components to quality of >> trainign that looking at working hours alone seems overly simplistic. >> >> We all want what's best for our patients. That has not and will not >> change in our profession, ever. No matter what generations you're >> looking at. >> >> Best wishes from across the pond >> >> >> Andr? de Castro Carneiro >> Specialist Registrar >> Anaetshetics and Critical Care >> The Leeds Teaching Hospitals NHS Trust >> >> Gross, Ronald wrote: >>> 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 >>> >>> Send trauma-list mailing list submissions to >>> trauma-list at trauma.org >>> >>> To subscribe or unsubscribe via the World Wide Web, visit >>> http://list.mistral.net/mailman/listinfo/trauma-list >>> or, via email, send a message with subject or body 'help' to >>> trauma-list-request at trauma.org >>> >>> You can reach the person managing the list at >>> trauma-list-owner at trauma.org >>> >>> When replying, please edit your Subject line so it is more specific than "Re: Contents of trauma-list digest..." >>> >>> >>> 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 >>> 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. >>> >>> >>> ------------------------------ >>> >>> 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 >>> >>> >>> __________________________________________________________________ >>> Looking for the perfect gift? Give the gift of Flickr! >>> >>> http://www.flickr.com/gift/ >>> -- >>> 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. >>> >>> >>> ------------------------------ >>> >>> 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 >>>> 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: 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/ >>>>> >>>> -- >>>> trauma-list : 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 >>>>> 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/ >>>>> >>>> -- >>>> trauma-list : TRAUMA.ORG >>>> To change your settings or unsubscribe visit: >>>> http://www.trauma.org/index.php?/community/ >>>> >>>> >>> -- >>> trauma-list : TRAUMA.ORG >>> To change your settings or unsubscribe visit: >>> http://www.trauma.org/index.php?/community/ >>> >>> ------------------------------ >>> >>> 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 n > e >> ed >>> 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 >>>>> 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/ >>>>> >>>> -- >>>> trauma-list : TRAUMA.ORG >>>> To change your settings or unsubscribe visit: >>>> http://www.trauma.org/index.php?/community/ >>>> >>>> >>> -- >>> trauma-list : TRAUMA.ORG >>> To change your settings or unsubscribe visit: >>> http://www.trauma.org/index.php?/community/ >>> -- >>> trauma-list : TRAUMA.ORG >>> 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 >>>> 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/ >>>> >>> -- >>> trauma-list : 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 >>>>> 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/ >>>>> >>>> -- >>>> trauma-list : TRAUMA.ORG >>>> To change your settings or unsubscribe visit: >>>> http://www.trauma.org/index.php?/community/ >>>> >>>> >>> -- >>> trauma-list : TRAUMA.ORG >>> To change your settings or unsubscribe visit: >>> http://www.trauma.org/index.php?/community/ >>> >>> >>> ------------------------------ >>> >>> -- >>> trauma-list : 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 >>> ******************************************* >>> ----------------------------------------- >>> Visit www.nyc.gov/hhc >>> >>> CONFIDENTIALITY NOTICE: The information in this E-Mail may be >>> confidential and may be legally privileged. It is intended solely >>> for the addressee(s). If you are not the intended recipient, any >>> disclosure, copying, distribution or any action taken or omitted to >>> be taken in reliance on this e-mail, is prohibited and may be >>> unlawful. If you have received this E-Mail message in error, notify >>> the sender by reply E-Mail and delete the message. >>> -- >>> trauma-list : TRAUMA.ORG >>> To change your settings or unsubscribe visit: >>> http://www.trauma.org/index.php?/community/ >>> -- >>> trauma-list : TRAUMA.ORG >>> To change your settings or unsubscribe visit: >>> http://www.trauma.org/index.php?/community/ >>> >> >> ------------------------------ >> >> Message: 4 >> Date: Thu, 7 May 2009 11:04:57 -0400 >> From: "Gross, Ronald" <Ronald.Gross at baystatehealth.org> >> Subject: RE: trauma-list Digest- Doc Holiday >> To: "'Trauma and Critical Care mailing list'" <trauma-list at trauma.org> >> Message-ID: >> <FD2BE6867A90F543AAD02E429F878633013B1FBC0BDD at bhsexc11.bhs.org> >> Content-Type: text/plain; charset="us-ascii" >> >> I will also let y'all know that the Surgical Skills Sub-Committee of the COT (that I am a proud member of) is in the latter stages of development of a cadaver lab that is specifically designed to provide senior residents with training in surgical exposures, and the second beta test of this course (done at Loyola in March) was a smashing success >> >> Ron >> >> -----Original Message----- >> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Krin135 at aol.com >> Sent: Thursday, May 07, 2009 10:49 AM >> To: trauma-list at trauma.org >> Subject: Re: trauma-list Digest- Doc Holiday >> >> for those of you who might not be familiar with the ATOM course, here's a >> link: >> >> http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2009-May/_http://atomcourse.com/find.php_ (http://atomcourse.com/find.php) >> >> I'll admit to being disappointed at the paucity of programs here in the >> US...even if I'll never qualify to take the course. >> >> I am also aware of a program at St Louis University Hospital Medical Center >> in coordination with the US DoD where medical teams rotating to combat >> zones go to 'brush up' on operative simulators. Jeff Bailey is doing a >> dynamite job with that program. >> >> ck >> Charles S. Krin, DO >> >> >> In a message dated 5/7/2009 08:31:46 Central Standard Time, >> Sheldon.Teperman at nbhn.net writes: >> >> 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. >> >> **************Big savings on Dell's most popular laptops. Now starting at >> $449! >> (http://pr.atwola.com/promoclk/100126575x1222382499x1201454962/aol?redir=http:%2F%2Fad.doubleclick.net%2Fclk%3B214663472%3B36502367%3Bg) >> -- >> 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. >> >> >> ------------------------------ >> >> Message: 5 >> Date: Thu, 7 May 2009 11:07:20 -0400 >> From: "Gross, Ronald" <Ronald.Gross at baystatehealth.org> >> Subject: RE: trauma-list Digest- Doc Holiday >> To: "'Trauma and Critical Care mailing list'" <trauma-list at trauma.org> >> Message-ID: >> <FD2BE6867A90F543AAD02E429F878633013B1FBC0BDE at bhsexc11.bhs.org> >> Content-Type: text/plain; charset="us-ascii" >> >> Excellent question, Charles. The reason is quite simple - I haven't been here long enough to get the wheels turning! But I can assure you that the ATOM course will be at Baystate very soon! :-) >> >> Ron >> >> -----Original Message----- >> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Krin135 at aol.com >> Sent: Thursday, May 07, 2009 10:55 AM >> To: trauma-list at trauma.org >> Subject: Re: trauma-list Digest- Doc Holiday >> >> OK, Ron...hows come Pret's got an ATOM course up at Maine Medical Center, >> but Baystate isn't represented? or do you go across town to Hartford >> Hospital? >> >> ck >> Charles S. Krin, DO >> >> >> In a message dated 5/7/2009 08:50:16 Central Standard Time, >> Ronald.Gross at baystatehealth.org writes: >> >> 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. >> >> >> **************Big savings on Dell's most popular laptops. Now starting at >> $449! >> (http://pr.atwola.com/promoclk/100126575x1222382499x1201454962/aol?redir=http:%2F%2Fad.doubleclick.net%2Fclk%3B214663472%3B36502367%3Bg) >> -- >> 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. >> >> >> ------------------------------ >> >> Message: 6 >> Date: Thu, 7 May 2009 11:23:43 -0400 >> From: "Gross, Ronald" <Ronald.Gross at baystatehealth.org> >> Subject: RE: trauma-list Digest- Doc Holiday >> To: "'Trauma and Critical Care mailing list'" <trauma-list at trauma.org> >> Message-ID: >> <FD2BE6867A90F543AAD02E429F878633013B1FBC0BE0 at bhsexc11.bhs.org> >> Content-Type: text/plain; charset="iso-8859-1" >> >> Hi Andre, >> >> First off - please don't call me "Dr. Gross" - it makes me feel far older than I wanna be!! Ron works just fine in my book :-) >> >> Please know that I agree with all of your points, in principle. Yes, the Link trainer has revolutionized the airline industry, and courses like ATOM, DSTC and the like serve as our link trainers. You must, then continue the comparison; someone who leaves flight school rarely moves on to flying a commercial jet carrying hundreds of passengers as the skipper of that ship; they almost always will fly in the co-pilot's seat, and will, after a prescribed number of hours in the air move into the other seat. Contrast this to a graduate of a surgical residency program who has only the "flight time" i.e. hours in the OR, that s/he has accumulated within those 80 hrs/week and who is now skipper of his or her ship with no one mandated to be at his or her side. >> >> What I am saying is that the model of decreasing hours without a viable training alternative will not work, and we have not as yet found that/those viable alternative(s) to surgical training that will provide the same sort of experience as those of us older HUMANS acquired working longer hours. >> >> And yes, we are all humans, there is no denying that. And yes, to err is human, I know that all to well - and when I forget, the love of my life will quickly remind me of that fact (thank God!) >> >> OK - I'll shut up now! >> >> Best wishes BACK across the Pond! >> Ron >> >> >> -----Original Message----- >> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Andr? de Castro Carneiro >> Sent: Thursday, May 07, 2009 10:59 AM >> To: Trauma and Critical Care mailing list >> Subject: Re: trauma-list Digest- Doc Holiday >> >> Dr. Gross, I would be genuinely interested in knowing on what evidence >> you base your assumption that more hours equals better training. >> >> The works based on the Airline industry have given us plenty of evidence >> that human behaviour is a core component of error (with or without fatal >> consequences) and as such has looked deeply at human factors suchs as >> exhaustion for a LONG time. >> >> We like to feel more than human. We all do. It's only... errrr... human. >> >> But we're not. We're not machines. We have limitations and we have to >> discover them and accept them, and then modulate them and mitigate them. >> >> Pretending it doens't exist doesn't solve the problem. >> >> We have to reduce working hours. It's law and it's not open to >> discussion, whether we all like it or not. >> I agree that there is a potential for training to suffer as a >> consequence, but there are so many different components to quality of >> trainign that looking at working hours alone seems overly simplistic. >> >> We all want what's best for our patients. That has not and will not >> change in our profession, ever. No matter what generations you're >> looking at. >> >> Best wishes from across the pond >> >> >> Andr? de Castro Carneiro >> Specialist Registrar >> Anaetshetics and Critical Care >> The Leeds Teaching Hospitals NHS Trust >> >> Gross, Ronald wrote: >>> 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 >>> >>> Send trauma-list mailing list submissions to >>> trauma-list at trauma.org >>> >>> To subscribe or unsubscribe via the World Wide Web, visit >>> http://list.mistral.net/mailman/listinfo/trauma-list >>> or, via email, send a message with subject or body 'help' to >>> trauma-list-request at trauma.org >>> >>> You can reach the person managing the list at >>> trauma-list-owner at trauma.org >>> >>> When replying, please edit your Subject line so it is more specific than "Re: Contents of trauma-list digest..." >>> >>> >>> 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 >>> 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. >>> >>> >>> ------------------------------ >>> >>> 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 >>> >>> >>> __________________________________________________________________ >>> Looking for the perfect gift? Give the gift of Flickr! >>> >>> http://www.flickr.com/gift/ >>> -- >>> 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. >>> >>> >>> ------------------------------ >>> >>> 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 >>>> 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: 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/ >>>>> >>>> -- >>>> trauma-list : 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 >>>>> 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/ >>>>> >>>> -- >>>> trauma-list : TRAUMA.ORG >>>> To change your settings or unsubscribe visit: >>>> http://www.trauma.org/index.php?/community/ >>>> >>>> >>> -- >>> trauma-list : TRAUMA.ORG >>> To change your settings or unsubscribe visit: >>> http://www.trauma.org/index.php?/community/ >>> >>> ------------------------------ >>> >>> 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 n > e >> ed >>> 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 >>>>> 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/ >>>>> >>>> -- >>>> trauma-list : TRAUMA.ORG >>>> To change your settings or unsubscribe visit: >>>> http://www.trauma.org/index.php?/community/ >>>> >>>> >>> -- >>> trauma-list : TRAUMA.ORG >>> To change your settings or unsubscribe visit: >>> http://www.trauma.org/index.php?/community/ >>> -- >>> trauma-list : TRAUMA.ORG >>> 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 >>>> 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/ >>>> >>> -- >>> trauma-list : 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 >>>>> 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/ >>>>> >>>> -- >>>> trauma-list : TRAUMA.ORG >>>> To change your settings or unsubscribe visit: >>>> http://www.trauma.org/index.php?/community/ >>>> >>>> >>> -- >>> trauma-list : TRAUMA.ORG >>> To change your settings or unsubscribe visit: >>> http://www.trauma.org/index.php?/community/ >>> >>> >>> ------------------------------ >>> >>> -- >>> trauma-list : 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 >>> ******************************************* >>> ----------------------------------------- >>> Visit www.nyc.gov/hhc >>> >>> CONFIDENTIALITY NOTICE: The information in this E-Mail may be >>> confidential and may be legally privileged. It is intended solely >>> for the addressee(s). If you are not the intended recipient, any >>> disclosure, copying, distribution or any action taken or omitted to >>> be taken in reliance on this e-mail, is prohibited and may be >>> unlawful. If you have received this E-Mail message in error, notify >>> the sender by reply E-Mail and delete the message. >>> -- >>> trauma-list : TRAUMA.ORG >>> To change your settings or unsubscribe visit: >>> http://www.trauma.org/index.php?/community/ >>> -- >>> trauma-list : TRAUMA.ORG >>> To change your settings or unsubscribe visit: >>> http://www.trauma.org/index.php?/community/ >>> >> -- >> trauma-list : TRAUMA.ORG >> To change your settings or unsubscribe visit: >> http://www.trauma.org/index.php?/community/ >> >> >> ------------------------------ >> >> -- >> trauma-list : TRAUMA.ORG >> To change your settings or unsubscribe visit: >> http://www.trauma.org/index.php?/community/ >> >> End of trauma-list Digest, Vol 71, Issue 12 >> ******************************************* >> -- >> trauma-list : TRAUMA.ORG >> To change your settings or unsubscribe visit: >> http://www.trauma.org/index.php?/community/ >> > -- > trauma-list : TRAUMA.ORG > To change your settings or unsubscribe visit: > http://www.trauma.org/index.php?/community/ > -- > trauma-list : TRAUMA.ORG > To change your settings or unsubscribe visit: > http://www.trauma.org/index.php?/community/ >
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