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Fri May 8 17:52:46 BST 2009

As I have found often over the years, Dr. Sise's comments are consistant with his profound wisdom.   Shel

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Sent: Thursday, May 07, 2009 11:36 PM
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Subject: trauma-list Digest, Vol 71, Issue 30

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Today's Topics:

   1. A dose of reality in residency training (Sise, Mike MD)
   2. RE:  (McSwain, Norman E Jr.)
   3. RE: A dose of reality in residency training (Gross, Ronald)
   4. RE: A dose of reality in residency training (Gross, Ronald)
   5. RE: Sleep deprived Critical Care? (Sherry, Scott :LPH Trauma)

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

Message: 1
Date: Thu, 7 May 2009 17:31:57 -0700
From: "Sise, Mike MD" <Sise.Mike at scrippshealth.org>
Subject: A dose of reality in residency training
To: trauma-list at trauma.org
Message-ID:
        <FEECA018557C774EB876F0D3BCB54E1B01F48512 at MSG02.corp.scripps.org>
Content-Type: text/plain; charset=iso-8859-1

Time for a reality check:

1.      "Old school" every other night on call was horrible and ruined many marriages and careers - errors were common and frequent. During that time in my life, my wife's favorite saying was that the world's biggest lie is that it will be better next year.
2.      It takes a very large amount of clinical experience to become a surgeon - a critical mass of sick patients, operative experience, mentored leadership time, and senior decision making responsibility
3.      Five years of 80 hours or less per week, truncated by mandatory time away, lack of longitudinal responsibility may not be long enough to accomplish the independent status required of graduates in the US system
4.      The European and Great Britain model of extended training after residency is probably out of the question in the US where medical school is not free and most interns already have $200,000 or more debt and don't get paid well as residents. Who will ask our new young surgeons to live with their debt another 2 to 4 years, maybe longer?
5.      Further work restrictions will demand of us a complete redesign of training programs and the expectations of graduate surgeons. Will we have a "1st Officer" status like the airlines where our young surgeons don't have primary operative responsibility for a set number of years and operative volume after residency? Work force shortages make that seem unlikely and yet young surgeons may be forced to do something like that on their own out of sheer necessity.
6.      Time to stop fighting over who's right and who's wrong over this issue. The old days are gone for good and any of us who trained that way and complain about the new graduates are not making it any more likely that we will find an effective new way to train the next generation of surgeons. They are just as dedicated and committed as we were and they deserve our unqualified support. They need us to help them learn what we did - how to be there for our patients in hours of desperate need when there is much at stake and decisive action is required.

Mike Sise, San Diego

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Message: 2
Date: Thu, 7 May 2009 19:41:48 -0500
From: "McSwain, Norman E Jr." <nmcswai at tulane.edu>
Subject: RE:
To: "Trauma and Critical Care mailing list" <trauma-list at trauma.org>
Message-ID:
        <B79C02DCC4FA074DB02381DF1C5D60BA0242BFBF at EX07.ad.tulane.edu>
Content-Type: text/plain;       charset="iso-8859-1"

I was a coauthor on a paper on that subject in the mid 90's. My opinion has not changed. A simulator is helpful in learning the basic techniques BUT it does not substitute for the operating room for the in depth learning

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 josemaya01
Sent: Thursday, May 07, 2009 1:50 PM
To: trauma-list at trauma.org
Subject:

Ron, Andr? and others:
In my opinion what bothers us the most is that we really don?t have the answer to all the questions that have arisen due to the changes that have ocurred in surgical training.  I myself would agree with Ron in the fact that no matter how good a simulator program is, it will never replace an OR scenario with a live patient, because even the mental state is not the same.
I think that a lot of work has to be done before we fall into a comfortable zone.
And yes, I consider myself a Jurassic specimen at this point.
Jos? Mayagoitia, MD, FACS
Hospital General de Mexicali, M?xico
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Message: 3
Date: Thu, 7 May 2009 21:14:26 -0400
From: "Gross, Ronald" <Ronald.Gross at baystatehealth.org>
Subject: RE: A dose of reality in residency training
To: "'Trauma and Critical Care mailing list'" <trauma-list at trauma.org>
Message-ID:
        <FD2BE6867A90F543AAD02E429F878633013B1FBC0C0A at bhsexc11.bhs.org>
Content-Type: text/plain; charset="us-ascii"

Hmmmmm.  Seems to me that you did a really nice job of restating my posts, Mike.  Thanks.  Only, I never said I was right - I just said we need to figure out who IS, and how we can build a better mouse trap, 'cause the one we have at the moment isn't working.

Take care,
Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Sise, Mike MD
Sent: Thursday, May 07, 2009 8:32 PM
To: trauma-list at trauma.org
Subject: A dose of reality in residency training

Time for a reality check:

1.      "Old school" every other night on call was horrible and ruined many marriages and careers - errors were common and frequent. During that time in my life, my wife's favorite saying was that the world's biggest lie is that it will be better next year.
2.      It takes a very large amount of clinical experience to become a surgeon - a critical mass of sick patients, operative experience, mentored leadership time, and senior decision making responsibility
3.      Five years of 80 hours or less per week, truncated by mandatory time away, lack of longitudinal responsibility may not be long enough to accomplish the independent status required of graduates in the US system
4.      The European and Great Britain model of extended training after residency is probably out of the question in the US where medical school is not free and most interns already have $200,000 or more debt and don't get paid well as residents. Who will ask our new young surgeons to live with their debt another 2 to 4 years, maybe longer?
5.      Further work restrictions will demand of us a complete redesign of training programs and the expectations of graduate surgeons. Will we have a "1st Officer" status like the airlines where our young surgeons don't have primary operative responsibility for a set number of years and operative volume after residency? Work force shortages make that seem unlikely and yet young surgeons may be forced to do something like that on their own out of sheer necessity.
6.      Time to stop fighting over who's right and who's wrong over this issue. The old days are gone for good and any of us who trained that way and complain about the new graduates are not making it any more likely that we will find an effective new way to train the next generation of surgeons. They are just as dedicated and committed as we were and they deserve our unqualified support. They need us to help them learn what we did - how to be there for our patients in hours of desperate need when there is much at stake and decisive action is required.

Mike Sise, San Diego

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Message: 4
Date: Thu, 7 May 2009 21:15:14 -0400
From: "Gross, Ronald" <Ronald.Gross at baystatehealth.org>
Subject: RE: A dose of reality in residency training
To: "'Trauma and Critical Care mailing list'" <trauma-list at trauma.org>
Message-ID:
        <FD2BE6867A90F543AAD02E429F878633013B1FBC0C0B at bhsexc11.bhs.org>
Content-Type: text/plain; charset="us-ascii"

And just for the record, it never does get better next year...........I just managed to get older!

Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Sise, Mike MD
Sent: Thursday, May 07, 2009 8:32 PM
To: trauma-list at trauma.org
Subject: A dose of reality in residency training

Time for a reality check:

1.      "Old school" every other night on call was horrible and ruined many marriages and careers - errors were common and frequent. During that time in my life, my wife's favorite saying was that the world's biggest lie is that it will be better next year.
2.      It takes a very large amount of clinical experience to become a surgeon - a critical mass of sick patients, operative experience, mentored leadership time, and senior decision making responsibility
3.      Five years of 80 hours or less per week, truncated by mandatory time away, lack of longitudinal responsibility may not be long enough to accomplish the independent status required of graduates in the US system
4.      The European and Great Britain model of extended training after residency is probably out of the question in the US where medical school is not free and most interns already have $200,000 or more debt and don't get paid well as residents. Who will ask our new young surgeons to live with their debt another 2 to 4 years, maybe longer?
5.      Further work restrictions will demand of us a complete redesign of training programs and the expectations of graduate surgeons. Will we have a "1st Officer" status like the airlines where our young surgeons don't have primary operative responsibility for a set number of years and operative volume after residency? Work force shortages make that seem unlikely and yet young surgeons may be forced to do something like that on their own out of sheer necessity.
6.      Time to stop fighting over who's right and who's wrong over this issue. The old days are gone for good and any of us who trained that way and complain about the new graduates are not making it any more likely that we will find an effective new way to train the next generation of surgeons. They are just as dedicated and committed as we were and they deserve our unqualified support. They need us to help them learn what we did - how to be there for our patients in hours of desperate need when there is much at stake and decisive action is required.

Mike Sise, San Diego

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Message: 5
Date: Thu, 7 May 2009 20:34:28 -0700
From: "Sherry, Scott :LPH Trauma" <SSherry at LHS.ORG>
Subject: RE: Sleep deprived Critical Care?
To: "Trauma and Critical Care mailing list" <trauma-list at trauma.org>
Message-ID: <A0584CAEDC056B49B2414F4A2B6F149D113E7A at SWM2005.LEGACYHS>
Content-Type: text/plain; charset="iso-8859-1"

didnt medical school and college teach you how to function in a sleep deprived mode?

________________________________

From: trauma-list-bounces at trauma.org on behalf of McSwain, Norman E Jr.
Sent: Thu 5/7/2009 10:57 AM
To: Trauma and Critical Care mailing list
Subject: RE: Sleep deprived Critical Care?

Ron
Very well said

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 Gross, Ronald
Sent: Thursday, May 07, 2009 12:59 PM
To: 'Trauma and Critical Care mailing list'
Subject: RE: Sleep deprived Critical Care?

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

Yes it does.  And that is why the special ops guys (Navy SEALs and Army
Rangers) are routinely subjected to sleep deprivation in conditions that
most on this list could never imaging, so That(God forbid) they are
captured, they will already have experienced this and will have a better
ability to withstand the effects of that  deprivation.  I am NOT -
repeat NOT - advocating that we torture ourselves or our residents.  I
AM advocating that we train the way we practice, and practice the way we
train.  And there WILL be times in every single one of our practice
lives when we will be sleep deprived.  Our patients already know that we
all work very hard - what I want to be sure of is that I have a doc who
is accustomed to the rigors of that hard work and can perform even when
bone tired.

'Nuff said.
Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Charlene M Morris
Sent: Thursday, May 07, 2009 1:17 PM
To: Trauma and Critical Care mailing list
Subject: Sleep deprived Critical Care?

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

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

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

cmm

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

>
>
>
> "Fire makes steel strong in
> > the
> > same way challenges toughen a person"..
>
>         It is precisely comments like this that required the NYState
> legislature to pass a law requiring stiff penalties for breaking ( the
all
> ready passed) law regarding resident hours.  Leaders in surgery in
this
> state were disingenuous with following the new rules.  They would have
two
> sets of "books" ( if you will) with the real and then the "doctored"
call
> schedule. Gentleman( ladies), get real.  Reflect for a moment how many
of
> your colleagues have become victims of Substance abuse, broken
marriages and
> even suicide or mental illness. I can think of many examples of each
of
> these in my fellow residents from the " good old days". Where is the
virtue
> and the "true calling" in that???
>
>        These were young, bright people whose lives were ruined by the
> crushing and completely unnecessary work burden of Residency.  We
shame
> ourselves, for suggesting that only we have the commitment and that
young
> people lack the drive or will to be surgeons. Think of the patients
never
> served and the operations never performed by those of us unfortunate
enough
> not to have survived those grueling times. Rather than carrying
forward with
> the torch of bravado, we should move on. Programs, that address the
changes
> necessary to adapt to these different times should be where words on
these
> pages lye.  For example, Len Jacobs' ATOM course or the simulations
labs
> cropping up all over the country address the issue of decreased
resident
> exposure to clinical material.  These are constructive programs of
real
> value, rather than the "Brutane" of old.
>
>
>          I suggest we look to ourselves, before criticizing  our
younger
> colleagues. We are to blame for those lost lives and lost careers. How
many
> of those broken homes and mental break downs are we responsible for
with our
> "Dinosaur" like attitudes?  In the words of Gomar Pile,  ...For Shame,
For
> Shame , For Shame.!   Sheldon
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org] On Behalf Of
> trauma-list-request at trauma.org
> Sent: Thursday, May 07, 2009 7:00 AM
> To: trauma-list at trauma.org
> Subject: trauma-list Digest, Vol 71, Issue 10
>
> Send trauma-list mailing list submissions to
>        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
>
>
>
>
__________________________________________________________________
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> it or its contents is prohibited. If you have received this
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>
> ------------------------------
>
> Message: 2
> Date: Wed, 6 May 2009 07:36:39 -0400
> From: "Gross, Ronald" <Ronald.Gross at baystatehealth.org>
> Subject: RE: Blunt CCA injury ina stable YOUNG pt
> To: "'Trauma and Critical Care mailing list'" <trauma-list at trauma.org>
> Message-ID:
>        <FD2BE6867A90F543AAD02E429F878633013B1FBC0BC7 at bhsexc11.bhs.org>
> Content-Type: text/plain; charset="us-ascii"
>
> How about an image or two?  Before I respond to this very complex
issue
> that has, to my knowledge, no real definitive answer in the surgical
or
> neurosurgical literature, why did you scan the patient in the first
place?
>  "Post-blunt trauma" is a pretty broad category....trauma where?  Was
the
> c-spine injured?  Was the blunt trauma directly to the neck?  Was this
a
> seatbelt across the neck?
>
> And lastly - is the really an injury, to refer to a phrase coined by
Ken
> Mattox, is this just VOMIT?
>
> Ron
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org] On Behalf Of khumar huseynova
> Sent: Tuesday, May 05, 2009 4:53 PM
> To: trauma-list at trauma.org
> Subject: Blunt CCA injury ina stable YOUNG pt
>
> 24M w post-blunt trauma. Stable. Has intimal dissection of common
carotid
> art w 50% lumen obstruction. Asymptomatic from injury currently. No
other
> injuries. What would you do-anticoagulate w LOW-dose heparin; give ASA
only;
> stent; or operate?
> KH
>
>
>
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> contain confidential and privileged information for the use of the
> designated recipients named above. If you are not the intended
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> it or its contents is prohibited. If you have received this
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>
> ------------------------------
>
> Message: 3
> Date: Wed, 6 May 2009 15:00:57 +0200
> From: Ante ?ori? <ante.coric85 at gmail.com>
> Subject: Re: Blunt CCA injury ina stable YOUNG pt
> To: Trauma and Critical Care mailing list <trauma-list at trauma.org>
> Message-ID:
>        <edddfb3e0905060600t5e9a462aid63e78b889df0f67 at mail.gmail.com>
> Content-Type: text/plain; charset=ISO-8859-1
>
> if the lesion is withdrawing by time l see no need for
anticoagulation,
> instead l would repeat ultrasound and see the situation, but if in any
> doubt, or unable to do any diagnostic test in short period of time, l
would
> anticoagulate him for a while, if otherwise healthy  young person...
but l
> don't think there is a great chance of him stroking because even in
this
> situation 50% lumen is more then sufficient to provide enough blood
flow,
> and if no major turbulence risk for endothelial injury thrombus
genesis is
> practically 100% not happening if lumen doesn't spread on its own,
then
> would consider intervening, surgically or radiology intervention Ante
>
> 2009/5/6 Gross, Ronald <Ronald.Gross at baystatehealth.org>
>
> > How about an image or two?  Before I respond to this very complex
> > issue that has, to my knowledge, no real definitive answer in the
> > surgical or neurosurgical literature, why did you scan the patient
in the
> first place?
> >  "Post-blunt trauma" is a pretty broad category....trauma where?
Was
> > the c-spine injured?  Was the blunt trauma directly to the neck?
Was
> > this a seatbelt across the neck?
> >
> > And lastly - is the really an injury, to refer to a phrase coined by
> > Ken Mattox, is this just VOMIT?
> >
> > Ron
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org [mailto:
> > trauma-list-bounces at trauma.org] On Behalf Of khumar huseynova
> > Sent: Tuesday, May 05, 2009 4:53 PM
> > To: trauma-list at trauma.org
> > Subject: Blunt CCA injury ina stable YOUNG pt
> >
> > 24M w post-blunt trauma. Stable. Has intimal dissection of common
> > carotid art w 50% lumen obstruction. Asymptomatic from injury
> > currently. No other injuries. What would you do-anticoagulate w
> > LOW-dose heparin; give ASA only; stent; or operate?
> > KH
> >
> >
> >
> > __________________________________________________________________
> > Looking for the perfect gift? Give the gift of Flickr!
> >
> > http://www.flickr.com/gift/
> > --
> > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> >
----------------------------------------------------------------------
> > CONFIDENTIALITY NOTICE: This email communication and any attachments
> > may contain confidential and privileged information for the use of
the
> > designated recipients named above. If you are not the intended
> > recipient, you are hereby notified that you have received this
> > communication in error and that any review, disclosure,
dissemination,
> > distribution or copying of it or its contents is prohibited. If you
> > have received this communication in error, please reply to the
sender
> > immediately or by telephone at (413) 794-0000 and destroy all copies
of
> this communication and any attachments.
> > For further information regarding Baystate Health's privacy policy,
> > please visit our Internet web site at http://www.baystatehealth.com <http://www.baystatehealth.com/> .
> > --
> > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
>
>
> ------------------------------
>
> Message: 4
> Date: Thu, 7 May 2009 04:23:31 +0800
> From: Jose Luis Danguilan <jdanguilan at gmail.com>
> Subject: Re: to Doc Holiday-DELAYED response
> To: Trauma and Critical Care mailing list <trauma-list at trauma.org>
> Message-ID:
>        <17d66fd60905061323u38c6dacaqef3a8f7e97be68c2 at mail.gmail.com>
> Content-Type: text/plain; charset=ISO-8859-1
>
> I fully agree with Dr. Gross. We seem to baby the new generation of
> surgical residents. Hard work has never killed anyone. Fire makes
steel
> strong in the same way challenges toughen a person or did I get my
metaphors
> mixed up?
>
> A fellow triceratops,
>
> Jose Luis J. Danguilan, MD
> Manila, Philippines
>
> On Wed, May 6, 2009 at 7:26 PM, Gross, Ronald <
> Ronald.Gross at baystatehealth.org> wrote:
>
> > And when you finally finish your truncated 5 year surgical
residency,
> > with protected educational time, sleep time and no more that 80
hours
> > per week, and you have to go out into the REAL world, will your
> > patients understand that you need to go home now 'cause you're
sleepy,
> > and someone they have never seen will be caring for them?
> >
> > Athletes learn endurance by working harder and longer in their
> > workouts then they have to do in the "real deal".  Our stakes are
FAR
> > higher than any athletes' stakes, and yet we are failing to teach
our
> > residents the expanse of knowledge they will need, and we are
failing
> > to prepare them for the real world, where there isn't protected
> > education time, and guaranteed sleep time.
> >
> > I know, my wife has told me on several occasions that I am a
dinosaur.
> > She is probably right.....but this dinosaur has been true to his
> > calling, and will never stop being fully responsible for the care of
> > his patients - all the time!
> >
> > (OOPS, need to take a nap now.  Worked too long.........)
> >
> > Best to you all,
> > Ron
> >
> >
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org [mailto:
> > trauma-list-bounces at trauma.org] On Behalf Of khumar huseynova
> > Sent: Tuesday, May 05, 2009 4:50 PM
> > To: trauma-list at trauma.org
> > Subject: to Doc Holiday-DELAYED response
> >
> > Dr Holiday, sorry for retarded response-just read your note on
> > resident hours (March). Thanks and yes, you are right, there is
> > evidence that long hours result in reduced effciency and eventual
harm
> > to the patient. I dont think I will ever agree witht eh 48hr/wk
> > schedule for SURGERY residents-it has to be MORE than that. Am not
> > saying 120hrs, but should be reasonable enough to get suffucuent
> > experience and not to feel 'dead' at the end of the day. Maybe
someone
> needs to design a study to determine the cutoff...
> > And you are right, there are perhaps other ways of increasing the
> > quality of residency without making the hours too long as well. The
> > problem is, given how conservative the health care system is, it
will
> > take decades to change it.
> > Cheers. KH
> >
> >
> >
> >
> > __________________________________________________________________
> > Get a sneak peak at messages with a handy reading pane with All new
> Yahoo!
> > Mail: http://ca.promos.yahoo.com/newmail/overview2/
> > --
> > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> >
----------------------------------------------------------------------
> > CONFIDENTIALITY NOTICE: This email communication and any attachments
> > may contain confidential and privileged information for the use of
the
> > designated recipients named above. If you are not the intended
> > recipient, you are hereby notified that you have received this
> > communication in error and that any review, disclosure,
dissemination,
> > distribution or copying of it or its contents is prohibited. If you
> > have received this communication in error, please reply to the
sender
> > immediately or by telephone at (413) 794-0000 and destroy all copies
of
> this communication and any attachments.
> > For further information regarding Baystate Health's privacy policy,
> > please visit our Internet web site at http://www.baystatehealth.com <http://www.baystatehealth.com/> .
> > --
> > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
>
>
> ------------------------------
>
> Message: 5
> Date: Wed, 6 May 2009 21:38:13 +0100
> From: Andre Carneiro <a.carneiro at enflurane.com>
> Subject: Re: to Doc Holiday-DELAYED response
> To: Trauma and Critical Care mailing list <trauma-list at trauma.org>
> Message-ID:
>        <5e8268ac0905061338o731c8db2t77e625c354456e15 at mail.gmail.com>
> Content-Type: text/plain; charset=ISO-8859-1
>
> Whilst I completely agree that we trainees are not being exposed to
enough
> workload (48 hours! Are they mad??), I would also like to remind you
that no
> athlete trains 80 hours a week (no matter how serious they are about
their
> performance) and high performing athletes are well aware of the risk
of
> overtraining.
> Meaning that surely there must be a happy medium that doesn't mean we
live
> in a complete state of tiredness which, I believe, has been proven
time and
> again to lead to incidents of varying degrees of severity.
>
>
> Best wishes from across the pond
>
>
>
> Andre de Castro Carneiro
> Specialist Registrar
> Anaesthetics and Critical Care
> The Leeds Teaching Hospitals NHS Trust
>
> 2009/5/6 Jose Luis Danguilan <jdanguilan at gmail.com>
>
> > I fully agree with Dr. Gross. We seem to baby the new generation of
> > surgical residents. Hard work has never killed anyone. Fire makes
> > steel strong in the same way challenges toughen a person or did I
get
> > my metaphors mixed up?
> >
> > A fellow triceratops,
> >
> > Jose Luis J. Danguilan, MD
> > Manila, Philippines
> >
> > On Wed, May 6, 2009 at 7:26 PM, Gross, Ronald <
> > Ronald.Gross at baystatehealth.org> wrote:
> >
> > > And when you finally finish your truncated 5 year surgical
> > > residency,
> > with
> > > protected educational time, sleep time and no more that 80 hours
per
> > week,
> > > and you have to go out into the REAL world, will your patients
> > > understand that you need to go home now 'cause you're sleepy, and
> > > someone they have never seen will be caring for them?
> > >
> > > Athletes learn endurance by working harder and longer in their
> > > workouts then they have to do in the "real deal".  Our stakes are
> > > FAR higher than
> > any
> > > athletes' stakes, and yet we are failing to teach our residents
the
> > expanse
> > > of knowledge they will need, and we are failing to prepare them
for
> > > the
> > real
> > > world, where there isn't protected education time, and guaranteed
> > > sleep time.
> > >
> > > I know, my wife has told me on several occasions that I am a
dinosaur.
> >  She
> > > is probably right.....but this dinosaur has been true to his
> > > calling, and will never stop being fully responsible for the care
of
> > > his patients -
> > all
> > > the time!
> > >
> > > (OOPS, need to take a nap now.  Worked too long.........)
> > >
> > > Best to you all,
> > > Ron
> > >
> > >
> > >
> > > -----Original Message-----
> > > From: trauma-list-bounces at trauma.org [mailto:
> > > trauma-list-bounces at trauma.org] On Behalf Of khumar huseynova
> > > Sent: Tuesday, May 05, 2009 4:50 PM
> > > To: trauma-list at trauma.org
> > > Subject: to Doc Holiday-DELAYED response
> > >
> > > Dr Holiday, sorry for retarded response-just read your note on
> > > resident hours (March). Thanks and yes, you are right, there is
> > > evidence that long hours result in reduced effciency and eventual
> > > harm to the patient. I
> > dont
> > > think I will ever agree witht eh 48hr/wk schedule for SURGERY
> > residents-it
> > > has to be MORE than that. Am not saying 120hrs, but should be
> > > reasonable enough to get suffucuent experience and not to feel
> > > 'dead' at the end of
> > the
> > > day. Maybe someone needs to design a study to determine the
cutoff...
> > > And you are right, there are perhaps other ways of increasing the
> > > quality of residency without making the hours too long as well.
The
> > > problem is, given how conservative the health care system is, it
> > > will take decades to change it.
> > > Cheers. KH
> > >
> > >
> > >
> > >
> > > __________________________________________________________________
> > > Get a sneak peak at messages with a handy reading pane with All
new
> > Yahoo!
> > > Mail: http://ca.promos.yahoo.com/newmail/overview2/
> > > --
> > > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > > To change your settings or unsubscribe visit:
> > > http://www.trauma.org/index.php?/community/
> > >
> > >
--------------------------------------------------------------------
> > > -- CONFIDENTIALITY NOTICE: This email communication and any
> > > attachments may contain confidential and privileged information
for
> > > the use of the designated recipients named above. If you are not
the
> > > intended recipient, you are hereby notified that you have received
> > > this communication in
> > error
> > > and that any review, disclosure, dissemination, distribution or
> > > copying
> > of
> > > it or its contents is prohibited. If you have received this
> > > communication
> > in
> > > error, please reply to the sender immediately or by telephone at
> > > (413) 794-0000 and destroy all copies of this communication and
any
> > attachments.
> > > For further information regarding Baystate Health's privacy
policy,
> > please
> > > visit our Internet web site at http://www.baystatehealth.com <http://www.baystatehealth.com/> .
> > > --
> > > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > > To change your settings or unsubscribe visit:
> > > http://www.trauma.org/index.php?/community/
> > >
> > --
> > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> >
>
>
> ------------------------------
>
> Message: 6
> Date: Wed, 6 May 2009 20:53:41 +0000
> From: jduchesn at tulane.edu
> Subject: Re: to Doc Holiday-DELAYED response
> To: "Trauma and Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID:
>
>
<379830282-1241643222-cardhu_decombobulator_blackberry.rim.net-395344921
- at bxe1135.bisx.prod.on.blackberry
> >
>
> Content-Type: text/plain
>
> How can we set a time schedule for the PRIVILEDGE of being trained as
a
> SURGEON?
> The field of Surgery needs full time commitment not part time effort.
> Duchesne
> CharityOne- New Orleans
> Sent via BlackBerry by AT&T
>
> -----Original Message-----
> From: Andre Carneiro <a.carneiro at enflurane.com>
>
> Date: Wed, 6 May 2009 21:38:13
> To: Trauma and Critical Care mailing list<trauma-list at trauma.org>
> Subject: Re: to Doc Holiday-DELAYED response
>
>
> Whilst I completely agree that we trainees are not being exposed to
enough
> workload (48 hours! Are they mad??), I would also like to remind you
that
> no
> athlete trains 80 hours a week (no matter how serious they are about
their
> performance) and high performing athletes are well aware of the risk
of
> overtraining.
> Meaning that surely there must be a happy medium that doesn't mean we
live
> in a complete state of tiredness which, I believe, has been proven
time and
> again to lead to incidents of varying degrees of severity.
>
>
> Best wishes from across the pond
>
>
>
> Andre de Castro Carneiro
> Specialist Registrar
> Anaesthetics and Critical Care
> The Leeds Teaching Hospitals NHS Trust
>
> 2009/5/6 Jose Luis Danguilan <jdanguilan at gmail.com>
>
> > I fully agree with Dr. Gross. We seem to baby the new generation of
> > surgical
> > residents. Hard work has never killed anyone. Fire makes steel
strong in
> > the
> > same way challenges toughen a person or did I get my metaphors mixed
up?
> >
> > A fellow triceratops,
> >
> > Jose Luis J. Danguilan, MD
> > Manila, Philippines
> >
> > On Wed, May 6, 2009 at 7:26 PM, Gross, Ronald <
> > Ronald.Gross at baystatehealth.org> wrote:
> >
> > > And when you finally finish your truncated 5 year surgical
residency,
> > with
> > > protected educational time, sleep time and no more that 80 hours
per
> > week,
> > > and you have to go out into the REAL world, will your patients
> understand
> > > that you need to go home now 'cause you're sleepy, and someone
they
> have
> > > never seen will be caring for them?
> > >
> > > Athletes learn endurance by working harder and longer in their
workouts
> > > then they have to do in the "real deal".  Our stakes are FAR
higher
> than
> > any
> > > athletes' stakes, and yet we are failing to teach our residents
the
> > expanse
> > > of knowledge they will need, and we are failing to prepare them
for the
> > real
> > > world, where there isn't protected education time, and guaranteed
sleep
> > > time.
> > >
> > > I know, my wife has told me on several occasions that I am a
dinosaur.
> >  She
> > > is probably right.....but this dinosaur has been true to his
calling,
> and
> > > will never stop being fully responsible for the care of his
patients -
> > all
> > > the time!
> > >
> > > (OOPS, need to take a nap now.  Worked too long.........)
> > >
> > > Best to you all,
> > > Ron
> > >
> > >
> > >
> > > -----Original Message-----
> > > From: trauma-list-bounces at trauma.org [mailto:
> > > trauma-list-bounces at trauma.org] On Behalf Of khumar huseynova
> > > Sent: Tuesday, May 05, 2009 4:50 PM
> > > To: trauma-list at trauma.org
> > > Subject: to Doc Holiday-DELAYED response
> > >
> > > Dr Holiday, sorry for retarded response-just read your note on
resident
> > > hours (March). Thanks and yes, you are right, there is evidence
that
> long
> > > hours result in reduced effciency and eventual harm to the
patient. I
> > dont
> > > think I will ever agree witht eh 48hr/wk schedule for SURGERY
> > residents-it
> > > has to be MORE than that. Am not saying 120hrs, but should be
> reasonable
> > > enough to get suffucuent experience and not to feel 'dead' at the
end
> of
> > the
> > > day. Maybe someone needs to design a study to determine the
cutoff...
> > > And you are right, there are perhaps other ways of increasing the
> quality
> > > of residency without making the hours too long as well. The
problem is,
> > > given how conservative the health care system is, it will take
decades
> to
> > > change it.
> > > Cheers. KH
> > >
> > >
> > >
> > >
__________________________________________________________________
> > > Get a sneak peak at messages with a handy reading pane with All
new
> > Yahoo!
> > > Mail: http://ca.promos.yahoo.com/newmail/overview2/
> > > --
> > > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > > To change your settings or unsubscribe visit:
> > > http://www.trauma.org/index.php?/community/
> > >
> > >
----------------------------------------------------------------------
> > > CONFIDENTIALITY NOTICE: This email communication and any
attachments
> may
> > > contain confidential and privileged information for the use of the
> > > designated recipients named above. If you are not the intended
> recipient,
> > > you are hereby notified that you have received this communication
in
> > error
> > > and that any review, disclosure, dissemination, distribution or
copying
> > of
> > > it or its contents is prohibited. If you have received this
> communication
> > in
> > > error, please reply to the sender immediately or by telephone at
(413)
> > > 794-0000 and destroy all copies of this communication and any
> > attachments.
> > > For further information regarding Baystate Health's privacy
policy,
> > please
> > > visit our Internet web site at http://www.baystatehealth.com <http://www.baystatehealth.com/> .
> > > --
> > > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > > To change your settings or unsubscribe visit:
> > > http://www.trauma.org/index.php?/community/
> > >
> > --
> > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> >
> --
> trauma-list : TRAUMA.ORG <http://trauma.org/>
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>
> ------------------------------
>
> Message: 7
> Date: Wed,  6 May 2009 22:07:26 -0400
> From: Tidewater001 <tidewater001 at aol.com>
> Subject: Re: to Doc Holiday-DELAYED response
> To: "Trauma and Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID: <54261d19.b463.4432.b629.8f13e4b82c2e at aol.com>
> Content-Type: TEXT/plain; charset=us-ascii
>
> I just got home from my TYPICAL day of seeing patients in the office,
> operating, rounding, teaching, administrative responsibilities, seeing
> consults, teaching, responding to the emergent needs of my colleagues
caring
> for their patients, rounding, operating and finally...more paperwork.
I just
> sat down to open my e-mails at 2145...my day started at 0600. Typical
day
> for me and I enjoyed most all of it. Do the residents training today
(most
> of whom will be joining the ranks of private practice like myself)
honestly
> think their work week will only be 80 hours!!!?? In these days of ever
> worsening reimbursement and ever increasing business costs...you have
to
> work LONG and HARD to make a living and to be available to your
patients and
> the physicians who need your help and expertise as a WELL TRAINED
SURGEON.
> My program director beat that into us and I am a FIRM believer that
the
> patient comes first and last and really does not care if you are tired
when
> they are the ones in need
>
>  of your help!!
>
> Gregory T. Squires, MD FACS
> Clinical Assistant Professor of Surgery
> Medical University of South Carolina
> Director of Trauma
> Trident Regional Medical Center
> Charleston, SC
>
>
> In a message dated 05/06/09 16:56:04 Eastern Daylight Time,
> jduchesn at tulane.edu writes:
> How can we set a time schedule for the PRIVILEDGE of being trained as
a
> SURGEON?
> The field of Surgery needs full time commitment not part time effort.
> Duchesne
> CharityOne- New Orleans
> Sent via BlackBerry by AT&T
>
> -----Original Message-----
> From: Andre Carneiro <a.carneiro at enflurane.com>
>
> Date: Wed, 6 May 2009 21:38:13
> To: Trauma and Critical Care mailing list<trauma-list at trauma.org>
> Subject: Re: to Doc Holiday-DELAYED response
>
>
> Whilst I completely agree that we trainees are not being exposed to
enough
> workload (48 hours! Are they mad??), I would also like to remind you
that
> no
> athlete trains 80 hours a week (no matter how serious they are about
their
> performance) and high performing athletes are well aware of the risk
of
> overtraining.
> Meaning that surely there must be a happy medium that doesn't mean we
live
> in a complete state of tiredness which, I believe, has been proven
time and
> again to lead to incidents of varying degrees of severity.
>
>
> Best wishes from across the pond
>
>
>
> Andre de Castro Carneiro
> Specialist Registrar
> Anaesthetics and Critical Care
> The Leeds Teaching Hospitals NHS Trust
>
> 2009/5/6 Jose Luis Danguilan <jdanguilan at gmail.com>
>
> > I fully agree with Dr. Gross. We seem to baby the new generation of
> > surgical
> > residents. Hard work has never killed anyone. Fire makes steel
strong in
> > the
> > same way challenges toughen a person or did I get my metaphors mixed
up?
> >
> > A fellow triceratops,
> >
> > Jose Luis J. Danguilan, MD
> > Manila, Philippines
> >
> > On Wed, May 6, 2009 at 7:26 PM, Gross, Ronald <
> > Ronald.Gross at baystatehealth.org> wrote:
> >
> > > And when you finally finish your truncated 5 year surgical
residency,
> > with
> > > protected educational time, sleep time and no more that 80 hours
per
> > week,
> > > and you have to go out into the REAL world, will your patients
> understand
> > > that you need to go home now 'cause you're sleepy, and someone
they
> have
> > > never seen will be caring for them?
> > >
> > > Athletes learn endurance by working harder and longer in their
workouts
> > > then they have to do in the "real deal".  Our stakes are FAR
higher
> than
> > any
> > > athletes' stakes, and yet we are failing to teach our residents
the
> > expanse
> > > of knowledge they will need, and we are failing to prepare them
for the
> > real
> > > world, where there isn't protected education time, and guaranteed
sleep
> > > time.
> > >
> > > I know, my wife has told me on several occasions that I am a
dinosaur.
> >  She
> > > is probably right.....but this dinosaur has been true to his
calling,
> and
> > > will never stop being fully responsible for the care of his
patients -
> > all
> > > the time!
> > >
> > > (OOPS, need to take a nap now.  Worked too long.........)
> > >
> > > Best to you all,
> > > Ron
> > >
> > >
> > >
> > > -----Original Message-----
> > > From: trauma-list-bounces at trauma.org [mailto:
> > > trauma-list-bounces at trauma.org] On Behalf Of khumar huseynova
> > > Sent: Tuesday, May 05, 2009 4:50 PM
> > > To: trauma-list at trauma.org
> > > Subject: to Doc Holiday-DELAYED response
> > >
> > > Dr Holiday, sorry for retarded response-just read your note on
resident
> > > hours (March). Thanks and yes, you are right, there is evidence
that
> long
> > > hours result in reduced effciency and eventual harm to the
patient. I
> > dont
> > > think I will ever agree witht eh 48hr/wk schedule for SURGERY
> > residents-it
> > > has to be MORE than that. Am not saying 120hrs, but should be
> reasonable
> > > enough to get suffucuent experience and not to feel 'dead' at the
end
> of
> > the
> > > day. Maybe someone needs to design a study to determine the
cutoff...
> > > And you are right, there are perhaps other ways of increasing the
> quality
> > > of residency without making the hours too long as well. The
problem is,
> > > given how conservative the health care system is, it will take
decades
> to
> > > change it.
> > > Cheers. KH
> > >
> > >
> > >
> > >
__________________________________________________________________
> > > Get a sneak peak at messages with a handy reading pane with All
new
> > Yahoo!
> > > Mail: http://ca.promos.yahoo.com/newmail/overview2/
> > > --
> > > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > > To change your settings or unsubscribe visit:
> > > http://www.trauma.org/index.php?/community/
> > >
> > >
----------------------------------------------------------------------
> > > CONFIDENTIALITY NOTICE: This email communication and any
attachments
> may
> > > contain confidential and privileged information for the use of the
> > > designated recipients named above. If you are not the intended
> recipient,
> > > you are hereby notified that you have received this communication
in
> > error
> > > and that any review, disclosure, dissemination, distribution or
copying
> > of
> > > it or its contents is prohibited. If you have received this
> communication
> > in
> > > error, please reply to the sender immediately or by telephone at
(413)
> > > 794-0000 and destroy all copies of this communication and any
> > attachments.
> > > For further information regarding Baystate Health's privacy
policy,
> > please
> > > visit our Internet web site at http://www.baystatehealth.com <http://www.baystatehealth.com/> .
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>
> ------------------------------
>
> Message: 8
> Date: Thu, 7 May 2009 06:49:20 -0400
> From: "Gross, Ronald" <Ronald.Gross at baystatehealth.org>
> Subject: RE: to Doc Holiday-DELAYED response
> To: "'Trauma and Critical Care mailing list'" <trauma-list at trauma.org>
> Message-ID:
>        <FD2BE6867A90F543AAD02E429F878633013B1FBC0BCB at bhsexc11.bhs.org>
> Content-Type: text/plain; charset="us-ascii"
>
> You got 'em spot on!
>
> Ron
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org] On Behalf Of Jose Luis Danguilan
> Sent: Wednesday, May 06, 2009 4:24 PM
> To: Trauma and Critical Care mailing list
> Subject: Re: to Doc Holiday-DELAYED response
>
> I fully agree with Dr. Gross. We seem to baby the new generation of
> surgical
> residents. Hard work has never killed anyone. Fire makes steel strong
in
> the
> same way challenges toughen a person or did I get my metaphors mixed
up?
>
> A fellow triceratops,
>
> Jose Luis J. Danguilan, MD
> Manila, Philippines
>
> On Wed, May 6, 2009 at 7:26 PM, Gross, Ronald <
> Ronald.Gross at baystatehealth.org> wrote:
>
> > And when you finally finish your truncated 5 year surgical
residency,
> with
> > protected educational time, sleep time and no more that 80 hours per
> week,
> > and you have to go out into the REAL world, will your patients
understand
> > that you need to go home now 'cause you're sleepy, and someone they
have
> > never seen will be caring for them?
> >
> > Athletes learn endurance by working harder and longer in their
workouts
> > then they have to do in the "real deal".  Our stakes are FAR higher
than
> any
> > athletes' stakes, and yet we are failing to teach our residents the
> expanse
> > of knowledge they will need, and we are failing to prepare them for
the
> real
> > world, where there isn't protected education time, and guaranteed
sleep
> > time.
> >
> > I know, my wife has told me on several occasions that I am a
dinosaur.
>  She
> > is probably right.....but this dinosaur has been true to his
calling, and
> > will never stop being fully responsible for the care of his patients
-
> all
> > the time!
> >
> > (OOPS, need to take a nap now.  Worked too long.........)
> >
> > Best to you all,
> > Ron
> >
> >
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org [mailto:
> > trauma-list-bounces at trauma.org] On Behalf Of khumar huseynova
> > Sent: Tuesday, May 05, 2009 4:50 PM
> > To: trauma-list at trauma.org
> > Subject: to Doc Holiday-DELAYED response
> >
> > Dr Holiday, sorry for retarded response-just read your note on
resident
> > hours (March). Thanks and yes, you are right, there is evidence that
long
> > hours result in reduced effciency and eventual harm to the patient.
I
> dont
> > think I will ever agree witht eh 48hr/wk schedule for SURGERY
> residents-it
> > has to be MORE than that. Am not saying 120hrs, but should be
reasonable
> > enough to get suffucuent experience and not to feel 'dead' at the
end of
> the
> > day. Maybe someone needs to design a study to determine the
cutoff...
> > And you are right, there are perhaps other ways of increasing the
quality
> > of residency without making the hours too long as well. The problem
is,
> > given how conservative the health care system is, it will take
decades to
> > change it.
> > Cheers. KH
> >
> >
> >
> >
__________________________________________________________________
> > Get a sneak peak at messages with a handy reading pane with All new
> Yahoo!
> > Mail: http://ca.promos.yahoo.com/newmail/overview2/
> > --
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> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> >
----------------------------------------------------------------------
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> > you are hereby notified that you have received this communication in
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> > and that any review, disclosure, dissemination, distribution or
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> of
> > it or its contents is prohibited. If you have received this
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> in
> > error, please reply to the sender immediately or by telephone at
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> > 794-0000 and destroy all copies of this communication and any
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> > visit our Internet web site at http://www.baystatehealth.com <http://www.baystatehealth.com/> .
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> > To change your settings or unsubscribe visit:
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> >
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>
>
> ------------------------------
>
> Message: 9
> Date: Thu, 7 May 2009 06:55:25 -0400
> From: "Gross, Ronald" <Ronald.Gross at baystatehealth.org>
> Subject: RE: to Doc Holiday-DELAYED response
> To: "'Trauma and Critical Care mailing list'" <trauma-list at trauma.org>
> Message-ID:
>        <FD2BE6867A90F543AAD02E429F878633013B1FBC0BCD at bhsexc11.bhs.org>
> Content-Type: text/plain; charset="us-ascii"
>
> >no athlete trains 80 hours a week<
>
> Correct....and no athlete is responsible for anyones' lives but their
own.
>
> We are growing a new breed of physician - and they are apparently
happy to
> accept the shift work mentality.  Along with that goes the concept
that once
> they leave the hospital they have given up all of their
responsibilities
> until they return.
>
> Sad.  Very sad.  And scary, 'cause that same person is going to be
caring
> for YOU and ME one day, but only 8 hours at a time..........IF we are
lucky
> enough!
>
> Signed,
> The Dinosaur
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:
> trauma-list-bounces at trauma.org] On Behalf Of Andre Carneiro
> Sent: Wednesday, May 06, 2009 4:38 PM
> To: Trauma and Critical Care mailing list
> Subject: Re: to Doc Holiday-DELAYED response
>
> Whilst I completely agree that we trainees are not being exposed to
enough
> workload (48 hours! Are they mad??), I would also like to remind you
that
> no
> athlete trains 80 hours a week (no matter how serious they are about
their
> performance) and high performing athletes are well aware of the risk
of
> overtraining.
> Meaning that surely there must be a happy medium that doesn't mean we
live
> in a complete state of tiredness which, I believe, has been proven
time and
> again to lead to incidents of varying degrees of severity.
>
>
> Best wishes from across the pond
>
>
>
> Andre de Castro Carneiro
> Specialist Registrar
> Anaesthetics and Critical Care
> The Leeds Teaching Hospitals NHS Trust
>
> 2009/5/6 Jose Luis Danguilan <jdanguilan at gmail.com>
>
> > I fully agree with Dr. Gross. We seem to baby the new generation of
> > surgical
> > residents. Hard work has never killed anyone. Fire makes steel
strong in
> > the
> > same way challenges toughen a person or did I get my metaphors mixed
up?
> >
> > A fellow triceratops,
> >
> > Jose Luis J. Danguilan, MD
> > Manila, Philippines
> >
> > On Wed, May 6, 2009 at 7:26 PM, Gross, Ronald <
> > Ronald.Gross at baystatehealth.org> wrote:
> >
> > > And when you finally finish your truncated 5 year surgical
residency,
> > with
> > > protected educational time, sleep time and no more that 80 hours
per
> > week,
> > > and you have to go out into the REAL world, will your patients
> understand
> > > that you need to go home now 'cause you're sleepy, and someone
they
> have
> > > never seen will be caring for them?
> > >
> > > Athletes learn endurance by working harder and longer in their
workouts
> > > then they have to do in the "real deal".  Our stakes are FAR
higher
> than
> > any
> > > athletes' stakes, and yet we are failing to teach our residents
the
> > expanse
> > > of knowledge they will need, and we are failing to prepare them
for the
> > real
> > > world, where there isn't protected education time, and guaranteed
sleep
> > > time.
> > >
> > > I know, my wife has told me on several occasions that I am a
dinosaur.
> >  She
> > > is probably right.....but this dinosaur has been true to his
calling,
> and
> > > will never stop being fully responsible for the care of his
patients -
> > all
> > > the time!
> > >
> > > (OOPS, need to take a nap now.  Worked too long.........)
> > >
> > > Best to you all,
> > > Ron
> > >
> > >
> > >
> > > -----Original Message-----
> > > From: trauma-list-bounces at trauma.org [mailto:
> > > trauma-list-bounces at trauma.org] On Behalf Of khumar huseynova
> > > Sent: Tuesday, May 05, 2009 4:50 PM
> > > To: trauma-list at trauma.org
> > > Subject: to Doc Holiday-DELAYED response
> > >
> > > Dr Holiday, sorry for retarded response-just read your note on
resident
> > > hours (March). Thanks and yes, you are right, there is evidence
that
> long
> > > hours result in reduced effciency and eventual harm to the
patient. I
> > dont
> > > think I will ever agree witht eh 48hr/wk schedule for SURGERY
> > residents-it
> > > has to be MORE than that. Am not saying 120hrs, but should be
> reasonable
> > > enough to get suffucuent experience and not to feel 'dead' at the
end
> of
> > the
> > > day. Maybe someone needs to design a study to determine the
cutoff...
> > > And you are right, there are perhaps other ways of increasing the
> quality
> > > of residency without making the hours too long as well. The
problem is,
> > > given how conservative the health care system is, it will take
decades
> to
> > > change it.
> > > Cheers. KH
> > >
> > >
> > >
> > >
__________________________________________________________________
> > > Get a sneak peak at messages with a handy reading pane with All
new
> > Yahoo!
> > > Mail: http://ca.promos.yahoo.com/newmail/overview2/
> > > --
> > > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > > To change your settings or unsubscribe visit:
> > > http://www.trauma.org/index.php?/community/
> > >
> > >
----------------------------------------------------------------------
> > > CONFIDENTIALITY NOTICE: This email communication and any
attachments
> may
> > > contain confidential and privileged information for the use of the
> > > designated recipients named above. If you are not the intended
> recipient,
> > > you are hereby notified that you have received this communication
in
> > error
> > > and that any review, disclosure, dissemination, distribution or
copying
> > of
> > > it or its contents is prohibited. If you have received this
> communication
> > in
> > > error, please reply to the sender immediately or by telephone at
(413)
> > > 794-0000 and destroy all copies of this communication and any
> > attachments.
> > > For further information regarding Baystate Health's privacy
policy,
> > please
> > > visit our Internet web site at http://www.baystatehealth.com <http://www.baystatehealth.com/> .
> > > --
> > > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > > To change your settings or unsubscribe visit:
> > > http://www.trauma.org/index.php?/community/
> > >
> > --
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> > http://www.trauma.org/index.php?/community/
> >
> >
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> http://www.trauma.org/index.php?/community/
>
>
> ------------------------------
>
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--
The one important thing I have learned over the years is the difference
between taking one's work seriously and taking one's self seriously. The
first is imperative and the second is disastrous.
Margot Fonteyn
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