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Mon May 11 19:57:32 BST 2009

Can I politely ask therefore that we please stop using the "handover
is
dangerous" argument to justify/rationalise another dangerous practice?
Maybe the "long hours people" (including me, although I working on a
cure or
at least palliation ;-) ) need to admit we do it because we want to do
it,
or at least we want to do it too much to be able to achieve the
alternatives.

Regards

Bill 

A/Prof William Griggs AM
Director Trauma Services
Royal Adelaide Hospital
william.griggs at health.sa.gov.au

Bill, 

Handoffs ARE dangerous and they do go up under a policy of more doctors
working more frequent shifts. This is not an opinion, it's math and
data. That being said, my argument is that they are instituting changes
in systems that they don't understand, with no attempt to study the
effects thereof and no recognition that with either potential or real
benefits that there are potential and real downsides.

Because no one in "power" will admit that there are any down sides to
limiting work hours, there is no RRC committee level recommendations on
how to mitigate this; there is no recognition that more manpower is
necessary, and there is a willful blindness to problems that occur due
to this poorly instituted change in practice.

IMO these problems include:
1. More handoffs, poorly handled
2. Less resident education — no, they're not reading more, not doing
more research, not performing community service. While they are indeed
enjoying life and family more (here in Savannah — beach, drinking, and
really good food), their ABSITE scores are not improving, nor is their
understanding of basic science. This is seen across the board and at
many institutions as far as I can tell. While their caseloads remain
nearly unchanged, this means that all the other stuff that makes up a
surgical education has gone somewhere.
3.  Piss poor professionalism. When you're able to walk out of the
hospital at a specific time and have no further responsibility until you
walk in the next day it breeds a "not my problem" mentality that clearly
has infested a good proportion of the residents with which I interact. 
4. Rampant inefficiency — when you stay until the work gets done, the
work gets done ASAP. When you can hand the work over to the next guy
it's amazing how long it takes (see also OR turnover times). 

All of these things MAY have a solution, but cramming new work rules
into place and telling each residency program to figure it out for
themselves is not working as far as I can see.

Unless there is some new method of education, I for one will not sign
off on a resident's qualification to be an attending surgeon in
unsupervised practice after if the hour limits go down to 60 hours and
the length of residency training does not go up.

Bill Bromberg

William J. Bromberg, MD, FACS
Savannah Surgical Group
912 350-7412

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"Handovers are dangerous" so I never go home or go on leave...