Posted by: Salvatore J. Zambri, founding member and partner
“One of the oldest debates in the education of physicians is whether they learn best when subjected to brutally long and difficult working conditions, whether their patients have a right to know about it, and whether physicians and patients can be kept safe,” according to a recent Washington Post article.
As reported by the Washington Post, a new project partly funded by the National Institutes of Health is reversing a mandate from 2011 that banned 30-hour shifts for first-year, inexperienced doctors out of concern that sleep-deprived doctors could make deadly mistakes. This research study is attempting to study how to minimize the risks inherent with handoffs from doctor to doctor while trading for another set of risks associated with exhausted, sleep-deprived doctors. Before beginning the study, researchers sought approval from the ethics panel at the University of Pennsylvania, leaders of the research, which indicated that the risk was minimal to patients and new doctors, concluding that hospitals did not have to notify either the patients nor the doctors involved.
According to the Public Citizen’s Health Research Group, “it seems both patients and doctors have to be involved [in consenting], and both patients and doctors need to be able to opt out.” Conversely, the research is strongly endorsed by the Hasting Center, a nonpartisan research institute that studies ethical questions in health care. “We haven’t really studied whether [restrictions on work hours] made a difference or not, not in this kind of rigorous way. And I think we need to find out.”
Details of the current study:
- “The study involves 6,000 internal medicine trainees at 63 programs across the country. About 2,400 are first-year physicians. The rest are second- and third-year doctors. It began July 1 with the incoming crop of residents, with results expected in 2019. It is similar to a year-long study of longer work days for new surgeons that concluded in June.
- In the current study, 31 programs will stick to current rules on resident work hours. Along with the 16-hour limit for first-year trainees, second- and third-year doctors are restricted to 24 consecutive hours of work. Residents may not work more than 80 hours a week, must have one day off every seven days and may not work overnight more often than every three days — all averaged over one month.
- In the other 32 programs, directors who schedule residents’ work hours must observe most of those rules. But they can allow the young doctors to work as long as 30 hours consecutively or, in rare cases, even more.”
The 2011 restriction on 30-hour shifts for all trainees resulted from a study by the prestigious Institute of Medicine. Afterwards, the Accreditation Council for Graduate Medical Education “banned 30-hour work shifts for all trainees and prohibited first-year physicians from working more than 16 hours consecutively, with a few minor exceptions.”
“Duty hour rules were born out of a concern for patient safety. . . . But the pushback is they have greatly increased handoffs,” said David Asch, director of the Center for Health Care Innovation at the University of Pennsylvania’s school of medicine and the study’s lead researcher. “And we already know that handoffs affect patient safety.”
A significant part of the rationale in beginning this particular research is that the most important medicine for a patient happens within the first 36 hours after admission and allowing a resident to follow a case through that time period is better for both the trainee and the patient. Results of the study are not expected to be available until 2019. If the final results show no impact on patient health and safety, a request to reverse the work-hour restriction will likely be submitted to Accreditation Council for Graduate Medical Education.
If airplane pilots, truck drivers and other professionals are rightly prevented from working excessive consecutive hours, why is there such a push to increase the number of hours that doctors work? Are teaching hospitals actually helping residents or patients with these punishing schedules? Should patients and residents at least be notified that they are part of this research? Numerous studies on sleep-deprivation have shown that performance of any task decreases after the body and mind are too tired to react. Patient safety should come first.
About the author:
Mr. Zambri is a board-certified civil trial attorney by the National Board of Trial Advocates and a Past-President of the Trial Lawyers Association of Metropolitan Washington, D.C. The association recently named him “Trial Lawyer of the Year”. Super Lawyers recently named him among the “Top Ten” lawyers in the Metro Area (out of more than 80,000 attorneys). He has been rated by Washingtonian magazine as a “Big Gun” and among the “top 100″ lawyers in the entire metropolitan area. The magazine also describes him as “one of Washington’s best–most honest and effective lawyers” who specializes in personal injury matters, including automobile accident claims, premises liability, product liability, medical malpractice, and work-accident claims. He has successfully litigated multiple cases against truck and bus companies, the Washington Metropolitan Area transit Authority, and other automobile owners. His law firm, in fact, has obtained the largest settlement ever in a personal injury case involving WMATA. Mr. Zambri has also been acknowledged as one of “The Best Lawyers in America” by Best Lawyers (2014 edition) and has been repeatedly named a “Super Lawyer” by Super Lawyer magazine (2014) — national publications that honor the top lawyers in America.
If you have any questions about your legal rights, please email Mr. Zambri at email@example.com or call him at 202-822-1899.