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Physician, Heal Thy System

My former boss, Charlie Peters of Washington Monthly fame, has long been known for the many pet issues he likes to rant about. (And trust me: The man can rant.) Among these is the completely insane physician-training system in which residents are forced to work endless, sleepless shifts more appropriate to Gitmo than a responsible medical facility concerned with the welfare of its patients. (Click here for just one of the Monthly's many pieces on the issue.) I mean, if there's anyone you don't want falling asleep on her feet or making exhaustion-induced errors, it's the person who holds your fricking life in her hands, right? 

So I was heartened to see the WaPo's tidbit on this latest recommendation by the Institute of Medicine's calling for shorter shifts, mandatory sleep-breaks, and better supervision of interns. Of course, while setting stricter limits is all well and good, the real key will be enforcement. The medical establishment isn't clueless. It's well aware that the current system is crummy, and some restrictions are already in place. But those restrictions are routinely violated. (For instance, a 2005 survey of residents at Vanderbilt University Medical Center found that 85 percent had violated the existing 30-hour shift limit.) Unless hospitals get serious about making clear that the deeply entrenched treat-the-newbies-like-dirt culture is no longer acceptable, the situation isn't likely to improve anytime soon. (Think about that, all you Baby Boomers staring down the barrel of old age and all the health issues that accompany it.)

I understand the macho, trial-by-fire, if-you-can-survive-this-you-can-survive-anything appeal of the current system (or at least the appeal it holds for those on the far side of such hazing). And I realize that driving young doctors to the breaking point has its financial advantages. But both common sense and research suggest it's a lousy arrangement for patients and physicians alike.

--Michelle Cottle