Studies: Rules Don't Yield Rest for Medical Interns

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Rules intended to limit the work hours of doctors in training are being routinely violated, according to one study. Another says young doctors working long hours are at increased risk of injuring themselves with needles or scalpels.

ROBERT SIEGEL, host:

Rules intended to limit the work hours of doctors in training are routinely being violated. And those young doctors working long hours are at dramatically increased risk of sticking themselves with a needle or getting cut by a scalpel.

NPR's Julie Rovner reports on the results of two new studies.

JULIE ROVNER: Three years ago, the accrediting body for doctor training opposed nationwide work hour restrictions for interns and residents. The rules generally limit individual shifts to no more than 30 straight hours and the total workweek to no more than 80 hours. The popular primetime series Grey's Anatomy even based an episode around the rules earlier this year.

(Soundbite of television show, Grey's Anatomy)

Unknown Actor: Dr. Yang, you need to leave this O.R.

Ms. SANDRA OH (Actress): (As Dr. Cristina Yang) Excuse me?

Unknown Actor: You've exceeded your 80 hour limit for the week. You have to leave the hospital.

Ms. OH: Ok. Um, um, as soon as the (unintelligible) are dissected out.

Unknown Actor: Dr. Yang, now.

ROVNER: But like most everything else on the show, adherence to the 80 hour work week is pretty much fiction, according to the new study.

Mr. CHRISTOPHER LANDRIGAN (Harvard Work Hours Health and Safety Group): What we found is that 84 percent of interns nationwide were not compliant with the new standards.

ROVNER: Christopher Landrigan is with the Harvard Work Hours Health and Safety Group and lead author of the study in this weeks Journal of the American Medical Association. While the study followed residents only during the first year of the new rules, Landrigan says his impression is that many are still working longer hours than the rules permit.

Mr. LANDRIGAN: There was somewhat of a trend towards improved compliance with the work hours over the course of the year, but the trend was pretty modest.

ROVNER: The study's findings are based on confidential surveys with more than 1,000 residents. They appear to contradict data gathered by the Accreditation Council for Graduate Medical Education, which wrote and oversees the work hour requirements. It has reported that upwards of 95 percent of residents comply with the work rules. But David Leach, the group's executive director, says the council has not been shy about enforcement.

Mr. DAVID LEACH (Accreditation Council for Graduate Medical Education): We have in the last year withdrawn accreditation of 92 programs. We have about an 8 percent adverse action rate, which means probation. So we're putting inexorable pressure on the programs to comply with duty hours.

ROVNER: But academics say violations are vastly underreported to the agency, because to do so threatens residents' own careers. Troy Madsen is one of the few who has come forward. After graduating from Johns Hopkins in Baltimore, he started as an intern there in emergency medicine just as the new rules were supposed to take effect.

When his first schedule clearly violated the rules, he contacted the accreditation council. They promised to protect his identity, but the details of his accusations made it clear who he was. The reaction was such that Madsen ultimately had to transfer to another hospital to complete his residency. He says some of the angriest attacks came from his fellow residents, who were told -

Dr. TROY MADSEN (Johns Hopkins graduate): You know, as a result of this you may not be able to get a job. You may not be able to go on for fellowships because we won't be accredited.

ROVNER: Another problem is the culture of academic medicine. Older doctors say if they managed to work long shifts while they were in training, today's residents should be able to do the same thing. But Landrigan says things have changed from the days when doctors couldn't do that much for patients so they actually could sleep while on duty.

Mr. LANDRIGAN: As the intensity of care in hospitals has increased, the amount of time that doctors in hospitals are required to be awake in order to perform emergency interventions has gone up and up, such that on average they're only obtaining about 2.6 hours of sleep per night in the hospital now.

ROVNER: And other research has shown that's dangerous to everyone involved. Charles Czeisler is a Harvard sleep expert.

Mr. CHARLES CZEISLER (Harvard University): We know that the functioning of the brain is impaired by extended durations without sleep. In fact after 24 hours, the impairment is equivalent to that induced by three shots of whiskey taken over the course of an hour.

ROVNER: Previous studies have found that residents who work without sleep are five times more likely to make a medical mistake and twice as likely to be in a car accident driving home. Czeisler is one of the authors of a study also in this week's JAMA that uncovered yet another danger.

Mr. CZEISLER: What we found was that when an intern is working more than 20 consecutive hours, their risk of stabbing themselves with a needle or a scalpel while caring for a patient, the odds of that happening are 61 percent higher than when they're working for less than 12 consecutive hours.

ROVNER: Czeisler says that given the scientific evidence on sleep deprivation, there's no reason doctors shouldn't be subject to the same sorts of work hour restrictions as truck drivers and airline pilots. In fact, he thinks doctors should be required to tell patients if they haven't gotten a minimum amount of sleep in the previous 24 hours.

Julie Rovner, NPR News.

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