Letters to the Editor - Jan. 17, 2000.

An 81-hour work week for surgical residents? Not very likely, based on his experience - "Paperwork has become more important than the human being" - Too much potential for physician labs to serve interests of the doctor and not of the patient

An 81-hour work week for surgical residents? Not very likely, based on his experience

Regarding "Closer watch on residents' hours urged" (Article, Dec. 6, 1999): I always find it interesting when I see the reports of the average number of hours the different medical and surgical specialty residents work per week. The reported average hours that intrigue me the most are the 81 average hours for surgery residents and the 76 average hours for ob-gyn residents.

When I completed my surgery intern year, I do not recall ever working less than 100 hours per week. Many times the hours were 110 per week and more, and I felt that I was in a relatively "benign" surgical program. The ob-gyn residents shared the same hours we did. Many of my friends, who are in general surgery residency programs, also report regularly working more than 100 hours per week.

Who exactly was surveyed for this information, the residents or the program directors? I cannot fathom a surgical program where residents work an average of 81 hours per week. I know the issue of residents' hours is a controversial subject and one that has been debated for many years, but I felt that this mention of an average 81-hour work week severely did injustice to the many (the majority of) surgical residents who slave away in hospitals for the purpose of becoming well-trained surgeons. Ask the residents and I am sure you will find a different story. --Allan Couch, MD Lexington, Ky.
Editor's note: The figures reported in this story were contained in an AMA survey of graduate medical education programs. Data were supplied by program directors.

"Paperwork has become more important than the human being"

Regarding "AMA president calls 1999 a banner year for advocacy" (Article, Dec. 20, 1999): I love the paragraph in this article about physicians taking back the driver's seat in shaping health care. It is way past time for the insurance companies and government bureaucracies to realize that their incomes and salaries come from the people who actually see and care about the real patients.

We are not all crooks, trying to defraud the system. The majority of medical personnel do really care about the whole patient.

If the insurance companies and the federal government would spend a few dollars on actually communicating with real patients, there would be a much better gauge of the degree and quality of care being given. If the patient gets short-changed, it's because the paperwork has become more important than the human being!

The more administrative a medical person becomes, the further away he or she is from the reason medical professions even exist; the element of the human connection dies. The goal depreciates into rules, paperwork and money.

Hurrah and hallelujah that something is finally being spoken about and dealt with out loud at a level where results can occur. Thank you very much, AMA and AMA President Dr. Reardon. --Mary L. Grabski, RN Florence, Wis.

Too much potential for physician labs to serve interests of the doctor and not of the patient

I have a bone to pick with your article entitled "Lab allure" (Article, Dec. 13, 1999). Office laboratories have certainly proliferated in the last 15 years, with many office laboratories rivaling and even exceeding hospital laboratories. Some group practices engage in very esoteric tests, all justified under the umbrella of patient satisfaction, patient convenience, accuracy, in the name of good medicine, etc. I suspect that the underlying reason is primarily for profit and convenience of the physician, as many office laboratories operate within a few feet to a few blocks of a hospital laboratory.

If the laboratories are truly in the interest of better patient care, why would the article state that laboratory-ordering patterns could be used to get discounts from the suppliers (I doubt if the discounts are passed on to the patients) and also to exercise cherry-picking on test selection based on whether there is sufficient profit. Since it is very easy to transport specimens, I cannot buy the argument of patient inconvenience.

I just feel that there is too much potential for abuse when a physician, in his office, has a laboratory that profits from volume and he is in charge of generating the volume. There is nothing wrong with reasonable profits, to be sure, but in my opinion, human nature is truly put to the test when you stand to profit from ordering tests performed in your own laboratory. --T.S. Whittle, MD Galax, Va.