Letters to the Editor - Aug. 22/29, 2005

Growing pains worth the effort in reducing resident work hours - Return from retirement? Enjoy your life and don't even consider it - Corporate stipend gratefully recalled, but did not influence prescribing

Growing pains worth the effort in reducing resident work hours

Regarding "The 80-hour experience: What happens when residents have to leave" (Article, July 25): New work restrictions for residents are an important first step in physicians practicing what they preach (safety, balanced lifestyle, etc.).

However, they also demand a tremendous paradigm shift. For decades, the process of training physicians was unchanged, while the science and practice of medicine evolved rapidly. Physicians who are wary of the changes are quick to point out that the old system worked, but without anything to compare it with, their argument is weak.

Older physicians argue that continuity of patient care suffers as residents turn over their patients to other residents after the required 30 hours (do any residents really leave the hospital after 24?). This, too, is a bogus point. Patient turnover (to oncoming call teams, colleagues or other services) has always been a necessary part of hospital practice.

In my experience, a great deal of the "patient continuity" at 1 p.m. on my post-call day involves mindless administrative work -- such as setting up physical therapy or writing a discharge summary -- that few would describe as a quality learning experience.

I have trained under both the old and new systems and see both sides of the issue. However, I can honestly say that I did not learn more when I was working 120 hours per week than when I work 80. Rather, I have found that, since I am better rested, I am more eager to read and study. I also can concentrate better on rounds and listen more effectively during lectures. Most important, I find myself more eager to spend quality time with my patients.

For many residents, the old system created a degree of animosity toward patients. Residents frequently viewed them as the enemy, something keeping them from sleeping or even just sitting down for a few minutes. I've seen this attitude extend beyond residency and affect attending physicians, often resulting in early burnout and potential attrition from our ranks at a time when a physician shortage is imminent. I maintain that well-rested physicians are more likely to treat patients enthusiastically and compassionately while they relish the profession they set out to master.

Having said that, residents agree that long hours are a necessary evil, and the best way to learn medicine is to see as many patients as possible. Undoubtedly there will be growing pains as programs struggle to replace the work and cases lost by fewer resident hours. And surgical specialties that rely on building caseloads for procedures clearly have the most challenge.

But considering that the rest of the working world wonders how physicians can see an 80-hour work week as an improvement, it's good to see the medical community finally admitting that sleep deprivation is just as harmful for us as it is for an airline pilot or truck driver. After all, what would you say to your patient who works frequent triple shifts, experiences excessive daytime somnolence, has a poor diet, rarely exercises and has no time for any personal pursuits?

--Fernando Leyva, MD, Pensacola, Fla.

Return from retirement? Enjoy your life and don't even consider it

Regarding "Retrain retired doctors to avert future physician shortage" (Letters, July 18): Retired doctors would have to be nuts to go back into practice these days. It is not about retraining them.

Most retired docs enjoyed reasonable reimbursements for their services. Why come back out of retirement when an orthopedic surgeon is lucky to get $1,500 for a $6,000 knee replacement?

Those of us who are working in this business are commodities working at leveraged contracts for managed care, and even, although debatably, as if employees for the federal government. We have leveraged debt that requires we continue to work, kids who are not yet out of school, and many of us with student loans that have not been paid off, not because we don't want to but because it simply is not economical -- we have to finance everything!

My advice to retired physicians: Stay out of this nightmare and enjoy the rest of your life while you still can, before someone passes a law making you go back to work. (Yes, at this point, it would not shock me to learn that they find a way to put a virtual gun to your head to make you work in this business for these appalling rates.)

--Daniel J. D'Arco, MD, Pottsville, Pa.

Corporate stipend gratefully recalled, but did not influence prescribing

Regarding "Drug firms to fund residency slots in dermatology pilot program" (Article, July 18): In 1960, I received a Wyeth Pediatric Scholarship of $200 per month, for two years, for residency training at the Philadelphia Children's Hospital. This money was awarded for need, since I had two infant children and was partially supporting my widowed mother.

I am grateful to Wyeth for helping to support me during my residency training. There were no strings attached. I do not feel obligated to prescribe Wyeth products because of their generosity to me at a time of need. I see no reason why pharmaceutical companies cannot help support residents during their training.

--Gilbert A. Friday Jr., MD, Pittsburgh