Letters to the Editor - Aug. 14, 2006

Resident nap rooms shouldn't be shared, and especially not be coed - Resident nap study should not be used to make case for longer hours

Resident nap rooms shouldn't be shared, and especially not be coed

Regarding "Study shows naps improve residents' alertness on call" (Article, July 17): Your recent article is interesting, including the accompanying photograph. In this picture of a call room, there is a set of bunk beds with one trainee (a woman) sleeping while another trainee (a male) is sitting in front of a computer terminal. This may be for illustrative purposes only, but it does point out a number of problems in many institutions where physicians are expected to sleep and/or nap.

First, when multiple individuals share beds in the same room, especially if these are bunk beds, no one is likely to get much rest. Either person getting paged or called will disturb the other, in addition to the obvious fact that whoever has to climb to or from the top bunk will likely bother the individual on the bottom.

Furthermore, in an era of greater sensitivity to issues of sexual impropriety, it is not ideal for co-workers to be assigned to sleep in the same room, especially if they are of different genders. While many individuals would not openly complain about this, institutions should provide private call rooms for trainees and staff. The days should be gone when these kinds of accommodations are considered acceptable, and private rooms for patients (for several additional reasons) should also be the goal of modern hospitals.

--Mark A. Rockoff, MD, Boston

--David B. Waisel, MD, Boston

Resident nap study should not be used to make case for longer hours

I became increasingly disappointed as I read the AMNews article on a study that concluded that naps improve resident's alertness on call. As a recent graduate from a primary care residency program, it strains credulity that the reality of contemporary residency training is seemingly unrecognized (Article, July 17).

The lead author of this study speculated that the 30-hour on-call limit could be extended if naps are included. However, I believe the conclusions of this study lend uncompromising support to the continuing improvement of resident working hours.

Many who demand extension of the working hours (i.e. a return to the past) suggest such hours are a necessity for patient care. This is disingenuous at best. Working 80 or more hours a week is an abnormal endeavor that results in an inefficient and dangerous decline in functional acuity.

Many of those who suggest otherwise have lost touch with the reality of residency as it is today. The increasing numbers of complex patients with multiple comorbidities and the concomitant avalanche of paperwork alone progressively eclipse the core purpose of residency.

Residency should be perceived as a protected, unique period dedicated to clinical education and transformation of medical school graduates into humane and compassionate physicians. It must not be construed as an opportunity for indentured abuse of trainee physicians.

--Scott A. Weinstein, MD, PhD, Bayside, N.Y.