December 3rd, 2008
Should hospitals feature a rectory?
The headline on the sleep-deprivation of medical residents is a bit misleading. (Is Scrubs the new Cheers? Some think so.)
The Institute for Medicine is not suggesting that residents work less than the 80 hours per week they now put in.
The cost of that would break most hospitals, which depend on the indentured servitude of newly-minted doctors to keep their operations going at anything near break-even.
What they seem to be suggesting instead is that hospitals give new doctors what my old Catholic church called a rectory. That is, a simple, spartan place to sleep, on campus, supervised by mature hands.
In other words make residents into real residents.
How else are you to meet the report’s main goals, namely to restrict resident moonlighting, guarantee rest periods, and assure closer supervision.
For married residents, especially those with children, this is going to be an enormous burden. The in-hospital rectory would operate during the current 80-hour “time in” period.
It has to be more than a cot in a closet. It has to be a comfortable space with a modicum of privacy that assures the resident stays rested. Maybe some Japanese-style “tubes” next to a shared room staffed by nurses, psychologists or recent residents? And with very nice showers?
The rectory facility could also house an office where those coming on shift could be briefed on the patients they’re taking over. These briefings could also be supervised. Hand-offs are where most mistakes happen, the report said.
The committee estimates that spending $1.7 billion each year (less than .5% of the current Medicare budget) would save thousands of lives now lost to mistakes.
This is where lawyers can help. Everyone agrees that similar rules put in place in 2003 are routinely violated. So next time someone dies due to an error made by a tired scrub, sue the hospital out the wazoo.
By making sleep deprivation an issue in court, we can force hospitals to do something guaranteeing the doctor who sees Aunt Martha isn’t out on their feet, and thus likely to make a mistake that might kill her.
Or that said doctor doesn’t leave work so exhausted they crash into your car on the way home, killing you both.
Dana Blankenhorn has been a business journalist since 1978, and has covered technology since 1982. He launched the Interactive Age Daily, the first daily coverage of the Internet to launch with a magazine, in September 1994. See his full profile and disclosure of his industry affiliations.
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| 12/03/08
