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Jewish World Review July 10, 2002 / 1 Menachem-Av, 5762

Bob Greene

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A rest cure for America's young doctors | LINCOLN, Neb. Lost on South 70th Street, I passed a hospital -- the St. Elizabeth Regional Medical Center -- and pondered what might be going on inside.

I knew nothing about this particular hospital. But there has been a debate inside the medical profession for the last several years, which has come to the boiling point in recent months, and it concerns what goes on in virtually every American teaching hospital.

It's something the rest of us -- non-doctors -- have vaguely been aware of, but have seldom questioned. The medical profession -- even in our new era of relative openness between doctors and patients -- has always been a mystery to outsiders; the customs and practices have seemed like those of a secret society, not to be challenged by people without medical degrees.

So what, to the rest of the world, might have appeared to be a violation of basic common sense was, inside the world of medicine, not only accepted but embraced.

I'm talking about the time-honored practice of having medical residents work as many as 36 hours in a row. Thirty-six hours straight, routinely.

You'd hear about it, from friends in medical school, or from the spouses of residents who would worry aloud about what the long hours were doing to their loved ones. It was the ultimate rite of medical passage: young doctors, on the verge of going out on their own, being assigned to hospitals as residents, and being put on 36-hours-straight shifts. Often, the workweeks for the doctors-in-training would exceed 100 hours.

Why? Explanations varied. Physicians needed to learn to work under intense pressure. Physicians working 36 hours in a row would see a wide variety of illnesses, from dawn to midnight to dawn again, and beyond. Physicians working those non-stop shifts could observe the hour-to-hour changes in a single patient confined to a hospital.

To outsiders, it sounded puzzling. Thirty-six hours straight, on a routine basis, in a profession as important as medicine? If you were flying across the country, how would you feel if you knew your pilot was in his 30th hour of wakefulness without any sleep? If you got onto a bus or into a cab, what would your reaction be if the driver told you you were his last fare on this shift, because he had been without sleep for 35 hours? If you were meeting with your boss about a decision that would have an effect on your career, and you needed his or her full attention, how would you feel if, on Tuesday morning when the meeting began, he or she told you that he or she had been at the office since Sunday night?

Evidently the medical profession is asking itself some of these same questions. Early in June, the Accreditation Council for Graduate Medical Education announced that, as of next year, medical residents will not be required to work those killer shifts, and that hospitals that do not comply can lose their accreditation. Then the American Medical Association made its wishes official: Medical residents may not work more than 80 hours a week, or more than 24 hours straight, except under exceptional circumstances.

That still sounds like work guaranteed to cause confusion and invite mistakes; 24 hours of work in a row is an exhausting concept, and an 80-hour workweek, while more bearable than 100-plus hours, is not exactly a stroll by the lake. And some critics of the long shifts have alleged that weary-to-the-bone medical residents have fallen asleep during surgery, or while driving home after work.

Makeba Williams, of the American Medical Student Association, told the Associated Press that research has shown that being awake for 24 hours straight can cause mental impairment similar to drunkenness: "Yet we say it's OK to deliver babies."

There has long been a Marine boot camp aura to what medical residents go through -- they may not love the long hours, but many have taken pride in the idea that what they have endured, in pursuit of becoming good physicians, separates them from the rest of the world.

The new rules seem to be saying: Whether or not the long shifts are good for the doctors, there is a real chance they are dangerous for the patients. First, do no harm -- and get some sleep, doc.

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JWR contributor Bob Greene is a novelist and columnist. His latest book is Once Upon a Town: The Miracle of the North Platte Canteen. (Sales help fund JWR). Comment by clicking here.

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