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Law of Unintended Consequences – needs of the few should not outway the needs of the many

[preamble]We see this insanity all the time – if an accident occurs, some grieving person yells loud enough we get streetlights and stop signs all over the place causing traffic delays and chaos. Just because something bad happens does not mean anyone is at fault and that we need a law or we need to do something. Knee jerk reactions from politicians to look good and get votes causes chaos. Health care crisis, sealtbelts, obesity, too much sugar, our kids are fat – all knee jerk reactions to LIFE… Long term consequences are never discussed. Sorry but not every persons crusade is my crusade nor society’s crusade – grieving parents need to grieve not advocate anything.[backtopost]

In 1984, Libby Zion died following an emergency admission to a New York hospital. Concluding that her death was the result of a medical error by exhausted housestaff, her well-connected father launched a crusade which ultimately led to resident work hour restrictions prescribed by the ACGME.

Now, we learn that restricting work hours for PGY 1 housestaff to 16 hours leads to a significant decline in surgical experience.

… Compared with the four academic years before the change, the year immediately following the restriction saw significant declines in total operative cases (by 25.8%), major cases (by 31.8%), and first-assistant cases (by 46.3%) performed by the interns (P˜0.008 for all), according to Christian de Virgilio, MD, of Harbor-University of California Los Angeles Medical Center, and colleagues.
The drops were seen across most types of surgery, the researchers reported online in JAMA Surgery.
“If the 16-hour shift were to be extended to all postgraduate year levels, one can anticipate that additional years of training will be needed to maintain the same operative volume,” they wrote, noting that the reduced experience of interns entering postgraduate year two “may have a domino effect on subsequent competence.”
While errors caused by sleep deprivation must be kept at an irreducible minimum, we must acknowledge the threat of unacceptable errors caused by inexperienced doctors. Perhaps, before instituting guidelines, august bodies should base their decisions on evidence, not eminence.
Of course that’s just my opinion. I could be wrong.