Talk:Medical resident work hours

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There are several peer-reviewed studies on the subject, e.g. in NEJM last year about the quality of care in Intensive Care Units. This is more reliable than some external links. JFW | T@lk 09:09, 5 January 2006 (UTC)

While most residents would agree, the claims of "long, brutal hours", and "poor supervision" are all in fairly POV language and need tracing to a source that has qualified the working patterns as such. I have asked Ombudsman for sources[1]. JFW | T@lk 09:18, 5 January 2006 (UTC)

The points raised by the article are less of an issue with the ACGME 80 hour work week. What has emerged are issues related to continuity of care that have been brought up by the NEJM article. I'll put the reference in the article. Andrew73 12:38, 5 January 2006 (UTC)

It also neglects the situation in other countries. If there is to be a merge it is not a problem, but in Holland and the UK there is a European Working Time Directive which has effectively restricted hospitals from overworking doctors, forcing a shift-system rather than an on-call system and having its own problems with continuity of care. JFW | T@lk 17:21, 5 January 2006 (UTC)

[edit] Merge

I'm thinking this page would be better merged with residency (medicine). --CDN99 15:33, 5 January 2006 (UTC)

Agree with merger. I guess the key question is merge with residency (medicine) v. medical residency. Andrew73 17:46, 5 January 2006 (UTC)

Talk:Medical residency suggests that Medical residency be merged into residency (medicine) (that discussion is from Oct. 2005), so I'll probably merge everything tonight if there's no objections. --CDN99 18:44, 5 January 2006 (UTC)

Agree with merger. Those two pages should be merged anyway. JFW | T@lk 17:51, 5 January 2006 (UTC)

I suspect the rv to the original version was accidental[2]. JFW | T@lk 18:07, 5 January 2006 (UTC)

Ahhh, I was wondering why things suddenly looked different...my mistake. --CDN99 18:44, 5 January 2006 (UTC)

• The fact is, long hours have long been a major source of controversy in the medical field, and merging would only serve to bury the debate. In fact, it is just this sort of acculturation in the field that has contributed to the unjustified knee-jerk dismissal of medical orthodoxy criticism, typified by the dubious assertion that controversy in the field equates with superstition. Pushing a merger would only exacerbate the widespread suppression of informed debate regarding the roots of iatrogenic adverse events. Ombudsman 19:03, 5 January 2006 (UTC)

Two more days of discussion and voting, then I will merge if the consensus is to merge. Right now, it's 3 merge vs. 1 don't merge. Residents work long hours, there's no suppression of that fact. --CDN99 03:16, 6 January 2006 (UTC)

Then why bury the issue? If the fact was so well known, why hasn't it been dealt with by means more effective than voluntary guidelines that are way too lax and likely not even complied with? The system is terribly flawed because of the lack of debate, whether or not the fact is neglected. The matter affects the lives and well being of many, as preventable hospital fatalities are among the leading causes of death in the US. It is always so surprising to see every last xbox game and romance novelist have their own articles, but when it comes to the chance for a penetrating, in depth analysis of a major issue confronting medicine, the wagons circle, another article is killed off, and the Wiki is handed another disservice. Hopefully, you will reconsider your hasty plans. Ombudsman 03:55, 6 January 2006 (UTC)

I'm not "burying the issue," I'm allowing a merge vote to take place. Is there a source for hospital fatalities due to doctors' mistakes (not due to opportunistic infection, diseases with no effective treatment nor patients refusing care) being the leading cause of death? So many declare this as "fact," but so few can give a reliable reference. --CDN99 04:58, 6 January 2006 (UTC)

I'd be for keeping it separate if it were made NPOV and referenced. It's an important subject in the US, at least. As for whether voluntary guidelines have been enough, I'd be interested in any data which suggests otherwise. I know I was working 90-110 some times before and less than 80 afterwards, but obviously anecdotal. InvictaHOG 11:29, 6 January 2006 (UTC)

Heh. Actually physicians work long hours, especially hospital based physicians. My work hours went up after graduating residency. I dare say that applies for a lot of physicians. And I vote Merge. --DocJohnny 23:16, 6 January 2006 (UTC)

The votes are now 4 merge vs. 2 don't merge. I just merged the two residency pages, but I'll leave this for a couple more days to see if anyone else has any comments. --CDN99 16:04, 8 January 2006 (UTC)

Disagree (strong) - Both are reasonably long articles although I agree that both could do with editing-down and rewording of their current content. However both need further expanding/boadening:

• The residency article in particular could do with expansion to cover the situation in other countries (currently terribly US-centric).
• The working hours can have a useful discussion on:
  • rotas
  • doctor fatigue. Is it better to get no sleep during a night shift covering for several teams, or being on-call more often covering fewer patients and so getting some sleep?
  • Does doctor fatigue cause greater clinical errors. Unfortunately, for the juniors medical staff, much of the the evidence in the UK suggested not: it did take longer to make decisions and more care (ie greater effort) made to ensure not making errors (ie more looking up of information or dosages calculated twice to make sure)
  • Access to training
  • EU vs UK in implementing changes, relationship between those in training and consultants (who after all tend to control the Medical regulatory authorities).

I think good articles of each will be/should be (if they are comprehensive and thoughtfully written) too long to be merged. David Ruben ^Talk 19:46, 17 January 2006 (UTC)

The narrow US focus is my main problem with this. As also mentioned by JFW | T@lk under Preview, there is a great deal of legislation and political impetus behind the reduction of doctors' hours in the EU and UK, and I don't think we yet have any articles on this, despite the major impact of several European Court rulings on the issue. If this article was turned into one about long working hours for doctors in general, that would probably be useful - though it would then have to be retitled since "medical resident" is a US term. --Tobelia 00:25, 26 January 2006 (UTC)

[edit] bad title

In the UK it is Juniors' hours, no doubt other countries have other names, but it is the same thing. Medical working hours would be a better one. How about lawyers though? Or troops? Midgley 16:53, 23 March 2006 (UTC)

Ask Ombudsman. It was his idea. JFW | T@lk 21:13, 23 March 2006 (UTC)

It's not just the title - as mentioned above this is a specifically US-focused article (hence references to interns, the 80-hour work week, etc), although this is also a critical issue in Europe, and is also a matter of concern in Africa, India, Australia and elsewhere. Before changing the title, I would first ask whether we ought to deal with other countries' long medical working hours in separate articles (which would make a stronger case for merging this one with medical residency), or whether we should expand this one to cover medical working hours in general, which would mean revising its layout somewhat. Tobelia 19:32, 24 March 2006 (UTC)