SHEER IDIOCY FINALLY COMING UNDER ATTACK

Truck drivers can spend only 11 consecutive hours on the road legally, with a 60-hour-per-week maximum. Airline pilots can fly only eight hours in a 24-hour period, and no more than 30 hours per week. It's no wonder those rules exist. Exhaustion in either group invites mistakes that kill. So why is it that medical interns and residents, who hold sick people's lives in their hands, can regularly work 100-hour weeks, including 30-hour shifts?

Two new studies reported in The New England Journal of Medicine now confirm that sleep-deprived interns make substantially more serious medical mistakes when they work shifts of 24 hours or more than when they work shorter shifts. The details are eye-opening. Interns in the coronary and intensive care units of Boston's Brigham and Women's Hospital who worked 80 hours per week, including 24-hour shifts, made almost six times as many diagnostic errors and 36% more medical errors as colleagues who were limited to 16-hour shifts and 63 hours per week. The errors included sticking a tube in the wrong vein and ordering 10 times the correct dosage of a medication. Other staffers often found and corrected the mistakes before serious harm was caused, researchers said. Interns working the longer hours also were more likely to nod off on their shifts. The same results presumably would be found for residents, who work the same hours. Both are doctors in training, with residents having a year or more of experience.

Just 17 months ago, the Accrediting Committee for Graduate Medical Education (ACGME) tightened rules governing interns' and residents' hours. They are now limited to an average of 80 hours a week in any four-week period and can't work more than 24 hours straight, though six hours can be added for paperwork and classes. That results in some 100-hour-plus weeks. Simple logic - not to mention the new research - says those rules are too loose. But two powerful forces work against reason.

The first is medical tradition. Many physicians believe an onerous residency is a necessary rite of passage to expose young doctors to the real world. The attitude is, "We went through it. So should they." Very tough. Not very smart.

The second factor is cost. After seeing the studies' findings, Brigham and Women's Hospital cut interns' hours substantially. Changes so far have cost $500,000, on top of nearly $1.9 million for complying with the new ACGME rules. Expensive, but better than killing people. Medicine will never be a 9-to-5 job. But the goal is to deliver quality care, not to run a tough-man competition or cut costs so severely that patients are endangered.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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