WHY DOES THIS INSANITY CONTINUE?

The long work weeks of doctors in training leave them so fatigued that their reaction times are comparable to someone who is slightly drunk, researchers said on Tuesday. Resident doctors following a "heavy call" schedule that can require a 90-hour work week performed more poorly on a driving simulation test than those on a "light call" rotation averaging 44 hours a week who then drank liquor until their blood alcohol level reached 0.05 percent, the study said. Drivers with a 0.08 percent blood alcohol level are considered drunk.

The research echoes a previous study that found interns who worked heavy schedules made 50 percent more mistakes with patients and had 22 percent more serious errors on critical care units.

A survey of resident doctors also found that they were three times more likely than average to have been involved in a motor vehicle crash.

New rules enacted in 2003 lowered the weekly work schedules for U.S. doctors-in-training to a maximum of 80 hours, the report said. "Residents must be aware of post-call performance impairment and the potential risk to personal and patient safety," study author Todd Arnedt of the University of Michigan, Ann Arbor, wrote in this week's issue of the Journal of the American Medical Association. "Because sleepy residents may have limited ability to recognize the degree to which they are impaired, residency programs should consider these risks when designing work schedules and develop risk management strategies for residents, such as considering alternative call schedules or providing post-call napping quarters," he wrote.

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ANOTHER AUSTRALIAN PUBLIC HOSPITAL "THIRD WORLD"

Patients at Hervey Bay Hospital were in "very unsafe hands" because of three overseas-trained orthopaedic surgeons, Queensland's medical malpractice inquiry has been told. In the first day of evidence to the restarted Queensland Public Hospitals Commission of Inquiry, the focus switched from Bundaberg to Hervey Bay hospital. The inquiry had previously focused largely on the employment of Dr Jayant Patel as director of surgery at Bundaberg Hospital where he has been implicated in the deaths of at least 80 patients. But retired judge Geoff Davies, who was appointed to replace Tony Morris as head of the inquiry, made it clear today its terms of reference were not only confined to Bundaberg when it came to medical conditions in Queensland hospitals.

He called on evidence today from Dr John North, who co-authored a report into orthopaedic services at Hervey Bay Hospital earlier this year. Dr North said in a submission that conditions at the hospital orthopaedic unit were third world. He said the conduct of Hervey Bay Hospital's Director of Orthopaedic's Dr Morgan Naidoo and Senior medical officers in Orthopaedics Dr Damodaran Krishna and Dinesh Sharma had put patients at risk. Dr North said there were shortcomings in the trio's clinical assessment, basic communications with staff and patients and surgical skills. "A summary of the cases noted confirm the investigators knew that the people of the Fraser Coast are in very unsafe hands from the point of view of doctors Naidoo, Sharma and Krishna," Dr North said in his report. "It appears that there is a third world culture with respect to patient care at Hervey Bay Hospital simply as a consequence of the training of those employed there. "Under the circumstances prevailing at this hospital patient's safety is at severe risk."

Earlier this month the Supreme Court found Mr Morris was biased and the inquiry was effectively shut down, but resumed last week with Mr Davies in charge. Dr North told the inquiry that South African trained Dr Naidoo, and the Fijian trained Dr Krishna and Dr Sharma should have significant limitations placed on them. He recommended Queensland Health take steps to ensure all orthopaedic surgical health care activity in the public sector at the Fraser Coast cease and patients be transferred to a larger hospital where their orthopaedic care be monitored.

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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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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