Unintended Consequences: The Accreditation Council for Graduate Medical Education Work-Hour Rules in Practice

摘要

Seventy-nine-year-old Doris K. was admitted to the hospital with weakness at a bad time for my team and me, especially considering the limits of the new 80-hour workweek. It had been a frenetic day. We were swamped with 11 patients who came before Doris K., and her weakness brought us to a dozen. Keeping up was exacting, made worse by the pace: Six new admissions hit the floor in just 3 hours. As one of the interns succinctly put it, we were “getting spanked.” But in addition to the volume of admissions, our night felt increasingly overwhelming from a unique and novel burden: We had to finish everything by 11:00 p.m. Each of us did the math and tried to conceive of a method of seeing 5 more patients and leaving the hospital in the next two and a half hours. It couldn't be done, and realizing this made us feel exponentially more frazzled, rushed, and suffused with fatigue. This was medical training under the mandatory work-hour restrictions for physicians.