Thursday, January 19, 2017

Residency Work Hour Restrictions: Is the Pendulum Swinging Back?

Author: Mike Wilk, MD
PGY-1, Brown EM
Originally Published: Common Sense January/February 2017

“I walked into the hospital on my first day of residency and didn’t walk out until 36 hours later. Those were the darkest days of my life, but I am the doctor that I am today because I went through that,” I still distinctly remember these words from one of my more senior physician mentors when our discussion turned to work hour restrictions. As I wondered how it was possible to physically stay awake for so long, there was no doubt in his mind that work hour restrictions were dampening the training experience of newly minted residents.

First instituted in 2003 and revised again in 2011, interns now “enjoy” an 80-hour work week restriction with a maximum shift length of 16 hours (PGY-2s and above are still allowed to work up to 28 consecutive hours). However, the pendulum may be swinging back on strict work hour restrictions as new research on the topic becomes available.

The event that led to work hour restrictions was the death of Libby Zion in 1984. An overworked medical intern on a 36-hour shift prescribed meperidine to the 18-year-old patient, who was on an antidepressant, the MAO inhibitor phenelzine. This drug combination is thought to have caused the serotonin syndrome, leading to Zion's death.

Sunday, January 15, 2017

Group Therapy

Author: Mary Haas, MD
AAEM/RSA President '16-'17
Originally Published: Common Sense January/February 2017

It was Monday night, and Halloween. It was the perfect storm of an ever-expanding waiting room and a revolving-door resuscitation bay occupied by sick patient after sick patient. Following an emotionally exhausting shift, I sat with some fellow residents at The Pizza House, a local late-night joint where we grab food after a shift, tell stories, and debrief in Ann Arbor. We often jokingly refer to these sessions as “group therapy.” The mood that night was more somber than usual, despite the roar of intoxicated college students at nearby tables dressed up like Pok√©mon trainers and Game of Thrones characters.

My co-resident shared the story of two young males who suffered cardiac arrest by drowning, after jumping into a cold lake to rescue their friends who, unknown to them, had already made it to shore after a boating accident. Another resident shared the story of a teenage boy who died after being struck by a car while crossing the street on his way to school. Another shared the story of caring for a mom who presented with pre-eclampsia, a few days after her infant was unsuccessfully resuscitated by another of our colleagues and died from SIDS. I had just cared for a man who suffered a massive intracranial bleed while going to open the door for a few trick-or-treaters. I looked his teenage son in the eye and tried not to well up with tears as I translated the findings of the CT within five minutes of meeting him. Suddenly, it made sense that we had been so eager to sit, relax, and have a beer together. We had certainly earned it, based on the events of the last week. All of us needed to talk to someone who would understand.