Headlines in the WSJ indicate that the state made a surprise series of raids. No these were not drug dealers, smugglers, rapists, murderers or other felons. These raids were on non-profit and university hospitals. Were they selling organs or body parts? No, they were checking on the hours that the house staff was working. These hospitals had already hired phlebotomists and others to reduce resident’s workload.
These inspectors showed up at the hospital’s doorstep declaring “they would be here 24 hours a day and over the weekend.” They asked the administrators to leave the room as they conducted their interviews. After interviewing first-year residents, they check those facts with the second-year resident and so on to the staff physicians.
Dr Speck, the COO of New York & Presbyterian Hospital, decried the Bell rules, which were being enforced as ridiculous, arbitrary and capricious. He stated the residents have to get the appropriate amount of sleep, but more important, they have to get the proper amount of instruction.
One rule is that residents in a medical ward can’t work more than 24 hours straight.
Dr. LaDue at UCSF, in commenting about the 24-hour shift, stated the traditional 36 hours on and 12 hours off was more in tuned with human circadian rhythm. During the night that the intern or resident is on, he may only get 3 or 4 hours of sleep, but they will be deep sleep when the core body temp is low and thus the sleep is very effective. If the resident goes home after 24 hours, he will be tired at home, may nap or even have a restless sleep, which will not be REM sleep since the core body temp is not down. That evening, the resident will again have a fitful sleep since he won’t be tired, having napped during the day. The possibility of errors is increased the following day when he returns to duty.
As usual, laws are quite insensitive, never physiologic and seldom based on medical evidence. As physicians we should keep our own house in order without having lawmakers always regulating us.