Regulating Physicians

Drs. Merrill Mitler and Mindy Cetel present a misleading and superficial allegory invoking fantasy and unrelated events in making a plea for legislative regulation of medical residents’ working hours (“Why the Doctor May Fall Asleep on Your Case,” Op-Ed Page, April 9).

To begin with, under 10% of our hospitals have residents working in them. If a problem then, indeed, does exist, it affects a relatively small population. Residency programs have rules and regulations that require proper and appropriate supervision by attendant physicians (physicians who have completed their residence training and are in practice). If a resident is so fatigued as to be unable to make proper judgment or perform proper motor activities, the remedies are apparent. In any event, unless the training program does not so require it, there must be an attendant present when he operates! Invoking anecdotes that suggest an incorrect call by a sleepy resident is at best unconvincing and at worst improper and sensationalistic.

It is essential that physicians in training be subjected to vigorous schedules including emergencies and other untoward events. It is their responsibility and that of the training programs to be sure that patient care is not compromised by this system. It is not the duty of the state to legislate solutions, although the qualifying and certifying of all medical care receiving government funding does require peer review and this agency should be invoked to assure quality.

If there are any residency training programs manned by physicians who have not slept for two or three days at all, those programs must be immediately disciplined and the situation corrected. The issue and solutions must involve certifying bodies for the training programs already in place. In terms of the potential of excess working hours, this can reasonably be addressed with the proper utilization of attending physicians. To call for a remedy from the legislative arenas is naive and unprofessional, illogical, and without historical support.

MICHAEL H. SUKOFF, M.D.

Santa Ana