Opinion: If doctors don’t learn how to work 28-hour shifts in residency, when will they?

To the editor: Most data demonstrate that the work-hour rules that resulted from the unfortunate Libby Zion case in New York (she died under the care of overworked residents) have actually caused more handoff-related harm from supposedly better-rested residents. (“Young doctors could work 28 hours straight under new plan, despite possible dangers,” Dec. 16)

Our profession reacted to external forces (including the media) and strictly limited resident shifts without the scientific data to support its decisions. This has weakened the skills of our younger physicians, especially those in surgical specialties.

As an obstetrician who has been available 24 hours a day, seven days a week, for more than three decades, I ask patients whether they would prefer a doctor who is available when needed or one who punches a clock. If doctors are not expected to learn and think when fatigued during their residencies, society has to accept physicians working shifts who are more likely to miss something during a handoff.

Howard C. Mandel, MD, Los Angeles

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To the editor: As a physician who has worked far too many 24-hour shifts over 35 years, I can see both sides of the issue.

When one has worked all night and then starts a surgery, it is almost impossible to walk out of the operating room when your 24-hour shift is over and abandon the patient you have followed day and night.

However, nowadays one must know how to just say no and let the fresh doctor take over. It’s tough to do, but better for the patient.

Michael L. Friedman, MD, Torrance

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