It’s becoming increasingly difficult to practice the type and quality of medicine that we medical professionals have cherished throughout our careers!!!! The professionalism and the expected standards of care have been systematically and insidiously degraded over the last decade.
It began with the use of the Libby Zion case to rally around fatigue as a cause of medical errors and has evolved into the complete transition of the medical profession to a shift-work, employment based model!!!
At first the powers-that-be, namely the ACGME who governs all things regarding Medical Resident Training, began to use ‘fatigue’ as the reason to restrict work hours, including total hours worked. This has become increasingly restricted to not only include short work shifts, but days off for personal time, days off for rest, time away from the patient for various non-clinical obligations and amazing restrictions on patient numbers.
In effect, a houseofficer can essentially work 12 hours, take care of 5-7 patients in that time, must leave the building and their patient at the end of their work shift and completely lose the ability to observe and care for his/her patient during the most critical and educational time in the hospital, the first 36 hours. In essence, medicine has been transformed into a shift-work, employment based occupation where continuity, doctor-patient relationship and strong sense of ownership of a patient’s care have been all but eradicated.
There is also a strong push to separate inpatient and outpatient training and make the mutually exclusive. This will, and I believe it is by intention, further degrade the doctor-patient relationship. Already it is difficult to get a primary physician to evaluate, treat and engage his patient when he is needed most….when the patient is seriously ill enough to require hospitalization. This will be eliminated at it’s origin….at the time of training. The physician who cares for his patient when both well and ill will cease to exist, as will any form of relationship and continuity.
Currently, the most caring and capable physicians are those that care for their patient’s when both well, when sick, and back to being well again…..this will be a thing of the past by design. Sadly….
The current training process will eliminate the ability for a physician to be everything to his patient, care will remain fragmented, communication sloppy, relationships weak and care poor.
As it is i’m repeatedly faced with arriving for rounds, there is no information available from the prior housestaff work shift and the explanation for various occurances repeatedly is ‘I have no idea, they didn’t tell me anything about what happened’…..the saddest thing is that no one seems to think this is a problem. Hey, it wasn’t my shift!!!! Yes….and they don’t feel like it’s their patient either….just another number to deal with during their 12 hours on the way to the day off!!!!!
God I hope I don’t get sick!!!!