I understand the arguments in favor of this proposal. Longer, and more traditional, hours allow more continuity of care and permits the residents to learn more. If this is true, why not make the limit 36 hours, allowing the young people to get 30% more education?
Because people need sleep to function, that is why. And while continuity of care is important (although most patient care in hospitals are caused by nurses, but they tend to work only 12 hour shifts), the earlier doctors learn about the ability to effectively communicate with other health care professionals the better, given the number of errors caused by failure to communicate.
Yes, communication errors are a huge problem. The patient safety experts at CRICO Strategies estimates these communication errors cost the healthcare system $1.7 billion, including the price tag of hefty malpractice payouts for serious injury or death. CRICO Strategies also reports that
The errors occurred in the inpatient setting, the outpatient setting and the emergency department. Injuries to the patient caused by these errors were mostly of high and medium severity. Out of all the high-severity injury cases reviewed, 37% involved some sort of communication failure.
I have represented patients in medical malpractice cases for over thirty years, and I can tell you the “37%” figure above is consistent with my experience. While it is true that some number of medical errors are due to lack or lapse of knowledge, many errors are due to lack of communication between providers and the patient slips through the cracks in the system.
So, while no one can ever discount the desirability of any professional having more knowledge, we cannot discount the need to train professionals on the need to effectively communicate that knowledge. In the health care setting, that includes the need for each health care provider to communicate to other providers what the former observed during his or her treatment of the patient.
So, the rule change not only means that young physicians will be working in a sleep-deprived state on more occasions but it also means that they will have fewer occasions to hand – off patients, which in turn means they will have fewer occasions to hone their oral communication skills.