Healthcare on bankers hours

Today started off by watching the powerful film on Lewis Blackman, a 15 year old boy who lost his life due to medical errors. This film raised a number of issues that all contributed to an ultimate tragic outcome. It also highlighted for me many of the ways we are still making these same errors today. One particular area that really touched home for me was cross coverage of patients and patient hand offs. While there are many important issues surrounding these topics there are two in particular that I feel I have been a part of already in my time as a resident that had a huge potential for causing patient harm. The first is poor hand off between residents. As the night time resident you may be covering 30-40 patients. I feel this number alone makes effective patient hand off difficult. We are all too often left with not nearly enough information about these patients for whom we are assuming responsibility. I think part of this is a lack of ownership for these patients and a thought that we should defer major decisions to the patients primary care team. I also think our acceptance of this has a lot to do with the second point I wanted to emphasize. And that is, that we have created a culture where for some crazy reason we have all bought in to this idea that patients are somehow less sick over night or on the weekends. We’ve adopted this 9-5 Monday- Friday healthcare model where we allow an unsafe reduction in staffing and resources over night and on the weekends. We need to stop letting this occur. It is not okay for a second year resident to be the most senior physician in house over night covering ICU patients. This is certainly not meeting the expectations our patients should have for their care. We owe our patients and our trainees a better system.

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