At least things didnt get worse. Thats the take-away from two recent studies on the impact of limiting the work hours of medical residents on patient mortality. As reporter Andis Robeznieks describes in this issues Beyond the Headlines, the first study found that work-hour limits lowered the death rates of nonsurgical patients at Veteran Affairs hospitals, while the second found that such limits had no effect on the death rates of surgical patients at the same hospitals.
Both studies examined the impact of limiting resident duty hours to 80 hours per seven-day workweek, averaged over a four-week period. The Accreditation Council for Graduate Medical Education imposed that limit on all accredited teaching hospitals on July 1, 2003. The thinking was that the historic 100- to 120-hour weekly grind faced by doctors-in-training was a threat to patient carein the short term from zombielike residents and in the long term from physicians whose training they remember only as a blur. Traditionalists argued against the new limits, saying that tough programs are necessary to produce the best doctors.
As is often the case, health services researchers were called in to settle the matter much like football referees using instant replay to decide whether a wide receiver was out of bounds after a key reception. But what they found wont settle anything. Advocates of the duty-hour limits will point to the drop in the death rates of nonsurgical patients. Critics of the duty-hour limits will point to the unchanged death rates of surgical patients.
Were just glad more patients didnt die. The best-intentioned regulations often produce even worse results whether its in the healthcare field or any other setting. The studies surely will prompt some to argue for limiting duty hours even further while others will cite the studies to argue for lifting the limits entirely. Hopefully the industrys medical regulators will resist tweaking the duty-hour limits again in an effort to get the desired results. Just leave it alone.