PO Box 409095
Chicago, IL 60640
Length: 4 minutes, 12 seconds
Interviewer: David Burda, editor, Modern Physician
Interviewee: Darrell Kirch, President and chief executive officer of the Association of American Medical Colleges
[00:00:05.28] David Burda: Hello everyone, this is Dave Burda, editor of Modern Healthcare and Modern Physician magazines; visiting with us today, Wednesday Oct. 24, is Dr. Darrell Kirch, president of the Association of American Medical Colleges. Dr. Kirch, welcome to Modern Healthcare.
[00:00:19.08] Darrell Kirch: Its my pleasure.
[00:00:21.03] David Burda: Just a few quick questions on the impact of the limits on resident work hours. Two studies came out recently, linking the limits to patient mortality. One study found a link between the limits and lower mortality of nonsurgical patients. Another study found no connection between the resident hour limits and the patient mortality of surgical patients. Are you familiar with those studies? And what are your reactions to those findings?
[00:00:52.07] Darrell Kirch: Like most people in academic medicine, I did notice those studies, and in looking at what seemed to be divergent conclusions, I was intrigued, too. I think what those studies really tell us, though, is this is not a simple equation. Most observers in academic medicine realize that it was a problem for us to not be sensitive to the issues of duty hours, but more importantly, to issues of attention and fatigue among individual healthcare providers. And I think the core truth of duty hours is that now we are paying attention to that, and were trying to put systems into place.
But I think the other thing that weve learned is that healthcare is such a complex environment, and different patients present different kinds of challenges that were going to have to have, perhaps, more flexibility than very rigid, formulaic controls on hours.
[00:01:59.25] David Burda: Are you saying that the AAMC would support some sort of relaxing of these resident work hour limits?
[00:02:10.09] Darrell Kirch: Rather than use the phrase relaxing, I think that what we need to now move into is a phase of coordinating duty hours with specific clinical needs. And the clinical needs in a nonmedical, less-acute-care situation are very different than in an operative situation, or in the situation of patients with multiple complications or the like, and that duty hours will have to be tailored in a way that really fits those. In the end, one part of the equation was the alertness, fatigue, those kinds of issues in the individual providing the care. Now we need to develop the equation to factor in the needs of a specific patient in that situation. How do we provide more? Guarantee the continuity of care, the continuity of attention that patients needs.
[00:03:05.07] David Burda: There was a study that actually came out, I believe, yesterday, from AARP, on residents and interns and medical errors, tying medical errors to lack of communication. I dont know if youve seen that yet and could comment on that.
[00:03:21.21] Darrell Kirch: That study illustrates, I think, one of the greatest lessons weve learned from the duty hours process. And that is, it isnt just an issue of the individual and their readiness to deliver care; its the team, and how well the team communicates. And that just isnt physician to physician. Its nurses, other allied health professionals in the clinical-care setting. I believe one of the benefits of the duty hours attention is that it is one more factor moving us in the direction of creating the kinds of healthcare teams that patients really need and deserve.
[00:04:03.10] David Burda: Very good. Dr. Kirch, thanks for being with us today.
[00:04:05.08] Darrell Kirch: Its my pleasure, thank you.