The Accreditation Council for Graduate Medical Education held a congress on duty hours this summer at which time it listened to hours of testimony from physician groups and medical specialty societies. ACGME intends to release a report that reviews new duty limits imposed in 2003 and may recommend further changes.
It could be argued that the reason they were going through this exercise was because Sidney Zion demanded it.
Zion died Aug. 2 at age 75. He was a journalist, prosecutor and novelist, but he will be best remembered as an early advocate for patient safety who embarked on a crusade to lower medical resident work hours and increase supervision for doctors in training when his 18-year-old daughter died a few hours after entering New York Hospital on the night of March 4, 1984.
“I give him full credit for being the first person to put this on the map,” said patient-safety pioneer Lucian Leape, a Harvard School of Public Health adjunct professor of health policy. “Too bad it wasn’t a physician who said it, but that’s the way life is. I don’t think there’s any question he’s had an impact.”
An investigation found that a resident treating Libby Zion deviated from practice by not consulting a more experienced physician at 4:15 a.m. It was also found that residents prescribed Demerol for Libby Zion, which reacted with the antidepressant she was taking. Eventually, a jury said that New York Hospital should not have left a resident in charge of 40 patients at night, but also ruled that this did not contribute to Libby Zion’s death. In the meantime, however, the issue came into American living rooms during a 1987 “60 Minutes” segment when a resident who was being interviewed on the 25th hour of his shift forgot the question he had just been asked by reporter Mike Wallace.
“His outrage about his daughter’s death led to the Bell Commission,” said Leape, referring to the panel convened in 1987 whose recommendations led to New York state capping the resident workweek at 80 hours and limiting shifts to 24 hours in 1989. ACGME adopted similar nationwide limits in 2003, and a December 2008 Institute of Medicine report called for further restrictions on resident work hours.
Libby Zion’s story became the subject of a 1995 book, The Girl Who Died Twice, which—unlike most best-sellers—was reviewed in major medical journals, including the Journal of the American Medical Association. Leape wrote the review. “He was a very aggressive person, and he turned people off—almost like Michael Moore—people found it hard to take the message from him,” Leape said of Sidney Zion. “But he didn’t let go. He didn’t win any friends, but that wasn’t his objective.”
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