As a third-year resident in internal medicine at Duke University Medical Center, I disagree personally, empirically, and theoretically with the position taken in Dr. Green's recent article [1].

I feel that working long hours facilitates both optimal patient care and educational experience by allowing the house officer to see the full effect of his or her interventions. By following a patient through the critical initial hours, a resident is uniquely able to reevaluate the patient.

Studies have supported my experience. Petersen and colleagues [2] suggested that a fatigued intern with detailed knowledge of a patient may provide better care than a well-rested intern who is cross-covering. Lofgren and colleagues [3] showed that hospital admission by a cross-covering resident results in a significant increase in the total number of laboratory tests and a trend toward longer hospital stay and the further occurrence of fever. Thus, although Dr. Green touches on continuity of care, his review is incomplete.

I also question Dr. Green's contention that residency overwork interferes with the promotion of virtue. What about the virtue of commitment, dedication, and perseverance? Each of these virtues might be learned or reinforced through an arduous clinical schedule. At Duke University Medical Center, we have accepted the challenge of virtuous patient care and live up to the basic tenet of our former chair, Eugene Stead, who stated: "The sick never inconvenience the well."

My fellow housestaff and I chose a system that offers the best in patient care and medical education; we did not merely "consent" to it. As we reform medical training and change to a system that acknowledges some virtues and ignores others, we may create a future that provides medical shift workers rather than dedicated physicians.