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LETTER
Residency Overwork
Laura A. Petersen, MD, MPH;
Troyen A. Brennan, MD, JD, MPH; and
Thomas H. Lee, MD
15 May 1996 | Volume 124 Issue 10 | Page 933
TO THE EDITOR:
Dr. Green [1] reviewed the debate on the effects of residency work hours and discussed limitations on the hours worked in a given week, which are offset by night float and other types of cross-coverage arrangements. In his summary of the effects of these work-hour limitations and the relation between continuity of care and patient outcome, he states that no evidence suggests that improved patient outcome is related to continuity of resident care. However, in a case–control study controlling for clinical factors, we showed that preventable adverse events were strongly associated with cross-coverage [2]. Our results should not be interpreted as reason to increase housestaff work hours. We agree with Dr. Green's conclusion that overwork interferes with the development of physicians as mature professionals and with their ability to care compassionately for patients. Our results, however, emphasize the importance of improving and maintaining quality within the present framework of work-hour limitations. In fact, we designed an intervention to improve the continuity of care on the inpatient service and have studied the effectiveness of the intervention while continuing to decrease the excessive number of hours residents spend on duty [3].
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Author and Article Information
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Brockton/West Roxbury Veterans Affairs Medical Center; West Roxbury, MA 02132
Harvard School of Public Health; Boston, MA 02115
Brigham and Women's Hospital; Boston, MA 02115
1. Green MJ. What (if anything) is wrong with residency overwork? Ann Intern Med. 1995; 123:512-7.
2. Petersen LA, Brennan TA, O'Neil AC, Cook EF, Lee TH. Does house-staff discontinuity of care increase the risk for preventable adverse events? Ann Intern Med. 1994; 121:866-72.
3. Petersen LA, Orav EJ, O'Neil AC, Teich JM, Brennan TA. Housestaff-based intervention increases continuity of inpatient care and prevents medical injuries [Abstract]. J Gen Intern Med. 1994; 9:63.
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