Healing with an eye on the clockBMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f5436 (Published 06 September 2013) Cite this as: BMJ 2013;347:f5436
- Suzy Frisch, freelance journalist
- 1Minneapolis, Minnesota
Internal medicine resident Cathy Handy believed one of her patients at Johns Hopkins Hospital had cancer, but she needed to order diagnostic blood draws and other laboratory work to confirm the illness. After building a rapport with this older man, Handy wanted to see him through the tests, explain his disease, and help coordinate his treatment.
But to Handy’s frustration, her 16 hour shift ended and she was required to stop working. She had to hand off her patient to another physician—leaving the man to get some terrible news from a new doctor, who didn’t know anything about him.
It happens time and again for interns, who may work shifts of no more than 16 hours, and to residents after 24 hours, because of duty hour restrictions from the Accreditation Council for Graduate Medical Education (ACGME). For residents like Handy, most shifts are a race against time. They admit multiple patients and tackle a long checklist, including diagnosing patients’ conditions, ordering tests, lining up drugs, and formulating treatment plans, all before the clock runs out.
When it’s time to go, they must hand over their patients’ care to other residents. Often, Handy’s chief priority feels like making sure she doesn’t overstay her time, and she’s constantly uneasy about missing something vital during a hand off.
“Then when you’re picking up someone else’s cases, you’re playing catch up because you don’t get all of the back story,” says Handy, a second year resident. “It becomes a bit of a game of telephone, and you don’t get as much information as you would have had you done the full history and the full physical. There is a lot of room for errors.”
The increased risk …