Killing Our Residents Softly

As stated by many, a return to abusive work hours during residency is a setback for "health" care. It is another indication that health care is not really about health or care or caring. One would think that health care leaders would not want to expose such truths or how insensitive they are.

Today with yet another article indicating the increased health risks for those with even 1 hour less sleep a day, there is more than just another bad mental health day at stake. There is a large body of evidence, but then evidence basis denied is apparently OK for those who lead health science efforts.

Residents are dying, most assuredly they are dying. 

Some die in accidents. Others die in family tragedies. Yet others have long lasting sleep disruptions. Mental health issues are increasing. Their lives are dying and drying up. 

The title of a blog can make all the difference. 

Killing Our Residents Softly was an easy title to choose. The singing of Roberta Flack is easily heard in the background. The origins of the song are even more haunting.

Strumming my pain with his fingers
Singing my life with his words
Killing me softly with his song
Killing me softly with his song
Telling my whole life with his words
Killing me softly with his song

These words were originally written by Lori Lieberman in response to Don McLean as he was doing his American Pie songs. These songs were reflections upon the deaths of music, sanity, peace, and reason in the United States. Lieberman cites Empty Chairs as the most direct influence.

I feel the trembling tingle of a sleepless night
Creep through my fingers and the moon is bright
Beams of blue come flickering through my window pane
Like gypsy moths that dance around a candle flame
And I wonder if you know
That I never understood
That although you said you'd go
Until you did I never thought you would
More direct and just as powerful is the deeply moving Vincent by McLean: 

And now I understand what you tried to say to me
How you suffered for your sanity
How you tried to set them free.
They would not listen
They did not know how
Perhaps they'll listen now.
Hopefully when you hear any of these songs or others about tragic end of life, you will remember that health care leaders could have acted to save many lives and many decades of work including work from some of the most dedicated physicians. But then their main agenda is to train more residents even if they have poor support for residents and what they do. As with too many areas, it will take a very costly lawsuit and some very bad press to make health care leaders change their ways - but then again this was what Libby Zion was all about in the first place.
Being sensitive to life is all about being sensitive to death
Apparently insensitivity is about being a health leader.
Those who train more have much to gain from less support and more leaving MD DO NP PA and RN duties sooner with the need for ever higher levels of replacements. I suspect that the true costs for training, for more replacements, and for loss of experienced workforce will never be known.

It is sad that health care designs that pay astronomical sums for little gain in life, also deny life to those just beginning their new life as a physician.

Addendum 1 - It is a great device to promote damage to patients as the reason for better work hours. But patient outcomes are about numerous other factors other than Resident Work Hours. This was best demonstrated in studies comparing outcomes before and after the original work hours limitations. These are the best studies done on the same populations in the same facilities. The issue of greatest focus during residency training should be more humane treatment as residents begin their new lives as physicians. There should be continued efforts to reduce abuses - with or without work hours restrictions. Also health care has to stop this captain of the ship thinking that physicians shape outcomes. Outcomes are shaped by numerous non-clinical factors. There are many that shape outcomes other than residents.

Addendum 2 - Unethical studies - Studies were done demonstrating hand offs as a problem to justify work hours increases. In addition to structuring the study to demonstrate what was found, these should be considered to be unethical studies. The studies lacked informed consent, were not beneficent in intent (cost cutting focused), and they were done on vulnerable populations (residents). Those approving and performing these studies discredit themselves and distract efforts to promote greater sanity in residents and physicians.

Addendum 3 - Logic errors in study interpretations - If the problem is poor hand offs, then the training institutions should increase hand offs to practice better teamwork, better faculty supervision, better communication, and other improvements prior to releasing residents into full unsupervised practice.

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