How tired should your surgeon be?

Recently, the New England Journal of Medicine published results of a study comparing the effect on patient safety of different work schedules for surgical residents who are receiving training in hospitals. The study is known as Flexibility in Duty Hour Requirements for Surgical Trainees, or FIRST. It compared the current system in which working schedules are capped at 80 hours a week and overnight call is limited with an unrestricted system. The purpose of the research was to determine whether patients are better off receiving care from the same doctor whose hours are unlimited or from a fresh doctor who has picked up their care when the first one went off-duty.

The study has raised two significant concerns. One is that the outcomes it measured do not accurately reflect actual patient care. Another is that the researchers did not fully inform either residents or patients about the nature and risks of the research in which they were taking part.

What would a patient want or need to know before being admitted to a hospital that was testing the effects of different resident schedules? We asked a group of 34 health care consumers for their thoughts. While this was not a systematic poll, it helped to shed light on what patients care about.

Thirty of the 34 preferred residents with restricted hours, and 32 of them felt it was important to know their hospital's policy. Only four preferred unrestricted hours, with two of the four feeling no need to know about the policy.

Commenting in favor of restricted hours, one physician observed, "I did call every other night as an intern and was totally exhausted. Weekends were Thursday Friday or Saturday Sunday."

Comments from patients were mostly similar. Here are a few:

"Residents require down time to rejuvenate and rest like other professions so they can make appropriate medical decisions."

"I've been in hospitals with residents that are so tired we had to remind them what was going on."

"Just experienced hospital stays during which new residents came in having fully absorbed info in computer and they were rested and informed of my case."

"I want to know if restricted or not. Makes a difference in how much oversight energy I must put in as an advocate or patient."

"I think continuity of care is very important. I don't favor restricting hours. When my brother was dying it was very annoying to have doctors coming in and needing to be "caught up." I think not only is time wasted but care suffers as information gets lost."

What does this mean for you as a patient? Ask yourself whether you would fly with an airline that announced it would let pilots fly an unrestricted number of hours. The difference  (with the hospital resident policies) is that you would know about this change and could make an informed decision on whether to use that airline. The FIRST study and a similar one on medical resident hours called iCOMPARE were conducted in 190 hospitals across the country, but neither one informed hospital patients that the research was underway. How could patients make an informed decision about taking part?

The iCompare study does not end until July 2016, and hospitals in your region may be part of it. If you are about to be admitted to a hospital, make sure to ask about its policy on resident working hours and whether a study of them is taking place and then make an informed your decision.

You have the right to refuse to participate in a research study that you do not want to be part of.  Be empowered.

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Maryanne McGuckin, Dr.ScEd, FSHEA, a former faculty member of the University of Pennsylvania, is president of McGuckin Methods International and an invited task force member of the World Health Organization's Global Patient Safety Challenge. She is also the co-author of The Patient Survival Guide: 8 Simple Solutions to Prevent Hospital and Healthcare Associated Infections.

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