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Physicians work hours: desperately seeking evidence

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Commentary on the paper by Gander et al (see page 733)

Evidence-based medicine is the cornerstone for excellence in healthcare delivery. However, as a group, physicians have been reluctant to advance the necessary science and to examine in depth related science to formulate evidence-based safe work schedules.

A case in point is the history of work hour regulation for physicians in training in the USA. The first statewide attempt to regulate work hours occurred over 20 years ago in response to the death of a young woman in a New York City hospital. The womans father was a New York Times reporter and former federal prosecutor, who pressed for criminal prosecution. A grand jury heard the case and concluded that the prolonged work hours of the house staff (junior doctors) caring for the woman contributed, in part, to a medication mistake that resulted in the young womans death. An ad hoc advisory committee of prominent physicians, without expertise in sleep and circadian disorders or neurobiology (the Bell Commission), reviewed the grand jurys report and agreed that excessive work hours might have resulted in fatigue-related errors. The committee developed a work hour policy based simply on the mathematical midpoint between the 40-hour workweek schedule for the majority of the American workforce and the 120-hour workweek that many house staff in New York City were working at that time. Without a well-substantiated scientific basis, this costly regulation was not enforced. Eventually, medical students in the American Medical Student Association began to …

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