I agree with nearly all of it, but have to criticize some points...
You're right about many people not understanding that total exhaustion. On the other hand, because the profession didn't handle problems like resident fatigue and night float adequately, the ACGME was put into the position of having to push through something less than perfect. I also find it rather insulting to claim that there's no understanding of these problems just because there are disagreements--note that the surgical "profession" (trade?) receives the benefit of government intervention by supporting the "guild" restrictions that keep the number of surgeons down. A truly "free" market would not prosecute those who don't have a government license requiring concurrence of the guild.
So how was this presentation received during Grand Rounds?
(BTW, if that study was in the ANALS of surgery, does it mean it's only for colo-rectal surgeons?? ;-)
And another question...isn't it unethical to provide elective care to lawyers, when their interests are so contrary to your own? Isn't any surgeon thereby acting in a potential conflict-of-interest situation?
And finally, a wonderful tribute to Taylor and Derek.
Glad you liked it. I agree that as a profession we didn’t handle work hour issues effectively. There have been benefits to the 80 hour work week... I think we work more efficiently now and some of the abuse of residents has subsided. That being said we are starting to see a change in the mentality of those entering surgery residency... more see it as shift work and don’t accept ownership of the patient and that is dangerous.
The claim that there is no understanding regarding restrictions of resident work hours refers to the politicians that are pressuring the IM and ACGME to further restrict hours. I know those within the medical profession on those boards recognize the pros/cons of hour restrictions. We must also recognize a significant difference exists in how certain specialties are trained and that should be reflected in the ACGME’s policies.
Yeah, the Annals sounded a little more like Anals (I was too tired to go back and rerecord that audio though :))
It got an extremely positive response at Grand Rounds, all the requests for copies is what led me to post it online.
The Guild issue is an interesting one, and honestly I hadn’t really thought about it. I still think it is necessary to ensure that those practicing have meet certain requirements that the profession establishes for the safety of patients.
Is it unethical to treat Lawyers? I don’t think I would go that far. I only aim to point out that it is not unethical to refuse elective care to those that would destroy us.