on the shift-limit era

” a mad shuffling of pages invariably ensues, as trainees flip through their lists until someone finds the patient and utters the six saddest words of the shift-limit era: ‘I don’t know. I’m just covering.’ ”

I was recently sent this New Yorker article via two rad friends, and thought I’d pass it along. Having done just one rotation — in surgery at our county hospital and major trauma center — I can certainly say that the realities of ‘patient care’ are far from the expectations.  From the student-trainee perspective, the constant handoffs and checklists mean that there is also no continuity of education: just chance overlaps with overworked residents. It wasn’t until my last week when one attending said, “We need to have patients’ full names on the (rounds) list; how can we deliver care to acronyms?”

The most effective metric I’ve seen, to continue valuing what is quantifiable, is lowering the resident-to-bed ratio. I think sleep is less a factor than volume; when residents have 5 patients, they’re able to keep track. When there are 20 each day, it’s nearly impossible. Sadly, due to budget and social structure, hospitals that treat minority populations often have the most overwhelmed residents. But hospitals are massive and inefficient wheelhouses in general: it’s amazing the number of people — again, often minorities and working-class people — who present with dire surgical cases that could have been avoided with regular primary visits and self-care.

 

imagenew yorker courtesy of the New Yorker

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