How You Look at Things (Residents and Patient Deaths)

Am I going crazy? I saw this article “shortening trainee doctor hours hasn’t harmed patients” and was confused. I am seeing a young lady and they are seeing the old lady.

The brilliant “educators” are saying this:

“Some still long for the old days of 100-hour work weeks, but most of the world has moved on and realized there are better ways to train residents,” said Dr. Karl Bilimoria of Northwestern University Feinberg School of Medicine, who was not involved in the research published Thursday in the journal BMJ.

Eliminating extra paperwork and some academic conferences for residents, while adding nurse practitioners to the workforce help make training more efficient, Bilimoria said.

I am so biased against these pontificators that I immediately smelled a rat. The world has moved on? What a pompous thing to say. Adding NPs makes the training more efficient? What a ridiculous thing to say. Something must up.

So let’s look at the study. The crux of the conclusion is:

For the study, researchers analyzed data from more than 400,000 hospitalizations of Medicare patients. Using billing codes, they assigned each case to a key doctor who dealt most with each patient.

Then researchers compared cases from two six-year time periods: before and after 2006, when the first new doctors who were fully affected by the reforms had finished their residencies.

This was an era of improvements in patient safety. So researchers compared the new doctors — some affected by reforms and some not — to trends among veteran doctors with 10 years’ experience and all trained under the old rules.

They found no difference in patient deaths, readmissions or costs.

So, this proves that shortening their hours hasn’t harmed patients? Great, but does it prove that they are appropriately trained? NO!!! In fact, you can make the case that having residents working longer hours didn’t increase patient deaths! This supports them having longer hours of training.

Okay, if you read it differently then me will you please tell me what I missed?

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Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  2 comments for “How You Look at Things (Residents and Patient Deaths)

  1. To Ma
    September 20, 2019 at 9:19 am

    Harm here is binary outcome- live vs die. There is a lot of grey between. This is just horrendous.

  2. Debbie Sutcliffe
    September 17, 2019 at 4:46 pm

    Wow— don’t have a clue how you can actually draw such conclusions! (Old school trained, but don’t wish that really on anybody) From what I hear, residents have MORE paperwork and busy work (like all us practicing docs) then ever before! Get rid of that? Absolutely! (Give it to the NPs….)

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