Word: patients
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Harvard's Groopman, who has written three books about the doctor-patient relationship, lived through his own doctor-patient nightmare. It started when his son had a medical emergency in July, which every doctor knows is the worst of all months to go to a teaching hospital. "The new interns and residents begin July 1," he explains. "There's a very morbid joke: don't get sick on the July 4 weekend." But years ago, when he and his wife were new parents, they were visiting her family in Connecticut for the holiday when their 9-month-old son became...
Older doctors are also worried that rules designed to make young doctors' lives easier may make patients' outcomes worse. Back in the day, grizzled veterans say, a medical resident was called that for a reason: he--and they were all men--actually lived in the hospital. "We were aggressive about our training," recalls a former surgical resident at Boston's Brigham and Women's Hospital. "The only thing wrong with every other night call was that you missed half the good cases." But these long hours of dedication came at a cost: tired doctors made mistakes. Studies showed that long...
...reforms made intuitive sense; but the unintended result, older doctors warn, is a 9-to-5 mentality that detaches the doctor from the patient. They fear that young doctors don't get the experience they need or build the instincts and muscle memory from performing procedures so many times that they can do them in their sleep. Even the residents may agree: in a 2006 study in the American Journal of Medicine, both residents and attending physicians reported that they thought the risk of bad things happening because of fragmentation of care was greater than the risk from fatigue...
...medicine at UCLA. "It's all shift work now. When 5 o'clock comes, whatever it is they're doing, they just sign it all out to the 5 o'clock person. It's eroding the sense of duty, or commitment to being the person responsible for a patient's care...
...think of hospitals as cathedrals of science, yet doctors walk around with their pockets stuffed with 3-by-5 cards on which they write patient information; when they sign off for the day they read from the card to the doctor coming on duty. "My pizza parlor is more thoroughly computerized than most of health care," says Berwick. It's easy to see the advantage of giving everyone easy access to a patient's history and test results. But getting there can be painful. Enter a hospital when it is in the process of introducing more computers, they...