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Helene Pavlov, M.D.

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Is Rest Time for Physicians and Pilots Out of Control?

Posted: 01/18/11 12:20 PM ET

When did things become so controlled? Is too much control a problem? We encourage hand washing, but too much, e.g., hand washing for no reason, would be labeled obsessive.

Recently, at the airport, my plane was prevented from taking off because the crew that was on board the plane would have been on duty beyond their mandated work hours. Sounds like an idea with safety for passengers and crew in mind. However, my immediate thought was -- it is only a two-hour flight -- could that additional time truly affect safety? Should there not be some built-in flexibility? Should not the "rule" allow for an occasional extended shift within a given specific time period? Perhaps this rule already exists, but as just one member of the traveling public, I am unaware of it and the chaos that followed at the airport from the flight cancellation could have been avoided.

This airline safety mandate, limiting the work hours of the airline crew, has a parallel with the "physician in training" restrictions. To summarize, a "physician in training," a Resident or Fellow, must by "law," have 10 hours without any responsibilities, daily. If a "physician in training" has responsibilities or is called for duty during their period of "rest" to finish attending to a patient during surgery or at the bedside, etc., then the trainee is required to leave and turn over the required care to another professional or they must extend the "time without duty" proportionately into the next day. The 10-hour rule applies even if it means that the trainee will miss an informative morning or afternoon conference, a surgical procedure of interest, which would benefit their education, etc. This mandate is so rigid that there are substantial penalties to the training hospital for failing to be in compliance.

I often wonder when the Resident or Fellow is no longer "in training" will he/she still expect protected "rest" time? Will their patients understand that their physician may not be reachable during "protected time" and maintain a "no call time period?" Will the physician even be able to react appropriately when their patient has an emergency during the physician's scheduled time off?

Clearly, exhausted physicians or pilots are not desirable, however, reasonableness is. Should there be some flexibility, some element of common sense, built into "safety" mandates? At what point do "safety" mandates compromise the goal of training and patient care and ultimately, safety? Do we need to re-think safety and flexibility in professions that do not work on a 9-5 model? Do we need to rethink of our physicians as hourly workers? When does control become obsessive and should possibly be more appropriately labeled, "out of control?"

HSS