The on-call experience of interns in internal medicine

Article Abstract:

Medical interns typically endure far longer training periods, with far greater stresses, than recruits in military boot camps. In addition, errors caused by fatigue and lack of experience, coupled with lax supervision, have potentially grave consequences. This was the case with a patient named Libby Zion, a young woman who died as a result of inappropriate treatment by a tired and unsupervised intern. In addition to the publicity given this and other cases in recent years, changes in values and a drop in the number of young people entering internal medicine are causing internship programs to be reevaluated. Older physicians' quasi-romantic memories of surviving their internships must be reconciled with the need to provide good teaching and good patient care. In this study, 11 interns were observed throughout a 34-hour on-call period. Although a special night team was supposed to evaluate newly admitted patients at night, interns often performed this task up to 2:30 a.m. The average length of time spent with a new patient decreased from 93 minutes before midnight to 85 minutes after midnight. Partly because of these late admissions, the interns averaged 2.5 hours of sleep over the 34 hours, and less than 1.5 hours eating. During the whole time, seven of the interns had five minutes of supervision or less, with five of them receiving no supervision at all. It is clear that these interns spent very little time with patients; they were frequently interrupted, lacked adequate sleep, and spent a tremendous amount of time filling out forms and performing data searches. These results are consistent with those of an earlier study in a different hospital. There was almost no bedside teaching and very little supervision of the interns. Training programs will have to be reevaluated in order to determine and correct deficiencies, attract more high quality interns, and provide adequate patient care. (Consumer Summary produced by Reliance Medical Information, Inc.)

Interns (Medicine), Medical interns, Graduate medical education, Internists

---

Changes in physician attitudes toward limiting care of critically ill patients

Article Abstract:

Ethical, moral, and legal decisions concerning the type and duration of treatment to be provided for critically or terminally ill patients must frequently be made by physicians treating such patients. In making these decisions, health care providers must weigh the benefits of administering life sustaining treatment against the risks of inflicting pain and prolonging suffering in the face of a hopeless prognosis. Numerous factors, including monetary (payment mechanisms), legal, and attitudinal (on the part of the medical establishment, lay persons, and medical ethicists) issues, have contributed to the shift seen in the last decade in the way treatment of terminally and critically ill patients is approached. To more fully quantify changes in physicians' attitudes, which may have taken place between 1980 and 1990, a confidential written survey was sent to all faculty members, medical fellows, and residents in the medicine department of an urban teaching hospital in 1981 and again in 1988. The questionnaire was sent to about 130 individuals at each time point. Survey questions dealt with topics such as the administration of aggressive treatment to patients with little chance of recovery, comfort level discussing "do-not-resuscitate" options (directions not to administer CPR or other life-saving treatments to a terminally ill patient), and other moral and legal issues concerning gravely ill patients. At both survey times, the patient's expressed desire to live or die was the most important determinant of the decision concerning the provision of care. In 1988, physicians were more concerned about malpractice considerations, more comfortable discussing options that would allow the patient to die, and were more likely to make decisions that would result in a patient being allowed to die (as per the patient's request) than in 1981. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Terminal care, Ethical aspects, Medical ethics, Life support systems (Critical care), Life support care

---

Are two (inexperienced) heads better than one (experienced) head?: averaging house officers' prognostic judgments for critically ill patients

Article Abstract:

Inexperienced physicians, generally referred to as house officers (interns, residents, and fellows), may have to make decisions about the prognosis and management of severely ill patients in the absence of an experienced physician. It was hypothesized that the combined judgments of several junior and senior house officers might be as good as decisions made by an experienced critical care attending physician. The probability of survival until hospital discharge for 269 severely ill patients admitted to the intensive care unit was estimated by interns, residents, critical care fellows, and attending physicians on duty within 24 hours of the admission. These judgments were compared with the actual death rates; 77 percent of the patients did survive until discharge. The results show that the judgments made by junior house officers and fellows were less reliable than those made by attending physicians. All physicians had good discriminating ability. A combination of judgments made by residents and fellows was as discriminating as that of the individual attending physician. Combining the judgments of several physicians may compensate for any extreme individual estimates and may also utilize complementary abilities of different physicians. One method whereby the decisions of physicians with varying degrees of experience could be effectively combined is voting on decisions by secret ballot. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medical care, Study and teaching, Health services administration, Prognosis

Similar abstracts:

• Abstracts: The sensitivity and specificity of clinical diagnostics during five decades: toward an understanding of necessary fallibility
• Abstracts: Carotid endarterectomy in a community hospital: a change in physicians' practice patterns. Comparison of regional and general anesthesia for carotid endarterectomy
• Abstracts: Healers and strangers: immigrant attitudes toward the physician in America - a relationship in historical perspective
• Abstracts: Healers and strangers: immigrant attitudes toward the physician in America - a relationship in historical perspective. part 2
• Abstracts: One year's experience with a noninvasively monitored intermediate care unit for pulmonary patients. Intensive care of status asthmaticus: a 10-year experience

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.