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Comment and Controversy

Limitations on work hours make residents and patients safer

May 2008 · Vol. 20, No. 05
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“Fatigue: It’s a fickle member of the obstetrical team,” by Robert L. Barbieri, MD (Editorial, December 2007)

I trained in the era of 36-hour call every third to fourth night and 120-hour work-weeks in residency. I had four young children, including a toddler. My husband picked up the oldest three kids, but I would swing by the day-care center for my youngest child on my way home from work.

One evening, I awoke at the wheel as we jolted to a stop in a bar ditch, with my 3-year-old exclaiming, “Whoa, Mommy! Whoa, Mommy!” Neither I nor my daughter was hurt, but we had just come through a busy two-way stop at a major highway intersection, which I did not remember driving through. I apparently crossed through it and entered the ditch several hundred feet past the intersection.

After that, I never picked up any of my children after call again. Changing the way we worked as residents was not an option—it was accepted that that was the way things were.

I am teaching now, after many years in private practice in which I often carried over to the next day to see patients or operate after being up all night with a delivery. I welcome the changes taking place in residency and practice. Although I do believe there are times when continuity of care is lost in what has become shift work with the residents, I think residents and patients are safer in the long run—even if it is just to drive home after work.

Virginia A. Rauth, MD
Galveston, Tex

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