Opening Pandora's box: residents' work hours.

In March 1984, an 18-year-old woman named Libby Zion died at the New York Hospital a few hours after she had been admitted through the Emergency Room. Her death was unexpected and therefore prompted a series of investigations that have resulted in recommendations for profound changes in the medical profession, at first in the USA and later in many other countries [1,2]. The media coverage of the Libby Zion case prompted questions about the quality of care in teaching hospitals. Many questions focused on the long hours that interns and residents work. The grand jury that investigated the case recommended that ‘the State Department of Health should promulgate regulations to limit consecutive working hours for interns and junior residents in teaching hospitals’. At the same time a sociological study of residents suggested that long work hours and other intense pressures of clinical training, condition physicians to view patients as enemies, in contradiction of the implicit and desired principles of patient care [3]. An Ad Hoc Advisory Committee, appointed by the commissioner of the New York State Department of Health, recommended that the shifts worked by house staff and attending physicians in emergency services be limited to 12 hours, and that physicians caring for patients outside of the emergency services work in shifts limited to 16 hours with at least 8 hours off between shifts. Potential problems of implementation included effects on graduate medical education, hospital staffing, malpractice litigation, and health care financing. Analysis of the proposed recommendation showed a need for an additional 2045 attending physicians and 974 ancillary personnel or their full-time equivalents in 50 New York City hospitals. The political pressures to limit residents’ working hours stem from both a desire to improve patient care and the personal demands of residents and …