They prescribed Demerol, a sedative. But her thrashing continued, and the intern on duty, who was just eight months out of medical school, injected another sedative, Haldol, and restrained her to the bed. Shortly after 6 a. Seven hours after she was admitted, Libby Zion was declared dead.
Reforms followed, albeit slowly. In , New York State cut the number of hours that doctors in training could work, setting a limit of 80 hours per week.
And in , the accreditation council imposed the hour limit on all U. To Landrigan, this was tremendous, if incomplete, progress.
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Interns working the traditional hour shifts made 36 percent more serious medical errors, including ordering drug overdoses, missing a diagnosis of Lyme disease, trying to drain fluid from the wrong lung and administering drugs known to provoke an allergy. But this is where the neat story of the correlation between doctor fatigue and hospital error hits a wall.
A massive national study of 14 million veterans and Medicare patients, published in , showed no major improvement in safety after the reforms. The researchers parsed the data to see whether even a subset of hospitals improved, but the disappointing results appeared in hospitals of all sizes and all levels of academic rigor. Landrigan was dumbfounded. His experimental results aside, he was also moved by his own experience. I was also a resident there at the time. One night in , he had just gone to sleep in a call room when a nurse burst in to say that a 9-year-old girl, who had been admitted with asthma, was deteriorating rapidly.
Rather than rushing to the suffocating girl, Landrigan, dazed from fatigue, arose from bed, sauntered into a bathroom, locked the door and began brushing his teeth in a confused state.
Another doctor responded and put the girl on a ventilator, saving her life. Landrigan was working on his own large-scale study when the Medicare study came out. His team read the hospital charts for thousands of patients from to The results, published last year , were equally sobering and showed that roughly a fifth of all hospitalized patients suffered harm from medical errors; cutting trainee work hours had no impact.
The question, then, is why? There are several possible explanations for the failure of the nationwide hour rule to reduce medical harms. In , the journal Pediatrics reported that two-thirds of residents regularly broke the rule, suggesting that poor enforcement, perhaps related to ingrained norms, had undercut the reform. Landrigan, one of the authors of that study, also thinks that the accreditation council did not go far enough; it had not, after all, banned being on call overnight and still allowed shifts up to 30 hours.
Now that the council has abolished extended shifts, at least for first-year residents, Landrigan expects fewer errors. And yet there are reasons to believe otherwise. About 98, people die every year from medical errors. Some of those mistakes are made by doctors whose judgment has been scrambled by lack of sleep.
But fixating on work hours has meant overlooking other issues, like lack of supervision or the failure to use more reliable computerized records. Worse still, the reforms may have created new, unexpected sources of mistakes.
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Shorter shifts mean doctors have less continuity with their patients. If one doctor leaves, another must take over. Work-hour reductions lead to more handoffs of patients, and the number of these handoffs is one of the strongest risk factors for error. As a result, many hospitalized patients are at the mercy of a real-life game of telephone, where a message is passed from doctor to doctor — and frequently garbled in the process.
To his mind, the fundamental problem is that most training programs fail to teach how to clearly convey vital information. A survey found that 60 percent of residents received no training in proper handoff procedures. Here is a stark example of what Sectish is complaining about, from a recent study of handoffs at Yale-New Haven Hospital, in which all trainee handoffs at the hospital were recorded for two weeks and analyzed to better understand communication problems. This is a verbatim record of a trainee giving a report to the doctor coming on shift:.
But she also had, she had something else. Yeah, I guess it was just this. How was the on-shift trainee to make sense of that? On average, one in four sessions studied resulted in errors. This was a light census; some nights, trainees can manage up to 40 patients. There were no supervising doctors or nurses in the room, which is typical.
View all New York Times newsletters. Next on the list was a toddler with meningitis. Twenty minutes after they started, the handoff was over. The interns were repeatedly interrupted. The chain of responsibility was sometimes left unclear. In a three-month pilot project, young doctors were given team training, used computerized patient summaries and a structured verbal handoff for example, always beginning with the sickest child, then a quick summary of the illness.
Impressively, medical errors fell almost 40 percent and the amount of time doctors spent with patients increased. Residents throughout the hospital adopted the system this summer the interns I saw had not yet been trained.
Doctor Who: 25 stories that deserve more love | Den of Geek
Clara returns to help, offering Akhaten the leaf that blew into her father's face on the day he met her mother, which contains an infinite amount of untold potential that Clara's mother never saw because she died early. Akhaten, overwhelmed by the infinite potential it has consumed, implodes on itself and the Rings are saved.
The Doctor returns Clara to her home on the same day they left and gives her back her mother's ring, telling her that all the creatures she saved wanted her to have it back. Edem's first medical school application wasn't successful, but he was accepted after gaining research experience and improving his MCAT score. Webb applied to medical school three times before getting accepted, and now he's an orthopedic surgeon.
Marius was inspired by his parents who immigrated from Nigeria, and the doctor who stabilized his scoliosis. Brent's interest in space exploration and reproductive health have led him to a specialty in Aerospace Gynecology. Ashtin is a first generation college graduate from a rural community who is interested in public health and health policy. Motivated by a personal family experience with cancer, Ogochukwu is pursuing oncology and medical research. Nicholas encourages pre-meds to explore interests outside of medicine because they will make you a better doctor and person in the long run.
Following an injury that left him paralyzed from the chest down, Jeff wasn't sure if he'd be able to go to medical school, but he continued to pursue his dream. Aaron grew up in project housing and dropped out of college twice before applying to medical school. Sarah talks about overcoming her illness and tells others that it's okay get to medical school on their own timeline.
Allison got accepted on her fourth application to medical school. Amanda talks about the importance of supportive family and friends and not giving up on medical school. Growing up as a refugee in Africa, Edmond was motivated by the need for health care.
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During nursing school, he wanted to keep learning so he decided to pursue medical school. University of California, Irvine, School of Medicine, His father's illness inspired Eric to leave his engineering career to pursue medicine. Jaclyn left her career in finance to pursue a career in medicine. Now she balances medical school with being a parent. Clay had a business degree, no science prerequisites, and no experience in a health care setting, but he decided to pursue a career in medicine anyway.
After a career in the church, Suzanne decided to pursue medicine at the age of She says you're never too old to live your dreams. Feeling limited in his role as a teacher, Tyler decided to pursue medicine to help those without easy access to health care. Wells found inspiration in his experience as a patient of polycystic kidney disease and receiving a kidney transplant at age Aponte shares stories about his underprivileged background on a radio show in New York City.
Chronic pain and hospitalizations exposed Julio to medicine at a young age, now he wants to use his experiences to help others. A cardiac doctor shares his journey in hopes of encouraging more minority students to become doctors. Okey explains how cultivating a love for reading, surrounding himself with positive people, and minimizing distractions helped him realize his dream of becoming a doctor.
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