The 80-hour week, and its aftermath

I read with interest your recent article on resident hours [“Re-creating the Residency,” Fall/Winter 2004]. I was among the physicians who testified at the grand jury that investigated the Libby Zion case. While it is true that the grand jury did not indict anyone, they did find that there was a significant cause for concern and issued a report to the New York state legislature. This led to the formation of the Bell Commission, which recommended the 80-hour workweek and increased supervision of house staff. It was this report that ultimately led to the passage of the 80-hour limit for house staff in New York.

The invective from organized medicine against these rules was ferocious. It put medicine at direct odds with the public, for whom these rules were self-evident and made unquestionable common sense. They believed that no one could work 100 to 120 hours a week and still provide the level of care and cognitive functioning that the public required of their physicians. They also intuitively understood that the more physicians were asked to deny their own needs while in training, the less they would be able to cater to the needs of their patients while in practice. The more medicine railed against the rules, the more the public began to question its judgment. As you correctly pointed out, in many ways this was one of the strong impetuses for the patient safety movement. In addition, as medicine chose to specifically break the law in New York by not adhering to the hours limit, the public perceived medicine as viewing itself as being above the law, as being paternalistic and as acting in its own financial best interests. The resulting furor has led, in part, to the distrust that has been increasingly seen in the public’s opinion of American medicine.

Yale has now taken a leading position in the intelligent implementation of these rules. Yale’s leaders assessed the problems for patient care that the rules raised and put into effect specific solutions that addressed them. They committed themselves to an ongoing look at the process and continued improvement as problems arise. The resulting system of training will be good for patient care, house staff training and the view of medicine by the public.

Gerald M. Brody, M.D. ’77
Tuckahoe, N.Y.