December 1, 2003

Running For Cover
As a physician at a major New York City teaching hospital, I have seen the training of house staff change from instruction in caring for individual patients to an exercise in rushing to the end of one’s shift [“The Doctor Is Out,” by Craig Horowitz, November 3]. I have seen resident physicians, after struggling to stabilize patients with multiple problems, forced to leave because their shifts were up. Resident physicians desiring to go to the library to learn are told to leave—studying on campus violates Bell rules. When I ask residents about a patient, they frequently answer, “I am covering the patient,” rather than, “I am that patient’s doctor.” Is that what we want? Lack of sleep has been shown to decrease the efficiency of airline pilots and cross-country truckers. In those settings, continuity is unimportant—easy enough to change driver or pilot. Continuity of care does matter in medicine.
—Richard J. Meyer, Manhattan

Outrage In Residence
I noticed that nowhere in Craig Horowitz’s article was there a single interview with a current medical resident. If he had gotten both sides of the story, he would have a fuller picture of the true intentions and benefits of the 405 law. Surgery is historically the worst residency, and the surgeons overseeing the program are intent on torturing those below them—a sort of “we went through it, so now you will” mentality. So of course surgeons are outraged when their residents can’t legally spend endless hours with patients; it means they have to come off the golf course and actually follow up with the person they cut open hours earlier. The 405 regulations aim to protect patients from the harms of overworked and exhausted residents, most of whom work well beyond the 80-hour limit.
—Madeleine Perez, Manhattan

Night Moves
As a practicing physician who finished residency training in 1986, I have strong opinions on the recent legislation regarding physician work hours. I know that now I am more useful to my own patients when they awaken me in the middle of the night than some well-rested covering physician would be. Similarly, as a resident, even in the middle of the night I was far more useful to patients I had examined and had seen daily on rounds than any wide-awake “night float” physician—who would be reading their chart for the first time—ever could be.
—Allen Natow, Woodmere, N.Y.

Doctor Deficit
Libby Zion’s death drew attention to the problem of residents’ hours, but the “solution” enacted two decades later omitted half of what was needed. Doctors in training no longer work 36-hour shifts and 110-hour weeks. But the other obvious half of the solution—hiring more doctors—never happened. Instead, we are left with even worse staffing shortfalls, and junior doctors are left to cover impossible numbers of patients. “The Doctor Is Out” notes that hospitals “don’t have the money to hire more nurses or physicians assistants.” Well, guess what? You get what you pay for! Find the money, and hire more residents or physician’s assistants—or don’t expect adequate care. 
—Daniel R. Jacobson, Manhattan

Wing and a Prayer
The loyal West Wing fans I know share John Leonard’s view that the post-Sorkin West Wing is no longer “must-see TV” [“Television: Fantasyland,” November 10]. It’s a hard thing to accept—and we’ve all tried—but we are sadly conceding that not only has thoughtful treatment of complex issues disappeared from the program but the dialogue, story structure, and shooting have all become lowest-common-denominator TV. Now my friends and I can no longer pretend that, if only for a brief, Wednesday-night fantasy moment, the A team is in the White House. We will just have to accept that it’s the American Enterprise Institute team 24/7. Maybe this is a good thing. Instead of bemoaning the loss of “our” West Wing, maybe it’s time for us to get busy taking back the whole building.
—Walt Borton, Santa Fe, N.M.

December 1, 2003