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There is a typo in the abstract, it should read:
"Unlike other professions where common sense, decency and a free market to negotiate one's job sets working hours, medicine is different.... https://twitter.com/NEJM/status/1276304166340587521
"Unlike other professions where common sense, decency and a free market to negotiate one's job sets working hours, medicine is different.... https://twitter.com/NEJM/status/1276304166340587521
... in violation of Sherman anti-trust, we have a monopoly on jobs, which permits us to engage in inhumane working hours, increasing needle-sticks and car accidents among our workers while keeping hours low and revenue high...
... this came about because a hundred years ago in one tiny region in one country a group of male doctors, many of whom used stimulant drugs, established these conditions...
... thankfully, we escape anti-trust litigation by having Congress and President GW Bush sign a law that specifically exempts us...
... of course, pressure to self regulate is high; so to that end, we launched a series of 'pseudo-research articles' --
typically we use a 1% 30 day Medicare mortality increase as a non-inferiority margin to show long work hours is non-inferior to shorter ones (aka safe)...
typically we use a 1% 30 day Medicare mortality increase as a non-inferiority margin to show long work hours is non-inferior to shorter ones (aka safe)...
... we pick that margin cuz it is big enough to parallel park a school bus in-- aka meaningless-- but folks will not be able to pick that up...
... in the latest edition of our 'pseudo-research' agenda, we ask if 24 hour shifts have more errors than 16 hour shifts. We find it has fewer errors (yay!)....
... of course, defining errors is subjective, and one wonders if an independent team of coders would conclude similarly...
... we also did not emphasize the fact that the shorter hour shifts had more patients per resident (aka greater workload)-- though there may be other ways to measure workload that we did not assess...
... we also made sure to not have a true control arm of 'reasonable hours' because that might look better than either 16 or 24....
... and we certainly don't want to live in a world, where we beginning by setting fair hours for staff and then build around them systems to keep patients safe...
... we reserve that only for physical therapists, nurses, attending physicians, respiratory therapists, kitchen staff, engineering, IT, custodial services, ancillary staff, administrators...
.... well, pretty much every other job in the hospital; except this one job, where residents will have to keep working until they themselves run the RCT proving they can go home for the day."
PS your are welcome
PS your are welcome
