1

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When you are admitted to a hospital through the ER, what standard of care do you expect from the attending Physician and the Resident Interns?

Answered on August 19, 2014
Created May 09, 2011 at 10:55 PM

http://www.kevinmd.com/blog/2011/05/acgme-work-hour-regulations-interns-friend-foe.html

This link goes to a posting by a resident intern in a hospital regarding the almost impossible tasks they undertake in an attempt to provide the best care possible under very difficult working conditions.

The intern outlines that beginning next month, shorter shifts are being implimented. But that may not be good for you, the patient...because now they have to see approximately the same number of patients in less hours.

When you go to a hospital, do you feel you are in good hands and will you survive your hospital experience?

On the night of October 4, 1984, a young girl named Libby Zion was admitted to New York Hospital in Manhattan for fever, agitation and strange jerking movements. No one knew that her death the next morning would, 27 years later, drastically change the quality of physician training, for better or worse.
When Libby was evaluated in the emergency room that night, neither the ER physician nor her family physician Dr. Raymond Sherman, consulted by phone, were able to make a definitive diagnosis of what was going on with Libby.
They decided to admit her for hydration and observation. When an intern Dr. Luise Weinstein and a resident Dr. Gregg Stone evaluated her for the admission, they also were not sure of Libby???s cause of illness ??? Dr. Stone termed it ???a viral syndrome with hysterical symptoms,??? suggesting that Libby may be overreacting to a benign viral syndrome. They prescribed her Meperidine to control shaking, and Dr. Sherman approved the plan by phone without evaluating the patient. Dr. Weinstein went on to care for 40 other patients in the hospital that day, while Dr. Stone went to sleep in the next building, to be reached by beeper if needed.
Later on that night, the nurse contacted Weinstein when Libby became more agitated and started pulling out her intravenous lines. Weinstein ordered restraints and Haldol, a medication used for agitation, without re-evaluating the patient. She also did not notify Stone or Sherman. Libby finally calmed down later that morning, until 630 AM when a vital sign check showed that Libby had a dangerously high fever to 107. Measures were taken to reduce her temperature, but Libby soon suffered cardiac arrest and died.
On careful review, it was discovered that Libby was taking an antidepressant named Phenelzine. Combined with Meperidine given to her in the hospital, Phenelzine can cause fatal serotonin syndrome, symptoms of which include hyperthermia resulting in cardiac arrest.
What follow were outraged parents, a high-profile court trial and the image of the bedraggled, unsupervised intern wreaking damage in hospitals featured in the pages of the Washington Post, the New York Times and Newsweek. Libby???s parents believed that her death was caused by inadequate supervision and fatigue from long work hours. This sparked work hour regulations for residents and interns, which continued to evolve even 27 years later. In 2010, the Accreditation Council for Graduate Medical Education (ACGME) announced stricter work hour regulations, from 30-hour shifts in 2003 to 16-hour shifts to take effect in July 2011. It also stipulated that residents must have 8-10 hours off between shifts, with total work hours/week not exceeding 80 hours.

Be sure to read the whole posting at: http://www.kevinmd.com/blog/2011/05/acgme-work-hour-regulations-interns-friend-foe.html

Do you have confidence in the staff at your local hospital? How does a lay person evaluate or do we go blindly to the hospital hoping we will survive the very best care possible?

06d21b99c58283ce575e36c4ecd4a458

(9948)

on May 10, 2011
at 05:15 AM

Water-ratt, It is great you have a relationship with Docs & nurses. But what about the rest of the folks with no advocates watching over them?

88cffa260e8259942de579503d282ee7

(466)

on May 10, 2011
at 12:59 AM

Yes I have confidence in my local hospital, as a paramedic I know most of the Docs & nurses. One suggestion is to always have an advocate for you at bedside. The advocate can ask questions and notice changes in your condition. Learn the assigned nurses name and be very nice/polite. Don't be afraid to ask questions? what are you giving me? for what purpose? are there any side effects? Try not to be a pain in the ass with the questions.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on May 10, 2011
at 12:03 AM

Luckily, emergency care is not closely tied with diet. So it's really that going to an emergency room kinda sucks no matter who you are. But quality of care is not generally thought to bad in the ED compared to other specialties (at least according to my old ED doc roomie). Emergency medicine residents are often interested in public health kind of stuff as well, and are fairly cool.

06d21b99c58283ce575e36c4ecd4a458

(9948)

on May 09, 2011
at 11:52 PM

Yeah, maybe off topic. But you have learned to eat paleo and take care of yourself and for some reason you end up in an ER by an accident or an illness and you have virtually no control over the care you receive.

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1 Answers

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21fd060d0796fdb8a4a990441e08eae7

(24543)

on May 09, 2011
at 11:32 PM

This question might be a little off-topic when it comes to paleo eating and lifestyle.

But to answer it anyway, you can look at ratemds.com or vitals.com to see doctor ratings, or US News and World Report to see hospital ratings. Both are extremely flawed, as things such as bedside manner or errors are not quantified. It's pretty much a crapshoot for emergency admissions.

I heard a rumor that maximum residency working hours are going down in 2015. That could be good, or really really bad.

06d21b99c58283ce575e36c4ecd4a458

(9948)

on May 09, 2011
at 11:52 PM

Yeah, maybe off topic. But you have learned to eat paleo and take care of yourself and for some reason you end up in an ER by an accident or an illness and you have virtually no control over the care you receive.

21fd060d0796fdb8a4a990441e08eae7

(24543)

on May 10, 2011
at 12:03 AM

Luckily, emergency care is not closely tied with diet. So it's really that going to an emergency room kinda sucks no matter who you are. But quality of care is not generally thought to bad in the ED compared to other specialties (at least according to my old ED doc roomie). Emergency medicine residents are often interested in public health kind of stuff as well, and are fairly cool.

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