Duncan spent four years observing, and sometimes living among, residents in more than a dozen U.S. hospitals. He saw dosages mixed up, drugs given that shouldn't have been, procedures put off for days because a resident forgot or was too busy, and horrific, life-endangering incidents that might never have occurred with proper supervision. He met overworked, pushed-to-the-edge residents everywhere, many suffering severe sleep deprivation, overwhelmed by a system that uses errors as a training tool and purposely places young physicians with minimal training in complex, intense situations. All those he interviewed spent at least 20% of their time-and often 70%-at such basic tasks as finding clean sheets and starting intravenous drips without backup support. Suicides and suicide attempts were shockingly frequent among residents. Duncan (Hernando de Soto) has written a chilling expose that should be read at all hospitals and medical schools. His proposed reforms, including protected sleep time, hands-on teaching, tighter supervision and caps on the number of hospital admissions, seem eminently sensible.
Copyright 1996 Reed Business Information, Inc.
From Library Journal
Being a physician is a privilege, but how that privilege is earned is an issue for educational theory and practice that is now being bitterly contested. Nowhere is this more evident than in the training of interns and residents. From William Osler and Abraham Flexner to recent events such as the Libby Zion case (see Natalie Robins's The Girl Who Died Twice, LJ 8/95) and the New York State Bell Commission, reformers have confronted traditionalists in an idealistic struggle. Duncan, a journalist and author married to a pediatrician, has gathered a riveting collection of facts and stories and fairly presented all sides of this vital and complex issue. Advocates of a "total immersion" residency program that they claim has produced the best doctors in the world are challenged by those who are convinced that residency programs are unduly harsh and leave new doctors scarred and burnt out at the beginning of their careers. Of fundamental concern is the question of how severely rigorous and demanding residency programs put patient care at risk by allowing inexperienced residents to learn the art of medicine on real people. Duncan's presentation of the powerful tension in medicine between differing pedagogic ideals is highly recommended for medical school libraries and other medical collections.?James Swanton, Harlem Hosp. Lib., New York
Copyright 1996 Reed Business Information, Inc.
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