Doctor Who? Patient Perceptions of Housestaff Involvement In Their Care

patientPerception  Critical decision making skills necessary for autonomous practice are acquired through experiential learning in residency. Increasingly restrictive duty hours may threaten the number of these experiences and sense of patient ownership during residency. In this 12 year study, patients were asked “who was most involved in your care?” and were given options of student, intern, resident, attending, nurse, other, and “I don’t know.” Not surprisingly, the most common response overall at this urban academic medical center was “I don’t know” (29%). Different duty hour periods were compared – defined as pre-2003 (80 hour workweek), post 2003 and pre-2011, and post 2011 (intern 16h work rule), and the results were intriguing. Pre-2003, patients equally reported housestaff and attendings as most involved (20%), but as time passed the percentages fell in favor of the attendings. Post 2011, patients reported the attending as most involved 37% of the time and housestaff only 13% (interns a dismal 3%). While causality cannot be proven, and co-interventions related to other quality improvement measures may be confounding, there appears to be a strong trend over time correlating to the reduction in work hours. Bottom line? Encourage ownership of the real patient in addition to the i-patient and pursue more direct observation of trainees. – Dana Herrigel, MD

Arora, VM, Prochaska, MT, Farnan, JM, Meltzer, DO. Patient perceptions of whom is most involved in their care with successive duty hour limits. J Gen Intern Med. 2015; 30(9): 1275-8.

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