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39th
$1,250,000
Madeline Friedman
ABR, CRS, GRI Vice President
296-1956 888-296-1956
Madeline is Your Connection to
Tucsons Favorite Neighborhoods!
www.tucsonazhomes.com TucsonHomeFinder@aol.com
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Adam D. Ray,
MD
W
hy the history for county medical societies to be established in every
lesson? There U.S. state and territory, stating that it was the
have been responsibility of professionalism to belong to a county
significant changes in the medical society. The county medical societies would
Pima County Medical be constituents of their respective state or territorial
Society (PCMS) recently societies. The state and territorial medical societies
and more will occur in the would then elect delegates to the AMA. This basic
near future, including the structure persists to this day, even though delegates
consolidation of Sombrero from specialty medical societies, medical students and
magazine with the publica- medical residents are now elect to the AMA.
tions of the Arizona Medical
At its annual meeting in April 1904, ArMA called for the
Association (ArMA) and
formation of county medical societies in Arizona. On
Maricopa Medical Society
October 13, 1904, seven physicians met and adopted
(MCMS). This is part of an
the constitution and bylaws for the Pima County
ongoing evolution, so I
Medical Association. The mission statement included
thought it was important to explore the relationships
so that the profession shall become more capable
among the medical societies, changes in the medical
and honorable within itself, and more useful to the
care environment in Pima County, Arizona and the U.S.
public, in prevention and cure of disease, and in
These changes are interrelated with changes in society
prolonging and adding comfort to life. The original
and methods of communication, which have also
members were William V Whitmore, MD, President;
evolved significantly during the last 170 years.
Arthur W Olcott, MD, Vice President; Joseph W
1847-1904 Lennox, MD, Secretary-Treasurer and charter
members Henry E Crepin, MD; Hiram W Fenner, MD;
The evolution of the Pima County Medical Society
Walter B Purcell, MD; and Mark A Rodgers, MD. Dr.
(PCMS) and Sombrero have paralleled the evolution of
Rodgers later founded The Rodgers Hospital, the first
clinical practice in Pima County and the evolution of
hospital in Tucson with obstetrical services.
national and international clinical communication.
Pima County almost had the first county medical The first functional typewriter was constructed in 1808,
society in Arizona. Mariano Samaniego, MD moved but typewriters were not successfully marketed until
from what is now Ciudad Juarez, Chihuahua, Mexico 1874. In 1904 a typewriter cost about $68, equivalent to
to Tucson in December 1878. The medical community about $1,700 today and did not come into widespread
was very small, and Tucson lacked a modern hospital. use until the 1920s. Consequently, in 1904, the
Dr. Samaniego was involved in the effort to create founding documents of PCMS were hand written.
what was to become St Marys hospital, the first
ArMA had already printed standard charters containing
modern hospital in Tucson, which was established in
the word Society, so the name was changed from
1880. On July 29, 1879, Dr. Samaniego hosted a
Pima County Medical Association to Pima County
meeting to explore the possibility of creating a county
Medical Society. In 1904, Yavapai and Maricopa
medical society. In September, 1879, Dr. Samaniego
Medical Societies reorganized according to the
suffered a family tragedy and returned permanently to
guidelines proposed by the AMA.
Ciudad Juarez.
Multiple historic events and movements affected the
The honor of forming the first county medical society in
medical environment before the turn of the 19 th
Arizona may belong to Yavapai County. Differing
century. The first Medical School for Women, the New
accounts date the formation of the society to either
England Female Medical College, was founded in
1884 or 1893. The Maricopa County Medical Society
1848. The first U.S. Female Dentist, Lucy Hobbs
(MCMS) was formed in 1892. The Arizona Medical
Taylor, began practicing in the 1850s. In the U.S., the
Association (ArMA) was establish+ed on May 25, 1892.
first formal meeting of activists for womens rights took
The AMA was formed in 1847 and underwent place on July 19-20, 1848. Approximately 100 people
reorganization in 1901. That same year, AMA called attended, about two-thirds were women. The meeting
T
he footprint of
academic
healthcare is
quickly expanding in
Tucson, with nearly $1
billion in state-of-the-art
buildings under
construction at the
University of Arizona
Health Sciences and
Banner University
Medical Center.
The new 670,000 sq. ft. University Medical Center Tucson
These new structures will is expected to be completed in 2019.
improve patient care and
health care delivery, and enhance interdisciplinary The Bioscience Research Laboratory Building (BSRL)
research and medical education across the University will provide new space for interdisciplinary research,
of Arizona Health Sciences. They will improve the which is a key component of the Colleges strategic
experiences of the College of Medicine Tucson vision for the future. By identifying the intersection of
students, residents and fellows, faculty and patients, health care issues and our areas of expertise, and
and will impact the way our faculty teach, our students then working across disciplines across departments,
learn and health care is provided. centers and other colleges we can find innovative
Health Sciences Innovation Building: solutions to the health care needs of today and
tomorrow.
220,000 square feet
Completion date: September 2018 Banner Health University Medical Center Tucson:
Interdisciplinary training of future doctors, nurses, 670,000 square feet
pharmacists and public health professionals Completion date: Spring 2019
State-of-the-art simulation and innovation 336 private patient rooms, 22 operating rooms,
The Health Sciences Innovation Building (HSIB) will imaging suites and public spaces
triple the space allocated to students community life New diagnostic imaging, diagnostic cardiology,
and interactive education. With an entire floor cardiac cath labs and interventional radiology
dedicated to simulation and the ability to expand our More than $50 million in new patient care
clinical teaching activities, we will be able to keep up equipment and computers for state-of-the-art
with the changing demands of undergraduate medical care
education. Additionally, this new facility fosters
trans-disciplinary collaborations and serves as a
unique place for interactions between teams of
health professionals, students and faculty in
medicine, nursing, pharmacy and public health. It will
serve as the vanguard for interprofessional health
education in the Southwestern United States.
Bioscience Research Laboratory Building:
100,000 square feet
Completion date: January 2018
Collaborative translational research space
(molecular basis for human health, aging and
disease)
Research facilities to support interdisciplinary
research in many health science disciplines The Bioscience Research Laboratory Building will provide much
needed space for interdisciplinary research.
790-2121
Se Habla Espaol
2434 N. Pantano
Established
1971
www.RinconCommunications.com
12 SOMBRERO December 2016
Health Risk
M
y wife, Amy, others. Last year there were more than 3,400
reminded me this confirmed cases of flu in Pima County and of
weekend that the those, 18 died. Even those who are not sick can
boys had not had their flu still be carriers and expose vulnerable
shots yet this year.Its populations including children, pregnant women,
always a bit of a challenge seniors and people who have pre-existing
coordinating schedules for respiratory conditions. Health care workers in
two working parents and particular should get a flu shot as they are caring
two kids, but this is for medically compromised members of the
something that has to be a community.
priority. Routine annual influenza vaccination is
recommended for most persons over the age of
Aside from the hassle of
six months and ideally, vaccinations should occur
being sick and missing
before the onset of flu activity in the community.
work or school, getting your flu shot is a responsibility
That is why its important to get your flu shot early
we all take part in to help protect the health of the folks
or as soon as the vaccine becomes available.
we come into contact with. Amys pregnant patients
and their families count on her to keep them well, and Where to get flu shots:
the last thing they need is to get sick from an
encounter with their OB doctor.The same thing with
Many major employers offer flu shots at the
worksite for little or no cost. Check with your
my boys, not only are they protected from getting the
human resources department to get information
flu, they are reducing the risk of potentially spreading
on flu shot clinics at work.
the flu with children at school who may not be
vaccinated or whose immune system may not be
Many drugstores offer onsite flu shots for a
minimal cost with little or not wait.
working well. For me, I am out every day meeting with
many different community members and I would hate
Local health clinics offer flu vaccinations for free
or at reduced costs.
to think that I made someone ill. Like many families
we spend time with older parents/grandparents who
The VA offers flu shots for those eligible
are more vulnerable and for whom the consequences
Contact your health care provider. Most
insurance plans cover it at little or no cost to you.
of the are more serious.
In addition to getting the flu shot, there are other ways
It is important that we take care of ourselves in getting
to protect yourself and others from getting sick. Flu
a flu shot every year and know that in doing so we are
viruses spread from person to person through
also taking care of our families and our community. So
coughing, sneezing, by touching something with flu
in that spirit, the following information includes a few
viruses on it and in some cases through the air. Make
good reasons to get vaccinated this year:
sure to wash your hands frequently, always cover your
Being sick is costly in terms of productivity for cough (use your elbow, not your hand) and stay home
everyone. None of us have enough time and it when you are sick.
makes good sense to protect ourselves from a
The flu is more serious than the common cold, so its
virus that could take valuable time away from
important to do everything you can to prevent its
other activities, both work and play. The vaccine
spread. Dont waitprotect yourself by getting a flu
is safe, generally has few side effects and doesnt
vaccination. You can be sure my boys, my wife and I
give you the flu.
will be doing the same. n
Limit the risk of serious illness for yourself and
I
m taking this occasion than 200 feet long lined up along the intercostal
to thank Charles waterways. I even knew a captain or two, and on
Simonyi for inspiring occasion while the rich owner was away, I would tie my
me to create my little 17 foot ski boat to one of their anchor lines and
December column. He party on board with friends.
created the main writing
However, I had never seen a ship such as this. It was
instrument that I used, the
more than 230 feet long, covered in military gray with
same tool that you
no corners, no sharp edges, no visible windows and no
probably use every time
identifying marks on its military-style hull except a
you dictate a letter, enter
cryptic number 9906. On the upper deck was a battle-
a paragraph into a
ready McDonald Douglas MD 520N helicopter. It
computerized record, or
appeared to me that the ship was designed to be
prepare one of those
completely invisible to radar. Awestruck, I approached
corny, self aggrandizing
our captain and asked, Is that a new battleship of
Johnny made the honor
Danish Navy design? I was thinking it was meant to
roll holiday letters to friends and relatives.
stealthily cruise the Barents Sea, invisible to Russian
I, like you, had no idea who the heck Charles Simonyi submarines known to frequent the area.
was until recently. I was cruising on my way to see
No, he replied. That super yacht belongs to the
Copenhagens famous Little Mermaid, when our
fellow who created Microsoft Word and Excel. He was
sightseeing boat turned south and headed for most
referring to Charles Simonyi who, somewhat
incredible ship I have ever seen. Growing up around
penniless, immigrated to the US from communist
Fort Lauderdale, I was used to super yachts of more
Hungary in 1967 to study engineering and math at UC
Berkeley. He eventually joined
Microsoft in 1981 as the head of
Microsofts application software
group, and became the chief
architect of Microsoft Word, Excel,
and other widely used application
programs.
Simonyi is also an active
philanthropist. His Charles Simonyi
Fund for Arts and Sciences supports
Seattle area arts, science, and
educational programs Forbes
magazine tags his net worth at an
estimated $1.8 billion. At that time I
did not know he was part of the
Silicon Valley million dollar club,
but with that boat I knew he had to be
one rich guy.
As I stared at this nautical marvel, a
little envy set in, since I knew that I
would never get to set foot on such a
dream ship, unless Charles had
severe allergies and I was the only
allergist nearby.
That night, as I penned a letter back
home, it dawned on me that was
using one of Charless great software
inventions, the same program
W
ay back when
the editor of
Sombrero
magazine, Stuart Faxon,
asked if I would be
interested in writing a
column about photography
and travel. It was around
2000 A.D. that I started a,
more or less, monthly
column titled Behind the
Lens.
Photography has been a
passion since I was a
teenager. I have had a
darkroom everywhere I lived until digital imaging came
along. I have used 120 Rolleiflexs (both double and
single lensed), 4x5 Speed Graphics, under water
Canons, and other brands but I have preferred to shoot
Nikon cameras. My first one was a new, top of the line
35 mm S2 rangefinder with a 50 mm f 1.8 Nikkor lens
that cost me $150 in 1956. Several years ago I sold it
to a German collector for $1500. However I still have
my 35 mm Leica M3 rangefinder and recently shot a
roll of black and white Tri X. Currently Im using a full
frame digital Nikon D 600.
In 1984 I began working with Tucson travel writer
George Ridge. One of our first publications was about
the Amazon River. We hired a boat, a river pilot and a
guide to take us from Leticia, Columbia up river into
Peru. After exploring the jungle, fishing for piranhas
and hunting crocodiles we would wearily adjourn to our
fishing shack hammocks. It set the standard for our Here is the Sombrero from December 1982 with the Matterhorn
reflection image on the cover.
many worldwide adventures.
For several years George and I had a monthly Travel
Page in the Arizona Daily Star. We were in Istanbul, the good fortune to work with many well known nature
Turkey when the Twin Towers came down. Shortly photographers.
thereafter, the columns ended when powers that be
I was just looking at some of my old Sombrero
announced no one would now be interested in
magazines. For the December 1982 issue Editor
traveling.
Eloise Clymer had a special section of photographs
My wife Dorothy and I had always tried to visit submitted by PCMS members. This issue featured
interesting places after an international medical three full pages of color, a novelty for the magazine.
meeting such as a meeting in Singapore on Systemic Dr. Paul Schnur had a page of three black-and-white
Lupus followed by a stay with headhunters in Borneo, images. Dr. Harold Kohl Jr. had Mooney Falls, Havasu
or driving for a week from brewery to brewery in Canyon and Dr. Robert P. Friedman submitted San
Bohemia after a meeting in Prague on Vasculitis. Xavier Mission. My color photo was of a Swiss man
and his dog with the mountain in the background titled
I retired from the daily grind of medical practice in
On a Matterhorn Trail.
1998, after which I became a Trip Leader for Arizona
Highways Photo Workshops. While leading these The December issue was also my first Sombrero
workshops throughout the American West, I have had cover. It is a black-and-white photo titled The Majesty
Full-color offset printing small and large run Fulfillment and inventory
Delivery
UV Coating
Full-color digitally printed envelopes
From concept to completion, West Press is your marketing communications provider.
Scan with
a QR code
520.624.4939 | 888.637.0337
reader enacted
phone. www.westpress.com
I
f youre ready for a rough and tumble adventure to
a town where the pigs outnumber citizens, about
40 miles southwest of Tucson down a washboard
road is a far out and funky sliver of Arizona cattle
ranching called Keeylocko. Its a great day trip to an
entertaining hideaway thats part cattle ranch and part
art installation/movie set.
To reach Keeylocko, head southwest along State
Route 86 to the westerly Hayhock Road turnoff at
Milepost 146. Take this dusty straightaway four miles,
to a Keeylocko signpost that will signal a right turn
onto a passable, bumpy ribbon of a dirt road. Driving Reach Keeylocko off of Arizona State Route 86, approximately
three miles further, youll travel through four more 40 miles southwest of Tucson.
signposts that encourage you onward through twisty
ranchlands. Then, theres a left turn that reveals a hands and cooks when needed. A Korean Army vet
dog-eared entrance gate. Take your car up the uneven, born in the Carolinas, Ed traveled the country after his
dusty risepassing junk oddities and old trucks. Army career before settling in the Sonoran desert
Finally, there it is, Keeylocko one gritty, bizarre street grasslands. He attended the University of Arizona,
set within the wild desert abutting the Coyote learning about agriculture, because he wanted to
Mountains. breed well-armed cattle that could protect themselves
on the range. (Give them back their horns, he says.)
The Cowboy of Keeylocko
He bought the land and built his Keeylocko tin-wood
At 85-plus, Ed Keeylocko still runs his Keeylocko ranch,
town with his own hands in the 1970s, mainly because
a spread of 30-plus acres with 10 wood-tin buildings
he wanted a working ranch to breed his cattle and
that form a Main Street-turned-roadside oddity.
horses.
He checks the fences around his ranch of about 100
Folk Art and Funky
head of cattle and a couple of dozen horses, with the
Over the years Eds eccentric Keeylocko was most
help of a few friends who double as trail bosses, ranch
Pigs outnumber humans on most days in Keeylocko. Photo ops abound around this odd Cowtown.
Keelocko was founded by rancher Ed Keelocko, who began The public is welcome to meander this imaginative
building his wood-tin town in the 1970s. whistle-stop, which has no facilities but plenty of photo
ops. Ed accepts appointments for groups, and for
successful in catching the interest of the avant-garde. these occasions hell fire up the generator, put on the
Now it draws unconventional explorers and a handful smoker, load up coolers of ice and open the saloon.
of music festivals, weddings and film productions each Hell also stomp around town, with the buildings
year. Theres plenty of folk life and character in usually closed until special events like KeeyLocko
Keeylockos creativetown, which includes a collection Days, an annual weekend fest of music, crafts, trail
of endearingly ramshackle buildings, guarded by a rides, BBQs and primitive camping that happens in
drove of squeaky pigs. Theres a fort to browse, the October.
Wild west memorabilia and an assortment of old vehicles are The Blue Dog Saloon is actually a working bar (but call ahead
situated like outdoor art fixings around the ranch. for the schedule of open times and musical performances).
SOMBRERO December 2016 19
Ed has a story behind each of his Keeylocko buildings, even this Stop at Todds (in historic Ryan Field) to get refreshed or order
one hand cashier bank. some good eats prior to your Keeylocko visit.
U
niversity of Arizona pain specialists are Pain clinics nationwide are under-utilized, Ibrahim
offering patients effective treatments for said. Patients think pain clinics are where you go to
chronic pain, most often without prescribing get prescription, which you can probably get from your
potentially addictive opioid-based medications. primary care provider.
In several cases, patients whose pain rendered them In fact, prescribing medications is the least of what we
unable to work have been able to resume working. do in our clinic. What we do most is procedures, and
we often have very good results.
Mohab Ibrahim, MD, PhD, and Amol Patwardhan, MD,
PhD, both assistant professors in the UA College of One example is the spinal cord stimulator, a small,
Medicine Tucson departments of Anesthesiology and implantable device that resembles a heart pacemaker
Pharmacology, are director and co-director of the and sends electrical signals to the brain to block the
Chronic Pain Management Clinic, an outpatient clinic sensation of pain.
at Banner University Medical Center South. In July, a
Patwardhan and Ibrahim are quick to point out that
third pain specialist, Vasudha Goel, MD, assistant
opioid drugs not only are safe when used correctly, but
professor of anesthesiology, joined the Chronic Pain
necessary for patients with chronic pain related to
clinic team.
cancer, surgery and severe trauma.
But whenever possible, patients who
visit the Chronic Pain Management
increase appetite in patients with
Thank you for trusting us to AIDS. More recently, its been used
care for your patients and their to treat neuropathic and multiple
families. We wish you a peaceful sclerosis related pain.
holiday season and a happy
One patient with severe left-sided
new year. pain following a stroke was getting
excellent relief from Dronabinol and
only infrequently resorted to an
opiate for additional relief.
Unfortunately, Patwardhan said, his
health insurance plan terminated
coverage for the medication.
520.544.9890 | www.casahospice.com The comprehensive pain clinic offers
Hospice services are paid for by Medicare patients several other procedures to
help reduce pain, including epidural
steroid injections, joint injections,
I
go to a lot of health care conferences, and of late organizational vein that, once tapped, has the power to
theres a seemingly obligatory slide that crops up in drive other downstream improvements as it
nearly every PowerPoint. Its a now-iconic image of reverberates through an organization. In the case of
a triangle divided in equal parts and labeled as follows: Alcoa, once employees were asked to suggest ideas
improve the patient experience, improve the health for safety improvement they began to surface other
of populations and reduce the per capita cost of issues that had been buried. The rising tide of a more
care. This is health cares Triple Aim, and it is open, problem-solving culture helped raise all of
definitely trending. Alcoas boats and profits.
I must confess that Im not a fan of the Triple Aim. Its At my company, Athenahealth, we are big believers in
not that I dont believe those three outcomes are vitally focusing ourselves and our clients on keystone habits
important. I just dont believe its possible to aim at and corresponding sentinel metrics. Our corporate
three things at once. As a manifesto or creed, its scorecard, for example, is a waterfall that begins with
inspiring. As a roadmap, its a bit hard to follow. workforce stability - over 17 years, weve found that
our success depends on focusing first on managing
A more effective approach to change, Id argue, is the
voluntary turnover, ahead of all other traditional
one taken by Paul ONeill back in 1987 when he was
performance measures (including the ones our
first appointed CEO of the aluminum giant Alcoa. As
investors care about). Any spike in voluntary turnover
New York Times reporter and author Charles Duhigg
is a canary in our coal mine and raises an alert that we
recounts in his bestseller, The Power of Habit,
take very seriously.
accidents were commonplace at Alcoa, as they would
be at any company in the business of handling molten So, what should health care providers focus on as their
metal on a regular basis. But the companys safety keystone habit? For my money its patient access -
figures werent bad in fact, they were better than that making it as easy, quick and worry-free to get an
of their competitors. appointment with a provider.
Nevertheless, ONeill stood up in front of his investors When provider organizations make it a habit of
that year and declared that the company would focus opening their schedules and committing to same-
its entire strategy on bringing workplace injuries to week-or-sooner appointments, other good things can
zero. If you want to understand how Alcoa is doing, happen. Appointment types can be simplified and
you need to look at our workplace safety figures, he streamlined, driving other opportunities for process
argued. No talk of profits, opening new markets, or improvement and efficiency. Care is more likely to be
any of the usual crowd pleasers. Everyone thought he directed as appropriate to lower-cost providers and
was nuts. nurse practitioners or even to virtual consults, cutting
costs and eliminating unnecessary care.
By the time ONeill left Alcoa in 2000 to become
Treasury secretary, the companys market cap had And, most important, physicians can be freed up to
increased by $27 billion and by 2010 not a single see the sickest patients when they need to be seen.
employee day was lost to workplace injury at 82% of
Jonathan Bush is the CEO and president of
Alcoa locations.
Athenahealth and the author of Where Does it Hurt?
So what happened at Alcoa? An Entrepreneurs Guide to Fixing Healthcare.
2015 Harvard Business School Publishing Corp. &
ONeill had located and had the discipline to focus on
The New York Times Syndicate. n
what Duhigg calls a keystone habit, a deep
M
edical science has enabled our health care There are, of course, limitations, one of which is
system to deliver outcomes that would have self-selection bias. People participating in an
been impossible a generation ago, and online community around their disease are
advances in fields such as genomics and stem-cell already more engaged, more informed and more
therapy offer immense promise to further accelerate tech savvy than many others. So while leaders in
medical innovation. the health care system integrate the (undeniably
valuable) insights from these communities into
As extraordinary as insights from the laboratory often
decision-making processes, we have to account
are, better understanding the experiences of patients
for these patients above-average sophistication
and health care providers can provide a roadmap for
and its implications for their treatment choices.
the critical last mile of medical care, where all policies,
procedures and practice converge into action. 4. Remember the other influences of patient health.
As impactful as the increasing focus on patient
Below, I offer some approaches drawn from my
voice can be, its critical for organizations to
experiences working in health-care-delivery
consider the other influencers of a patients
organizations, government and industry. (The
health that the patient himself might take for
principles I propose are my own and do not reflect
granted. Family members, cultural traditions,
official policies of any organizations with which I am
stress levels, sleep habits and numerous other
affiliated.)
lifestyle factors impact health but are often
1. We must strive to move beyond our own considered just how things are.
experiences. Those of us who work in health care
5. Overcome the risks - theyre usually worth the
inevitably refer to our own experiences with the
benefits. Because protecting patient privacy is so
health care system when making decisions about
important in health care, integrating patient voice
strategy and program design. Even at high levels
is not as simple as one might expect. Meeting the
of policy or strategy discussions, it is common to
regulatory needs of any health care organization
hear, when I was at the doctor. or when my
takes planning, flexibility and cooperation across
mom was sick. And while we can gain insights
teams.
from these personal encounters, its critical to
remember that our expertise inside the field Through engaging the patient voice, we have a
strongly informs our experience. powerful tool to inspire and shape new solutions in
health care, and there is real value in working through
All leaders in health care have a level of access,
the associated challenges. As the health care system
familiarity and comfort with medical care that
takes a more collaborative approach to helping
vastly exceeds that of the average patient.
patients and as patients become active participants,
Consequently, as health care providers, we have
everyone wins.
to ask ourselves this question: What stories are
we not hearing? If we dont keep ourselves Dr. Sachin H. Jain is chief medical information and
honest and consider the voice of the patient not in innovation officer at Merck, an attending physician at
the room, we overlook opportunities to improve the Boston VA Medical Center and a lecturer in health
care for a substantial number of people. care policy at Harvard Medical School.
2. Get authentic patient voices in the room. To lead Harvard Business School Publishing Corp.
change in health care, organizations must get in Distributed by The New York Times Syndicate. n
the room the voices of real patients - people
whose lives are touched by our products and
services.
3. Embrace online communities, but know their
limitations. Online communities are a powerful,
emerging avenue for insight into patient sentiment
about a disease or therapy. Many communities
are focused on particular diseases and focus
groups, offering a locus of conversation on
specific topics.
SOMBRERO December 2016 25
Medical Educaon
H
ow many hours should medical residents work? But I worry about how to interpret the results of trials like
Hospital care is a 24-hour-a-day enterprise, these, and what positive or negative findings may mean
but the question of which doctor should be for residency training discussions going forward. In a
there and how long he or she should already have profession driven by evidence, data is useful. But its
been there is among the most controversial and important to recognize datas limitations.
unsettled in medicine. Its a question that comes up
almost daily among my peers, and my own feelings about Many patient-care metrics we use to evaluate the impact
the issue often depend on whether Im trying to grasp of duty hour restrictions mortality, procedural
details about a new patient or struggling to stay awake at complications, adverse events, readmission rates are
the end of a very long shift. crude. They might make sense for hospitals and health
systems designed to increase efficiency and insulate
In 2003, at the genesis of the modern patient safety patients from human fallibility. But they fail to capture the
movement, the Accreditation Council for Graduate nuances of care delivered at the doctor-patient level.
Medical Education mandated that residents work no more Good patient care is about more than surgical infection
than 80 hours per week. In 2011, it limited individual rates and medication errors. At the end of a long shift, am
shifts for first-year residents to 16 hours. Since then, I the kind of doctor and person I want to be? Do I
research has been mixed on whether reducing the length make time to sit with a suffering patient? Do I snap at a
of shifts or total number of hours worked has improved well-meaning colleague?
resident health, medical education or patient outcomes.
Well-being is similarly difficult to study. Research
This year, two large national trials, known as iCompare suggests that ones judgment of happiness and life
and First, aim to shed new light on the issue. Researchers satisfaction is surprisingly fickle. For example, people
randomized first-year residents at internal medicine or interviewed on sunny days report being more satisfied
general surgery programs across the country to work with their entire lives than those interviewed on rainy
either 16-hour shifts, the current maximum, or longer days. So if you ask me about my training program after a
shifts of 28 hours or more. Shortly after the iCompare particularly bad 16-hour shift, Im likely to rate it worse
trial began, two advocacy groups sent an open letter to than during a particularly good 30-hour shift.
the Office for Human Research Protections, calling the
trial unethical and arguing that it exposes patients to Medical educators also worry that work hour restrictions
dangerously sleep-deprived residents while exposing force residents to see fewer patients and miss important
residents to a greater risk of car accidents, needlestick educational experiences. At the same time, we allow
injuries and depression. residents to spend hours scheduling appointments,
faxing medical records, gathering vital signs, obtaining
These trials come at a critical time, amid mounting prior authorization, and completing many other
evidence of serious mental health concerns for medical nonclinical tasks. We dont learn to do these tasks in
trainees. A recent study found that almost one-third of medical school; we shouldnt be spending our time on
residents exhibit symptoms of depression; other studies them as residents. If were concerned about resident
show that almost 10% of fourth-year medical students education, lets focus on increasing quality time spent on
and 5% of first-year residents admitted to having suicidal direct patient care and educational activities.
thoughts in the previous two weeks with higher rates
among minorities. The right answer on how many hours residents should
work may be more nuanced than weve been willing to
And yet, its not clear whether more restrictive work hours accept. It isnt the same today as it was 20 years ago, as
will make things better for residents or patients. When the complexity of caring for patients and medical technology
residents work fewer hours, there are more patient continue to evolve. It varies by subspecialty discontinuity
handoffs when a patient is transferred from one doctor may have graver consequences for neurosurgery, say,
to another. The process makes it more likely that important than for radiology. And it hinges more on the character of
details are overlooked, and intimate familiarity with a work than the length of it Id spend twice as long at a
patients recent clinical course is often left behind. And patients bedside if I could spend half as long at a
residents may not even be reporting their hours accurately. computer.
Whistleblower protections are lacking, and the penalty for
work hour violations is loss of program accreditation, Ultimately, the answer may be as philosophical as it is
which could hurt the resident reporting the problem. empirical. What kind of doctors do we want to be? What
kind of doctors do patients want us to be? And does what
In the face of uncertainty, we need more data and we cant measure still matter in a profession thats now
were starting to get it. Results from the First trial, judged and motivated by what we can?
published on Tuesday, Feb. 2, found no significant
differences in patient outcomes, resident satisfaction or Dhruv Khullar, MD is a resident physician at Massachusetts
educational quality when surgical trainees worked longer General Hospital and Harvard Medical School.
shifts. (Results from iCompare, which is looking at The New York Times. Distributed by The New York
internal medicine residents, are expected in June.) Times Syndicate n
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