When A Local Newspaper Investigates Local Hospitals . . .

Hackles rise and fur flies. As Maude Beelman, Deputy Managing Editor at the Dallas Morning News, explains in an essay cross-posted below, local newspapers have good reason to be wary of investigating their community’s most prestigious medical centers:

“Every place has its sacred cows,” she writes in a piece published on the Nieman Watchdog website, “individuals or institutions so prominent and respected that over time they become part of a community’s identity and culture. Questioning them is an affront to civic pride, and investigating them can be a high-stakes gamble.

“The University of Texas Southwestern Medical Center and Parkland Memorial Hospital are two such icons of Dallas,” she continues. “They have enjoyed largely positive press, some of it by design. Their leaders cultivated national profiles and courted some of the wealthiest and most influential Dallas residents, including media leaders, as advisers and donors.”  (Many thanks to Gary Schwitzer at HealthNewsReview Blog, for calling attention to this story.)

So when the Dallas Morning News decided to follow up on insider tips alleging that patient safety was being compromised at these venerable  institutions, the newspaper “faced a community backlash, including cancellation of advertising by UT Southwestern,” Beelman reports.  “Many of Dallas’ wealthiest and most powerful residents are longtime donors and supporters of the medical center and hospital. Some key players have sought to delay, if not derail, the investigation. They have recruited key opinion leaders in Dallas and nationwide to try to discredit us.”

Beelman’s candid report helps explain why local newspapers rarely report infection rates, medication mix-ups, or disparities in pricing at their top-tier hospitals. If local health care costs seem exorbitant, most would rather blame insurers.

Hospitals, after all, are major advertisers. In recent years, while retailers have been cutting back on newspaper ads, hospitals have been positioning themselves for health care reform, which often means expanding their marketing budgets.  Moreover, as Beelman emphasizes, the marquee hospital’s patrons tend to be powerful local figures. The newspaper’s publisher probably sits with them on various community boards. As for newspaper editors, some like to hobnob with the local elite. An editor is not likely to be invited to a table at an A-line charity event if his reporters are asking irritatingly indiscrete questions about the hospital that his host supports—and where that same host expects to get VIP treatment when he needs it.

Finally most readers really don’t want to hear that their local academic medical center is having problems with infections in the OR or the ICU. They would prefer to read a more reassuring piece about how luxurious the accommodations are in the New Wing.

                                       “Unhealthy Alliances”

In some cases, the relationship between local hospitals and local media has ventured beyond the pale, at least according to the Association of Health Care Journalists (ACHJ) and the Society of Professional Journalists. Two years ago, a newspaper in Maryland "sold" its health section to a local hospital, which then controlled content for the section. (I’m delighted to report that the arrangement was halted amid community protest after just one published issue.) 

In other cases, TV stations have made an exclusive arrangement to run stories that one of the local hospitals suggests. At times, ACHJ reports, pre-packaged segments produced by a hospital have been aired “with hazy branding or no branding at all, leading viewers to believe the local station reported the story.” 
                 Using the Dartmouth Data to Ask Questions

Few newspapers or local television stations have gone that far. But when they produce pieces about brand-name medical centers close to home, the story-line tends to be positive. If state regulators fine a local institution, the local newspaper will report the facts. But, with few exceptions, (the Dallas Morning News among those exceptions), hometown reporters don’t dig to uncover problems, even when patients, medical researchers, or whistle-blowers inside the institution try to draw attention to a story.

The Online Journalism Review’s Tom Grubisich has highlighted the problem. Grubisich asks why more newspapers don’t use their websites to publish the data that Dartmouth now makes easily available on local hospitals, offering numbers that allow reader to compare local hospitals to benchmark medical centers—hospitals that offer high quality care at prices well below the national average.

After all, “more spending on care, especially in the form of expensive testing and elective surgery doesn't produce better outcomes,” Gorbisich writes, linking to the non-partisan Medicare Payment Advisory Commission’s (MedPAC’s) June 2009 report.  He also points out that the newest Dartmouth data makes it much easier to drill down and see how a local hospital stacks up when it comes to providing equal care at a lower price. (see www.Dartmouthatlas.org)

Granted the Dartmouth data on individual hospitals is not perfect. There are too many variables to weigh, even when researchers compare very similar patients at different hospitals. And, as Dartmouth researchers have acknowledged, adjustments for factors such as the comparative health of incoming patients remain tricky. Nevertheless, Dartmouth has been doing this work for more than two decades, with no financial axe to grind. This is why the cognoscenti of the health care world agree that this is far and away the best information we have. Without question, the Dartmouth research offers a superb starting point for a curious reporter who wants to begin his own investigation on the ground.

It would take a bit of shoe-leather reporting,” Gorbisich observes. “But newspapers could find out why costs vary so widely within their metro area. Instead of just being passive platforms for rants, newspaper sites could invite (or, if necessary, arm-twist), local doctors, hospitals and outpatient centers to participate in live forums where they would explain and justify the disparities and answer user questions.” (This, in turn, would give hospitals that question the Dartmouth data an opportunity to provide evidence to support their arguments.)

                              Courage:  The Boston Globe

When it comes to ignoring local pressure, The Boston Globe deserves kudos for running a six-week investigative series on how the state’s brand-name medical centers have used their top-drawer names to force health-insurance companies to pay sky-high rates for the most common procedures—even though, when it comes to basic services, there is no evidence that these hospitals provide better care.

According to a Globe Spotlight Team, their review of private insurance data found that some hospitals in the state charge 15% to 60% more than competing hospitals for the same uncomplicated procedures. (This goes a long way toward explaining why health care in Massachusetts is so pricey.)

Boston’s most prestigious medical centers are not alone. When hospitals have the market clout, many charge much higher fees for routine procedures, and insurers pay up, passing the costs along in the form of higher premiums. But newspapers in New York, Los Angeles and other high-cost cities rarely investigate pricing in their own town’s top hospitals.

More importantly, patient safety cries out for media attention. Unfortunately, patients are at risk even at some of the nation’s most illustrious names. According to the Agency for Healthcare Research and Quality (AHRQ), medical records show that 11 percent of hospital patients suffer “adverse events …ranging from hospital-acquired infections to surgical complications.” Even worse, AHRQ reports that when patients are interviewed, fully 23 % report similar events, though close to half of those incidents seem never to have made it into the patients’ medical records.

Hospitals are places where vulnerable human beings are treated by fallible human beings: complications and mistakes are inevitable. But we can never learn which adverse events could have been prevented—and how to avoid them—unless they are reported and studied. Patients also have a right to know if certain hospitals are outliers, even if they boast a brand name.

Luckily, under the Patient Protection and Affordable Care Act, some adverse events will be publicly reported. Already, the legislation has spurred forward-looking hospitals to shift their focus from new construction to new rules that will protect patients.

In the meantime, the media could help the public understand why we need reform by acknowledging the challenges that even our very best hospitals face. Yet local news outlets are reluctant to question their community’s most esteemed institutions.

Below, the Dallas Morning News’ Deputy Managing Editor Maud Beelman reports on what happened when her newspaper dug into a story about two of her  city’s leading hospitals. (Hat-tip to Harvard’s Nieman Watchdog for featuring this essay.)
                     ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~                
The Morning News takes a long, hard look at hospital care in Dallas

By MAUD BEELMAN
Dallas Morning News Deputy Managing Editor
mbeelman@dallasnews.com

DALLAS—Every place has its sacred cows – individuals or institutions so prominent and respected that over time they become part of a community’s identity and culture. Questioning them is an affront to civic pride, and investigating them can be a high-stakes gamble.

The University of Texas Southwestern Medical Center and Parkland Memorial Hospital are two such icons of Dallas.

The medical center boasts of “world-class” research and residency programs that have turned out generations of excellent doctors. Parkland, which received a mortally wounded President John F. Kennedy, is the main training ground for the school’s new doctors. As a public hospital and major trauma center, it is also a safety net for the region’s most vulnerable patients.

Over the years, the two institutions have enjoyed largely positive press, some of it by design. Their leaders cultivated national profiles and courted some of the wealthiest and most influential Dallas residents, including media leaders, as advisers and donors. But after receiving a few insider tips and learning of the allegations in a whistleblower lawsuit, the newspaper decided it was time to investigate.

What we found was a system that for decades had deceived virtually all of its patients, put many at risk and, by the hospital’s own estimate, seriously and often needlessly harmed on average two people a day. Internal records from the two institutions, sworn testimony by current and former employees and federal inquiries also documented instances of a cowboy mentality among loosely supervised residents, a class-based culture of care and possible Medicare billing fraud.

Starting last March, we published on 15 different occasions over a nine-month period. Some were large packages of multiple stories and some were individual articles. We have linked everything we’ve done – stories, update posts on our “DMN Investigates” blog, video, original source documents, “ask the editor” columns – from one online site, which you can find at www.dallasnews.com/medinvestigation.

Among our findings:
•    Patients checking into Parkland had, for years, not been told that the experienced UT Southwestern faculty doctors who they thought would be operating on them would not actually perform the surgery. They might not even be present in the hospital at the time.
•    Most of the patient care at Parkland was delivered by doctors in training – first-year interns and other residents. Some patient care was even handled by students who had not yet graduated from medical school.
•    The UT Southwestern residents at Parkland were often left to their own devices. Residents supervised and trained interns and other residents. Faculty doctors often played little role in supervising. Institutional policies allowed faculty to claim they were supervising some procedures if they were available by cell phone. When some faculty did try to exert direct supervision, residents often bristled.
•    While junior staff members were tending to poorer, uninsured patients at Parkland, UT Southwestern’s faculty physicians focused on research and treating privately insured patients at the medical center’s other hospitals.
•    Some doctors within Parkland and UT Southwestern had complained that the lax supervision was hurting patients and offered specific examples of that harm. They were soon ostracized, and most left for other jobs.
•    Patients were harmed during surgeries by resident physicians, including a young mother whose common bile duct was severed during a gallbladder operation and a former Parkland employee who eventually had her leg amputated after knee-replacement and post-surgical care provided, in part, by medical students.
•    The Parkland culture has been based on a “see one, do one, teach one” style of medical training that emphasizes resident autonomy. The head of one UT Southwestern residency program even told colleagues that higher rates of patient harm were an acceptable price to pay for doctor training.
•    If patients and family ever learn they have been victims of medical error, which few seldom do, medical malpractice damage limits in Texas ensure that they often have little recourse.
•    Federal regulators don’t track such instances of patient harm. That’s because, while Medicare mandates levels of supervision for doctors to follow in billing for their services, it doesn’t do the same when it comes to patient safety. There are also no accepted “best practice” standards to guard against patient harm at the nation’s teaching hospitals, which treat more than half of all patients and account for about 70 percent of all charity care costs.
•    The kinds of problems identified at UT Southwestern and Parkland have occurred at other teaching hospitals around the country, especially ones in large urban settings.
•    Medicare billing fraud was found at two dozen academic medical centers and teaching hospitals in nationwide audits conducted several years ago – until the industry managed to quash the federal reviews. As a result, patients have suffered avoidable harm nationally because the business and culture of medicine have resisted meaningful change.
•    Alleged billing fraud by UT Southwestern and Parkland goes back decades. The institutions had previously been investigated for falsely billing the government insurance programs for the poor and elderly and are under current investigation by the U.S. Justice Department.

Getting to these truths has been a huge challenge.

UT Southwestern and Parkland told their employees not to talk to us, and they refused to share any aggregate data on patient outcome. Parkland’s $1.2 billion annual budget is supported almost entirely by local, state, and federal taxes, but it insisted that little if anything about its operations or outcomes should be open to public scrutiny. Even when we had signed legal waivers from former patients, who had released to us their entire medical record, the institutions refused to talk.

Our knowledge and ability to tell the stories accurately and fully depended almost solely on source development and the vigorous use of open-records laws. Our reporting team read through thousands of pages of hospital and medical center records obtained under the Texas Public Information Act, as well as documents from local and state courts and from the U.S. departments of Justice and Health and Human Services.

We often obtained records only over fierce, and sometimes comical, resistance by the two institutions. (Medical center officials once claimed it would cost them $1 million to produce a list of checks they had written.) The roadblocks forced us to hire a full-time public records lawyer, and the newspaper has filed four lawsuits in state court to compel the hospital and medical center to follow the open records law.

In response, the taxpayer-funded institutions have hired additional law firms, including one headed by a former Texas Supreme Court justice, and developed lobbying plans to try to force the state Legislature in 2011 to weaken the Texas Public Information Act. They have also hired public relations consultants to try to create public skepticism about the findings of our investigation into what have been two of Dallas’s most-venerable institutions.

The newspaper has also faced a community backlash, including cancellation of advertising by UT Southwestern. Many of Dallas’ wealthiest and most powerful residents are longtime donors and supporters of
the medical center and hospital. Some key players have sought to delay, if not derail, the investigation. They have recruited key opinion leaders in Dallas and nationwide to try to discredit us
. We have responded with absolute transparency, posting original research documents online at the time of our various publications and again in connection with three “Ask the Editor” columns the paper has published online to answer questions and address the criticism.

Behind the scenes, our reporting has attracted the attention of the Justice Department and Health and Human Services’ Office of Inspector General. A previously unknown investigation into alleged Medicare fraud was reinvigorated after The News released internal hospital documents showing that Parkland once estimated it owed the federal government up to $50 million but had withheld information from its own auditors in order to hide it from federal investigators. The Joint Commission, which accredits hospitals nationwide, confirmed in late December it was investigating one of the cases of patient harm we revealed in November. Jessie Mae Ned, who lost her leg after a doctor-in-training botched her knee replacement surgery, contacted us after reading an earlier story on patient harm at Parkland and realizing she was not alone.

But as our final major investigative story of 2010 showed, what happens in the nation’s teaching hospitals is clearly a topic the industry does not want discussed openly – despite the documented human toll. The medical community has fought for years to preserve what it calls “the privilege of self regulation,” and it spends hundreds of millions on lobbying Congress to protect that. Nobody wants to see patients needlessly harmed, but our reporting has shown that some in the medical industry see the alternative as giving up the cheap labor of residents, and others believe that new doctors can, in effect, learn only from their own mistakes.

Dallas County residents, however, now have enough information to question some of these practices and perhaps prevent future problems. And there are signs that change may be underway. Hospital insiders tell us that resident supervision is being newly emphasized in some departments. There are preliminary indications that some hospital performance measures may be improving. Several key officials at the hospital and medical center have been replaced, and county commissioners are said to be quietly considering plans to alter the special relationship between the public hospital and the medical center. While encouraged by these early signs, we realize there is much we still do not know. So, our investigation continues. With billions of dollars and thousands of lives at stake, we believe we have no other choice.
 
Maud Beelman is a deputy managing editor at The Dallas Morning News, where she directs a team of investigative and special projects reporters.
E-mail: mbeelman@dallasnews.com

12 thoughts on “When A Local Newspaper Investigates Local Hospitals . . .

  1. Wow! The unholy alliance between hospital and media is not limited to major cities. Our County of Berk’s largest employer is Reading Hospital and Medical Center. It’s incestuous relationship with the Reading Eagle Newspaper has been folklore in the area for many years. With interlocking directorates and on any given day a multitude of hospital ads in the paper, have fed this unholy alliance. Reading Eagle virtually never investigates our so-called prestigious medical center. It just isn’t going to happen! Berks County’s sacred cow.

  2. Same stuff happens in my town, the media is totally intimidated by the hospital as a powerful PR force and an advertiser and as an influencer of powerful poeple.
    Furthermore, I have heard the elderly, and even some not elderly, say that they feel they can not be truthful about how they feel about the local health care system or reveal what has happened to them because they fear their name will have a black mark beside it if they ever need care.
    Astounding, but they really feel that way, and it isn’t just a few who have voiced that concern to me.

  3. Re treatment by inexperienced interns at a “name” teaching hospital: My father was admitted to Georgetown University hospital in DC for treatment of a post-op infection. He was almost discharged the next day by a couple of new interns (their FIRST DAY!). They apparently didn’t read the chart to see what he had been admitted for, but did notice a note that his COPD was under control (he had been admitted to a cardiac unit because there were no other beds available). Until my wife, a retired nurse, had a serious (rather heated) discussion with the floor nurse supervisor, the discharge nurse was planning his discharge. He had had NO treatment for the infection. The other nurses were not willing to stick out their necks to educate the new “doctors” on chart reading. Needless to say, we emphatically refused to send him there ever again!!!

  4. Harry:
    My dad had similar experiences when he had bypass surgery at Georgetown three years ago.
    He had not told the staff he had sleep apnea and needed CPAP. I felt he would need BiPap after surgery, and made sure the ICU nurses knew this before I left the hospital for the night.
    Two hours after they extubated him, they had to reintubate him because they did not put him on BiPap.
    He was also hypotensive, and this was a concern for me. I did know that he needed to be a bit hypotensive to allow the surgery to heal . . . but I felt 90/60 was too low in a man who actually had hypertension on top of his other problems. The surgeon assured me this would not be a problem for discharge.
    He was discharged less than a week after his surgery. The day afterwards, he fell on top of my mother after passing out from orthostatic hypotension. She has osteoporosis, and was lucky not to break a hip.
    I was not happy with this.

  5. Harry, Panacea Greg & Joe–
    Thank you for your comments.
    It is, I’m afraid, true that many of our brand-name academic medical centers don’t consistently offer treatment that matches their reputations.
    One problem is that many let residents work longer hours than they should. And residents are not always well-supervised . .
    Most people don’t know that academic medical centers are able to ignore rules about work hours when they choose to becuase they resisted letting their residents and interns become part of a union.
    There is a very responsible union that represents residents and interns natoinwide (CIR– The Commitee of Interns and Residents) .
    I have met with their leaders and gotten to know them. I’m impressed. They are not just interested in pay and working conditions for residents; they are extremely concerned about patient safety, patient-centered medicine, health reform, and all of the issues I write about on this blog. I will be writing more about their work.
    In the meantime, academic medical centers resist unionization because they want to view residents as “students” not
    “employees.”
    In this way, they can avoid lawsuits that would insist that they respect labor laws. And, they can avoid some suits that would hold them responsible for harm that their residents might cause. (For instance, a reswdient falling asleep at the wheel after being forced to work illegal hours, and causing permanent injurty to the other drive. In some parts of the country it is possible for residents to live very close to the hospital; in many other areas, it isn’t–and there is no public transportation.)
    Meanwuhile, as you point out, local media do tend to be intimidated by the local hospital (or hospitals) that the pillars of the community support. And, as Greg points out, this doesn’t just happen in big cities.
    .

  6. Another problem is shift work mentality, poor patient handoffs and poor continuity of care the ACGME regulations have fostered. The 80 hour restriction has been in effect for 7 years now and there is zero data showing that it has improved patient care. I doubt unionization will do anything to improve patient care, but I consider it a suprise that Maggie Maher is now a supporter of physician unionization. I can get on board with that.

  7. http://www.ncbi.nlm.nih.gov/pubmed/16772790
    http://www.ncbi.nlm.nih.gov/pubmed/16307951
    http://www.ncbi.nlm.nih.gov/pubmed/15975341
    http://www.ncbi.nlm.nih.gov/pubmed/15337018
    Just a few, particulary the last two.
    Implimenting a union with the goal of improving patient care is foolhardy. It hasn’t worked in other areas. Unionization is about collective bargaining, period. If unionization would result in better patient care, I would have expected to see a similar goal work in other fields. The UAW has not allowed the US to build better cars. You yourself have voiced your disgust at American automobiles and their problems are well known. The teachers unions have not improved our education system. Neither one was designed to improve the product, they were both serve a primary purpose of collective bargaining, of which they have both done very well for themselves. Like I said I’m all for allowing physicians (which is what residents are) to collectively bargain. I’m glad you are too.

  8. Jenga–
    Thank you for the citations.
    They offer another crdible point of view on the subject,—though I would note that the last two links, which you highlight, are from the same medical center –which has a vested financial interest in using resdients for long hours.
    Also these articles were written 5 to 7 years ago. This doesn’t mean the researchers are wrong, but in recent years, views on residents working long hours have been changing . .
    The rules for how long residents are supposed to work changed fairly rencently. So we don’t yet have telling long-term data as to whether the changes are reducing adverse events.(In addition,
    residents report that many hospitals have been ignoring the new rules,making it harder to gauge the effect.)
    I would suggest that the views expressed in the articles you cite should be set side by side with what residents themselves say. On the one hand, these statements are merely anecdotal, describing how one resident feels. :On the other hand,
    neither hopsitals nor residents themselves are eager to acknowledge that long hours might have caused them to hurt patients. This is every docotor’s nighttmare, and not because they are afraid of being sued.. This makes these statements from residents compelling::.
    “Something I have found remarkable about residency is how much it has eliminated the joy I once had for the practice of medicine. In medical school, I thought delivering a baby was incredible. Now, at 4 am, after 20 hours without rest, I find I that I have lost all sense of compassion towards my patients, just wishing they would ‘deliver the baby already,’ and I always find myself shocked the next morning at how insensitive sleep deprivation made me.
    “In my exhaustion, I have forgotten to see patients that I was consulted on in the emergency room, I have confused medication orders, I have fallen asleep while standing up, and I once stuck myself with a contaminated needle on the 24th hour of my shift. I also never expected the physical toll that residency would take on me: the middle of the night nausea and chills, the post-call headaches. I don’t understand why doctors are expected to risk their health and the health of their patients in order to learn medicine.”
    -Obstetrics & Gynecology resident, New York, New York .
    “I drive 30 minutes on a busy expressway to get home after 27-hour shifts when I may have slept anywhere between 20 minutes and 4 hours. I am embarrassed to admit that I’ve fallen asleep at the wheel and by some miracle snapped myself awake before getting into an accident. This has only happened a few times, and it has happened less as I do it more often, but it scares me because it seems totally out of my control. No matter how loud I blast the music or how far I roll the windows down, my body wants what it wants. I am embarrassed because I should know better; as a physician I understand that driving with no sleep is as bad, or worse, than driving drunk. And I am embarrassed because I’ve seen patients devastated by injuries obtained in motor vehicle accidents. I realize it is irresponsible to put myself and other drivers at risk. But time becomes so precious during residency that you’ll take risks for it.”
    -Pediatrics resident, Bronx, New York
    “I was covering the medicine wards as an intern when a very sick patient arrived from the nursing home around 3 in the morning. I had been up all night running around the hospital attending to the usual concerns on a busy hospital service: admissions every few hours, elevated blood pressures, refill pain medications, follow-up on CT scans done overnight. I was mentally and physically exhausted.
    “My team and I wheeled her up to the ICU. Her pulse disintegrated and we began resuscitation. It was then that my emotional exhaustion washed over me. I wished that my new patient would die. At that moment, I cared nothing for my patient, her family, her life. Her living got in the way of my sleep. She was one more name to go on my patient list, one more life to attend to, countless hours I wouldn’t spend in bed.
    “Absolute exhaustion elicited by a demanding and disjointed health care system brought out a dark side of me I never want to meet again. That’s the side of a doctor no patient should have to face.”
    -Family physician, Los Angeles, California
    “What’s it like to work 30 hours without sleep? For me, after about the 15th hour, I become unproductive, although I am still able to perform basic tasks. One area that I find as a surgeon that suffers is the ability to carry out procedural tasks to the same efficiency as when awake and fresh. Post-call, I tend to feel confused in the morning, and very ‘slow’, and I often have to ask people to repeat themselves. I generally have a headache, and my body becomes hypothermic. My eyes ache to close. Yet it is expected that you will work just as well as you did pre-call. In the past, I have made numerous errors in the operating room while post-call. I operated too slowly, and it delayed cases for the attending surgeon. Recently, while post-call, I pulled the wrong chest tube from a patient …
    You’ll find these comments in a brochure titled Safe Work Hours/ Safe Patients, produced by the union that represents some 13,000 residents and interns nationwide (CIRSEIU) and the American Medical Student Association (AMSA) .The two organizations have joined forces to alert the American public to a major cause of medical errors

  9. Thanks for your detailed response. There is likely not going to be alot of new data. We are probably always going to have to look back from here on out to compare. Any prospective study about resident hours going over 80 hours will not meet IRB approval because it will violate ACGME guidelines. So far the majority of studies have not shown any improvement. Bob Wachter had a good article on kevinmd detailing some of these issues. The stories are compelling anecdotally but the data has not shown that the old pre 80 hour workweek was putting patients at risk so far. It appears any gains from the mandates may be lost with continuity of care (patient handoff) issues and there are real concerns about surgical volume lost from such mandates.

  10. Jenga–
    I agree that patient hand-off can be a real problem.
    But Med schools are beginning to teach courses in patient hand-off–it can be done well.
    And if it takes the resident who is leaving an extra 20 minutes, that’s fine.
    I don’t think most residents want to punch a clock. But they tell me that it is very scarey to find yourself trying to treat patients when cognitively impaired.
    Some of us need more sleep than others. Some of us can go 36 hours without sleep and still functio well..
    In my early and mid-20s I could. In college I regularly pulled “all nighters,” wrote good papers, and kept going the next day.
    But by the time I was in my early 30s (and had very young children), I found that I couldn’t function well without enough sleep.
    And today, I need 8-9 hours.I wouldnt’ even consider driving a car if I had been up for 13 to 15 hours.
    I’m sure individuals vary widely in this regard, but I don’t think we want residency to be an endurance test.
    Nor do we want to exclude people from the medical professional becaused they lack this particular type of physical stamina. (Possible exception: surgeons, who sometimes have to stay on their feet, and remain very, very altert through very long surgies.)
    But otherwise, qualities like intelligence, empathy, abilty to communicate clearly with patients, attention to detail, patience etc. etc. etc. seem to me more important
    than physical stamina.
    Finally, my sense is that the boot camp, endurance test, “Lord of the Flies”
    aspect of residents’ training has an unfortuante and lasting effect on some doctors’ personalities.
    This is why some attendings torture interns and residents. They’re bitter about what they went through, and want to make someone else is miserable as they were.
    This dark streak may also infect how some treat patients . .