During his travels, Odysseus must navigate a narrow strait where are on one side is Scylla, the legendary sea monster known to devour men alive and on the other is Charybdis, a terrible whirlpool known to destroy entire ships. What is he to do? This feeling of dread of having to make a choice between two equally unpleasant situations comes over me as surgeon teacher. It was during the middle of my training that the 80hr work rule was made law. In many ways, it was wonderful; it signaled to me as a resident that we were people whose private lives mattered and our free time mattered. We cared for our patients, but we shouldn’t feel guilty about caring for ourselves or our family. We were not just “residents”…we were human beings. In my mind, it was the beginning of any thoughts on physician wellness. There was one problem. The culture hadn’t really changed. The rules were in place; coverage plans were in place, but no one was signing out and everyone was sticking around to tie up “loose ends”. There was a guilt about “signing out” because that’s not what we did; it wasn’t who we were. Surgery residents took care of things; we didn’t go home at the end of the proverbial shift. We went home when the work was done. Many aspects of this culture were unhealthy; we didn’t “trust” someone else could take care of our patients. It also often lead to burnout, people quitting, and who knows how many relationship failures.
Fast forward a decade, at the same institution, at the same residency program, the culture has changed. Signing out is common place, and 80 hour limits are strictly enforced. A night float shift has been interwoven into the fabric of training. Are residents happier? Are less people quitting? Is there less burnout? I don’t know. What I do know is that I feel uncertain about what the right answer is. For example, a patient requires a return to the OR. The PGY3 who performed the original operation is still on service. He is on call at night; and the patient is going to the OR the next morning at 10AM. Should he stay and do the operation or should he go home? Another example, a patient requires an urgent operation but because of OR capacity the case won’t get started until 7PM. Should the chief resident of the service stay and do the operation on a patient she has been caring for or go home and sign out to the chief on call who is equally capable as she? What is gained and what is lost with the decision to stay or the decision to go?
I don’t know what the right answer is- for us as a profession, for our patients, and for us as future patients. What I do know is that patient care is still paramount, and we still pledge to care for and heal. And what we must hold in balance is the well-being of our trainees, and our own health so that we can care for and heal others while maintaining that sense of ownership and responsibility that helps us rise above the everyday fatigue that can keeps us from being our best. And although we have systems in place during training to let people go home at 7PM, there may some day be a situation when they are the ONLY one who can help the patient; I hope we have taught them to stay. In the end, isn’t it what it’s all about?