More on physicians and sleep
I read with interest October’s “End of the Medical Marathon” and Dr. Fink’s follow-up letter (December/02) noting the psychic toll caused by the old system of all-night duty for trainees. I would note an added detrimental effect on house staff, that of physical disease during training. In 1964–65 I was an intern at Boston City Hospital, which had established a “night float” system in some ways superior to that at the U of C. As understood by the Boston City house staff, the night float system was instituted because so many interns became ill during training, particularly with infectious diseases such as tuberculosis. While the story may be apocryphal, my impression was that the BCH interns were less ill and more alert post “on call” than interns at other university hospitals where I had later portions of my training.

The potential lack of continuity of a night float system can be largely avoided by consistent attention to passing information from the day intern to the night float. If loss of continuity was inevitable, then we would require nurses to work 36-hour shifts as well. As often is the case, physicians can learn from good nurses. The latter have standardized shift reports to maintain continuity between the succession of nurses taking care of a patient. While particularly important in health care, careful handoff systems also avoid errors in other areas of society.

Laurence A. Sherman, SB’56, AB’56
St. Louis