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There has been much hand-wringing over the dangers of medical residents’ grueling schedules. Doctors-in-training often forgo sle

admin2013-01-28  31
问题     There has been much hand-wringing over the dangers of medical residents’ grueling schedules. Doctors-in-training often forgo sleep entirely, racking up as many as 30 work hours in a single stretch. The term resident is in fact no accident, says Dr. Teryl Nuckols, an internist and assistant professor at the David Geffen School of Medicine at UCLA, who says that when she was in training 10 years ago, 36-hour shifts without rest were common. "Residents used to live in the hospital," Nuckols says.
    The issue is whether their presence, dizzy with exhaustion, on the hospital floor is a help or a hazard. An oft cited 2004 study of intensive-care units found that medical residents made 36% more serious mistakes during 30-hour shifts than during shifts half as long. So the simple solution to ensuring patient safety and resident sanity—would appear to be reducing the length of their shifts, a plan endorsed by a lengthy Institute of Medicine (IOM) report in December 2008 that assessed the impact of resident fatigue and proposed a new set of guidelines restricting shifts to 16 continuous hours if no rest is granted , mandatory uninterrupted five-hour naps for longer work sessions, lighter workloads and more oversight from experienced physicians. The current standards set in 2003 mandate 80-hour average work-weeks, with no shift to exceed 30 hours.
    But many in the medical community, including residents themselves, worry that shorter shifts could come at the expense of educational opportunities and possibly even patient safety. And implementing the changes wouldn’t be cheap, potentially costing teaching hospitals $1.6 billion a year, according to a study co-authored by Nuckols.
    Instituting the measures could be a boon for society, however, potentially reducing the overall price of errors—e.g. , subsequent hospital visits, extra posttreatment care and lost wages—to almost negligible levels, but only if the new policies can decrease the rate of preventable errors at least 11.3% , according to the study. " Medical errors are expensive, and most of the costs of medical errors actually affect people after they leave the hospital," says Nuckols, who is also a health-services researcher for the Rand Corp. , the nonprofit health-research group that sponsored the study. " If the recommendations do succeed at reducing medical errors, there could be some cost offsets. "
    There is no guarantee, however, that limiting residents’ shifts is the key to patient safety. Dr. Kenneth Polonsky, who co-wrote an editorial accompanying Nuckols’ study in the New England Journal, says that while some studies show a correlation between fatigue and mistakes, not all reach the same conclusion. What’s more, Nuckols says, studies aimed at determining the cause of a mistake are inherently complicated: they require highly skilled researchers to pinpoint exactly what went wrong and when, and many rely on self-reporting from residents who, for obvious reasons, would sooner attribute a mistake to exhaustion than to other factors.  
The IOM report proposed that______.
选项 A、only experienced physicians should work longer hours
B、the length of residents’ work shifts should be reduced
C、the current 80-hour workweeks should be cut to 30 hours
D、doctors dizzy with fatigue should stop working at once
答案B
解析 细节题。第二段提到IOM的报告，他们调查了疲劳对工作的影响，提出建议：要么限制住院医生连续工作的时间，或者保证他们一定的休息时间，或者减少他们的工作负担，或者由有经验的医生加强对他们工作的监督指导，以减少医疗事故。选项C是错的，因为第二段最后一句话跟这个选项表达的意思不一样。原文的30小时是说每个shift不能超过30小时，而不是说每周只工作30小时。故B符合题意，为正确选项。
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