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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  63
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.  
Implementing the IOM guidelines can be boon if______.
选项 A、it does not reduce the residents’ educational opportunities
B、it brings benefits to both the doctors and the patients
C、it has the effect of reducing the rate of medical errors
D、medical errors are made less expensive than they are now
答案C
解析 细节题。第四段提到：如果能reducing the overall price of errors的话，实施IOM报告中建议的那些措施对社会来说可能是件好事。第四段第一句提到如何从subsequent hospital visits, extra posttreatment care and lost wages等方面来减少医疗事故带来的代价，其中subsequent hospital visits指由于医疗事故的发生，没有治疗好病人，病人不得不再到医院来看病；posttreatment care指的是出现医疗事故后给病人造成伤害，因此不得不再通过治疗或护理手段对病人做出补偿。故C符合题意，为正确选项。
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