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

admin2014-05-20  26
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 workweek, 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 post-treatment 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.
Dr. Nuckols’ response to the assertion that fatigue is the main cause of medical errors would be that ______.
选项 A、it is a justified assertion
B、it is not a reasonable assessment
C、it is highly unlikely
D、it is not necessarily true
答案D
解析 推理题。最后一段提到了Polonsky的看法：不是所有的研究都发现疲劳和医疗事故相关。Nuckols博士也承认：研究疲劳和医疗事故之间的关系是一件很复杂的事情，而且其中很多研究靠的是医生自己的陈述，医生自己当然愿意把事故原因归因于工作疲劳，因为这样他们就为自己可能出的医疗事故找到了客观的理由。故选项[D]符合题意，为正确选项。
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