Health Policy

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By Katherine C. Kellogg

In 2003, within the face of blunders and injuries as a result of clinical and surgical trainees, the yank Council of Graduate scientific schooling mandated a discount in resident paintings hours to 80 a week. Over the process and a part years spent staring at citizens and employees surgeons attempting to enforce this new law, Katherine C. Kellogg chanced on that resistance to it used to be either robust and successful—in truth, of the 3 hospitals she studied did not make the switch. Challenging Operations takes up the plain paradox of doctors resisting reforms designed to aid them and their sufferers. via shiny anecdotes, interviews, and incisive statement and research, Kellogg indicates the advanced ways in which institutional reforms spark resistance after they problem long-standing ideals, roles, and platforms of authority.

At a time whilst a variety of rules were enacted to handle the nation’s hovering scientific expenses, asymmetric entry to care, and lack of primary-care physicians, Challenging Operations sheds new mild at the trouble of enforcing reforms and provides concrete options for successfully assembly that challenge.

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Extra resources for Challenging Operations: Medical Reform and Resistance in Surgery

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I had just witnessed the morning version of a long-standing daily work practice—the “signout” between the intern and the on-call resident—a practice that, I had discovered, would have to change if residents were to reduce their work hours to eighty per week. As an intern, Anne was respon- 24 CHAPTER ONE sible for all the routine work associated with the pre- and post-operative care of patients on the surgical oncology service. m. to complete this routine work. She then had met with Ryan to “sign out” to him.

26 In addition to being used frequently in New York, night float teams could often be created with minimal additional cash outlays by taking surgical residents from less busy surgical rotations and reassigning them to the night float team. Hiring new residents was not usually an option for hospitals, because each hospital residency program was funded for only a limited number of residents a year in order to control the number of newly trained surgeons entering the profession. Even had they been able to get approval from the RRC for additional resident positions, directors were loath to do so, concerned that this would dilute the educational experience of the existing residents by decreasing their caseload.

Dr. Cranford and Anne would take out the tissue around the needle and send it to radiology; the radiologists would then look at the calcifications and tell them whether they got an acceptable sample of tissue. Dr. Cranford and Anne were on one side of the table. Anne politely asked if she could switch places. Dr. Cranford told Anne what to do A DAY IN THE LIFE OF AN INTERN 31 and she did it. Then Anne asked whether she could use a certain technique. Dr. Cranford replied: “The tissue is so hard you won’t know what is tissue and what is wire.

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