Release date: 2017-08-22 From January to July 2017, according to public reports, 14 doctors have been killed. Domestic doctors frequently appear to be overworked due to excessive working hours, so that sudden deaths occur. So how is the working time of their residents in the most medically advanced United States? How does the resident's working time relate to medical quality and patient prognosis? Today I share a case with you and the changes that this case has brought to American medical care. Things happened in New York in 1984. On the evening of October 4, 1984, a young college student in New York, Libby, was sent to the emergency room at New York Hospital in Manhattan, New York. Libby Zion is a teenage girl with a history of depression. When she came to the emergency room, she showed symptoms of fever, irritability and strange convulsions. This quiet night changed the fate of Libby, and Libby passed away within less than 24 hours of admission. What is this all about? A college girl who was in the flower season died within 24 hours of being sent to the emergency room. It was her father who was a lawyer and a journalist. Sidney Zion couldn’t accept it anyway. When he learned that he would take care of him that night. When her daughter’s doctor was on the 36-hour class and lacked the resident doctors supervised by her superior doctor, his anger at the hospital and doctors was even more difficult to contain. However, it was because of his actions that led to post-graduate medical education in modern America. Reform - ACGME (America's Post-Graduation Medical Education Accreditation Council) a series of rigorous work-limited initiatives. Although controversial, the case in the emergency room in New York on 1984 was basically the same. That night, because the emergency doctors were difficult to diagnose the symptoms of Libby, they were treated with fluid replacement and observation. Dr. Shermon (attending physician), who has treated many members of the Libby family, was approved by the phone on his phone. After entering the ward, Libby was waiting for two residents: the first was Dr. Weinstein (hereafter referred to as Dr. W), the first year resident, just graduated from medical school; the second was Dr. Stone, the second year resident, One year more clinical experience than Weinstein. They also can't diagnose what disease Libby is. According to Dr. Stone, this is a "viral infection with hysteria symptoms", indicating that Libby's body is overreacting to a relatively mild disease. The two residents immediately gave Libby an analgesic sedative, Du Lengding, to control her tremors. Dr. Shermon (Libby's attending physician) also agreed to the treatment by phone. The events that followed in the next few hours were always the focus of controversy, and Dr. W left Libby to look after the other 40 patients in her hand. Dr. Stone went to the next building to sleep, and if there was something he would be called by the machine. After the two doctors left, Libby showed more anxious symptoms. The nurse called Dr. W several times. She prescribed a doctor to let the nurse physically restrain Libby at the bedside and tied her to prevent her from hurting herself. At the same time, Dr. W prescribed haloperidol to stabilize the patient. Since Dr. W was busy taking care of other patients, she did not come to reassess Libby's condition. Libby finally slept, but when the nurse re-measured her body temperature at 6:30 in the morning, Libby's body temperature reached 107 degrees Fahrenheit (41.6 degrees Celsius). The situation was critical. At this time, Dr. W was called again to reduce his body temperature, but Libby eventually Died of cardiac arrest. Dr. W called Libby's parents to inform them of the bad news and told them that the hospital had tried their best. However, Libby's father continued to understand the process and details of the matter, and he was even more convinced that this was because of the consequences of insufficient staffing at the teaching hospital in the evening. Two major questions revolve around the mystery of this case: 1) Whether the drug interaction between Du Lengding and Perphenazine (an antidepressant taken by Libby) causes high fever; 2) Is it reasonable to use limb restraint and another dose of sedative in patients who are becoming more and more anxious? With these questions, Libby Dad, a journalist and lawyer, slammed the hospital in a commentary on the New York Times: Can a low-level resident who works 36 hours in a row be able to make a correct judgment? Moreover, Dr. W still has so many patients in his hands to take care of, and Stone, a one-year resident who is partnering with her, has not been called at all. Even Libby's attending physician, Shermon, was not called when Libby's condition deteriorated that night. As a friend of Libby who has a wide network of contacts in the New York press, he continued to report on the incident through his influence, and eventually made things happen on TV. The Washington Post, The New York Times and Newsweek reported on the progress of the incident. Dr. W even went to court, causing widespread concern in the American community. Finally, the New York State Health Council chaired a commission of inquiry to assess the incident, led by Dr. Bell from Einstein College of Medicine in Bronx District. In 1989, Dr. Bell's suggestion: Residents could not work more than 80 hours in a week, and a shift of no more than 24 hours was finally accepted, and the accompanying senior doctor must always be in the hospital. Since then, the hospital's "night float" system has been created. With a special doctor to sit in the night shift, the new time-limited work regulations can be effectively implemented. Of course, from the perspective of resident physician training, it is advantageous from a clinical education perspective if a lower-aged physician can continuously observe the condition during the first 36 hours of the patient's admission. At the same time, the night shift system also led to the interruption of medical continuity. Because of the night shift doctors, the number of sign in-sign outs has increased significantly, and the number of doctors who have handled a patient has increased, leading to a series of problems. Because of this, from 1989 to 2003, many medical institutions in the United States have almost imposed a limit on the time limit for work. Until 2003, ACGME (American Post-Graduation Medical Education Accreditation Council) finally made the 80-hour time limit as a mandatory requirement, so the US resident training program must be followed, otherwise it will not be certified. Since then, the time limit for the work of US residents has gradually entered the right track. As a result, we often see in clinical work in the United States that many inpatients often count the working hours of their lower-grade residents to ensure that they do not work more than 80 hours a week. Even those residents who wish to stay in the hospital for a longer period of time are rushed home to sleep, a situation that the United States could not have imagined in the past. In 2004, NEJM (New England Journal of Medicine) reported research data indicating that working time restrictions did improve the attention and judgment of residents. However, in 2006, JAMA (American Medical Association) reported that 80% of American first-year residents still work overtime. How should the resident's working time be stipulated? The impact on the health of the resident, the medical quality of the medical institution, and the clinical education of the resident will always be a topic worthy of discussion. How to achieve a reasonable balance to ensure the quality of resident health and clinical training, while ensuring the quality of patients' medical care, requires the wisdom and courage of policy makers to create the best results for doctors and patients. Then, in the case of repeated deaths in doctors in China, what changes should we make? Source: Medical circles chlorella powder,spirulina powder, blue spirulina powder , rice protein etc Organic Powder,Butterfly Pea Powder,Chaga Mushroom Extract,Hericium Erinaceus Extract Youth Biotech CO,. Ltd. , https://www.youtherb.com