Preparing physicians for the real world/Dr. Parshuram responds/Dr. Howard responds

1. Parshuram CS, Dhanani S, Kirsh JA, Cox PN. Fellowship training, workload, fatigue and physical stress: a prospective observational study. CMAJ 2004;170(6):965-70. Is the reality of professional life for physicians, as described by John Acres, a desirable reality that we should be striving to sustain? In our study5 the average departure time of staff intensivists was after 9 pm, they were away from the unit for an average of 9.5 hours per day, they returned overnight every fifth on-call day, and they had contact with on-call, in-house physicians once or twice each night. With continuous on-call periods of 3 to 4 days, the potential for sleep deprivation and fatigue among these staff physicians should not be discounted, but any fatigue-related effect on patients was probably counterbalanced by the benefits of continuity. The "best" practice pattern has yet to be defined6 but it requires balancing a variety of factors related to continuity of care, fatigue and physician well-being. 5. Parshuram CS, Dhanani S, Kirsh JA, Cox PN. Fellowship training, workload, fatigue and physical stress: a prospective observational study. CMAJ 2004;170(6):965-70.