Surgery is different: A response to the IOM report

While fatigue is a real issue, as the “fatigue literature” has recently pointed out, the question for surgery is is the patient safer being cared for by a somewhat fatigued trainee who fully knows the patient and was present at the patient's operation. Since having been present, that resident also knows the circumstances under which the operation was carried out (for example, the degree of satisfaction with the colonic anastomosis). Suddenly at 3 a.m. on the 5th postoperative day the patient complains of sudden onset of abdominal pain, has some tenderness, has a fever elevation to 103 degrees and suffers a drop in blood pressure. The fresh resident, knowing that the surgeon who performed the procedure is an excellent technician might begin to evaluate the patient for line sepsis, pneumonia, or a urinary tract infection, etc., while the fatigued resident who is familiar with the operation through active participation might immediately call the attending surgeon and say, “the anastamosis that concerned us at surgery may well have blown.” Dr. Britt is currently a member of the American Board of Surgery, past chair of the Residency Review Committee (Surgery) and is currently Chair of the Board of Regents, American College of...