Laborist approach improves safety

OB/GYN News, May 15, 2006 by Louis Weinstein

Our specialty has not faced the reality of the importance of patient safety in preventing medical errors ("Physicians On Call: Count the Ways," March 15, 2006, p. 1).

The article addresses various ways of practicing, none of which is unique or attractive to the young people entering our profession. The typical way we structure our workday has led to many preventable medical and system errors, played a major role in the current professional liability crisis, and resulted in our profession becoming less attractive to medical students. But the concept of patient safety or the impairment of physicians who are working 24-hour shifts was not mentioned in the article. Evidence demonstrates that physicians working longer than 18 hours function as with a blood alcohol level of 0.08, which is the national standard for impairment. The article describes a young female physician with four children who takes 24-hour call from evening to evening instead of morning to morning and describes this as an improvement in lifestyle. Another comment is made about a group that reschedules office visits when the physician is needed on call. A third group uses a "pull back system" where a physician can be on call but returns to the office to see patients. A fourth group uses the laborist approach, but does this as a second job in order to make extra money for expenses.

If our profession is to eliminate preventable medical errors and become more attractive to the graduating medical students, we must change the archaic and dangerous way that we practice. We must realize that patient safety is our No. 1 priority by having people work reasonable hours and be available in a rapid response team approach for any obstetric emergency. An article published by this newspaper on the laborist movement ("Laborist Movement Poised to Take Off," June 15, 2005, p. 1) describes an approach that addresses both patient safety and improved lifestyle for the practitioner. I suggest that those of us that love and profess the importance of our profession to the public remember the following Latin maxim: Salus populi suprema lex (The people's safety is the highest law). It is now time for the practice of obstetrics/gynecology to embrace the 21st century.

Louis Weinstein, M.D.

Philadelphia