I don't usually read obituaries but a recent one in the New York Times caught my eye. It was for Sidney Zion, a prosecutor, lawyer and writer who became known because of the death of another. His daughter, Libby Zion, died in 1984 in what became a celebrated case in the medical world. Though it happened 25 years ago, the case remains relevant to the training of medical professionals today.
Zion, you may recall, was the young woman admitted to a New York Hospital who died eight hours later after being treated by a tired intern. Her parents, Sidney and Elsa Zion, filed a suit alleging gross negligence. They also lobbied for more supervision and workload restrictions on interns and residents. A grand jury - and the hospital itself - acknowledged that human error may have contributed to Libby Zion's death.
The case led to a series of changes in the rules governing work hours for interns and residents. The accrediting agency for medical schools in 2003 mandated that these trainees can't work more than 80 hours a week or 24 hours at a stretch. The rules remain controversial to this day. Though it's unfair - and possibly dangerous - to a patient to have them treated by a sleep-deprived intern, I think that there are tradeoffs. The intern who has admitted a patient may be forced to leave the patient's bedside when the intern's shift is up. I believe that this can be a hard thing for a conscientious new physician to do. Not only that, I have heard interns worry that some vital piece of information may be lost when they hand the patient off to another. So errors can occur in that process as well. I know interns - and the programs that train them - still struggle to find this balance today.