By Katherine C. Kellogg

In 2003, within the face of error and injuries attributable to scientific and surgical trainees, the yank Council of Graduate scientific schooling mandated a discount in resident paintings hours to 80 every week. Over the process and a part years spent looking at citizens and employees surgeons attempting to enforce this new legislation, Katherine C. Kellogg came upon that resistance to it used to be either powerful and successful—in truth, of the 3 hospitals she studied didn't make the swap. Challenging Operations takes up the obvious paradox of doctors resisting reforms designed to aid them and their sufferers. via bright anecdotes, interviews, and incisive statement and research, Kellogg exhibits the advanced ways in which institutional reforms spark resistance once they problem long-standing ideals, roles, and platforms of authority.

At a time while a variety of guidelines were enacted to deal with the nation’s hovering clinical expenditures, asymmetric entry to care, and absence of primary-care physicians, Challenging Operations sheds new mild at the hassle of enforcing reforms and provides concrete options for successfully assembly that challenge.

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Extra info for Challenging Operations: Medical Reform and Resistance in Surgery

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At least for now. , WEDNESDAY Anne’s day had been relatively uneventful, and because she was the one on call that night, there was no evening signout to observe between her and Bill or Ryan. m. I watched her prepare for her night on call. The whole floor had quieted down. There was one nurse sitting at the pod, and the rest were walking around. At the computer in one of the call rooms, Anne pulled up her list of patients. Only fifteen. That was light. When she had been working on tho- A DAY IN THE LIFE OF AN INTERN 27 racics (the thoracic surgery service), she said, she’d have two sheets singlespaced, and they’d all be complex patients with acute illnesses.

One attending had exploded: “This is all so much bullshit. ” SIMILAR HOSPITALS, SIMILAR PROGRAMS 43 In the face of this onslaught, the directors had held their ground because they felt that the new work hours regulations were inevitable. As the director of surgery later explained to me: “When Phillip Harris sits in my o∞ce today—he is a visiting professor and a traditional good ol’ boy general surgeon—and tells me that the ACGME is under the gun from the American Medical Student Association and other groups, and has already made its decision, then we know that regulation is inevitable.

Part of her felt irritated listening to it, and part of her asked why she couldn’t have it too. She tried not to think about marriage and kids, but she thought about both daily, hourly. “I think it’s bullshit. I think about it all the time. I care about my personal life. I don’t want to be a woman surgeon, old and alone. I turn a deaf ear, though. ” A patient paged Anne from his home. He had recurrent metastatic colon cancer—a forty-eight-year-old guy with kids. His recurrence was localized, so they had thought they might get the growth out and treat him with chemo.

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