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September 2014

Mourning the Need for So Many Handovers

Author Affiliations
  • 1Los Angeles County Department of Health Services, Los Angeles, California

Copyright 2014 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Intern Med. 2014;174(9):1434-1435. doi:10.1001/jamainternmed.2014.3019

As an internal medicine resident in the 1980s, I essentially lived in the hospital. On ward months, we were on an every-third-night rotation such that we woke up and went to sleep at home only 1 of every 3 days. On our on-call day we admitted patients all day and all night and spent the following day caring for our patients, often with minimal sleep. We had 1 day off each month, when the “swing day” fell on the weekend.

I do not romanticize this era before the institution of duty-hour restrictions. It was very hard, and we made mistakes in our fatigued states. But handovers were a pretty minor issue because we were always in the hospital, and we took great pride in getting our patients “tucked in” so that the on-call residents could focus on their new admissions rather than the issues of our already admitted patients. If that meant staying longer, we did.