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Editor's Correspondence
October 27, 2008

Interpersonal Communication and the Elderly: Not Clearly House Staff Specific

Arch Intern Med. 2008;168(19):2168-2169. doi:10.1001/archinte.168.19.2168-c

We had several concerns regarding the study by Fernandez and colleagues1 examining house staff awareness of potential risk factors for developing hazards of hospitalization in elderly individuals. First, the cross-sectional design2 lacked control groups including non–house staff health care workers such as nurses, geriatric fellows, attending physicians, or house staff at other academic or community hospitals, severely limiting the study's specificity. No measure of work duty-hour compliance or other variables that may affect medical errors by house staff3,4 such as administrative burden, fatigue, or other work stressors were addressed. Furthermore, the time lag between the conduction of the study and publication was not discussed, inferring that the group studied is representative of the current house staff program. Some of the significant changes since the 1999 through 2002 time frame of the study have included new leadership of the Medicine residency including the chair, program director, and associate program directors, a new competency-based residency curriculum that includes medical error recognition, Advancing Idealism in Medicine (a program that specifically addresses communication skills, professionalism, and patient advocacy), and a complete restructuring of the inpatient teaching service into an educationally based firm system with graduated house staff responsibilities; at least 80% of attending physician rounds have been conducted at the bedside to foster development of clinical and communication skills. Furthermore, a general medicine firm has provided inpatient geriatrics attending physician and fellow teaching of house staff throughout the year.

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