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Interpersonal Communication and the Elderly: Not Clearly House Staff Specific

Interpersonal Communication and the Elderly: Not Clearly House Staff Specific 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. Just as “[t]ime demands may lead house staff members to be less compulsive in their patient interviews,”1(p393) the study required house staff to complete the questionnaires within 2 hours of the encounter; the authors did not include whether protected time for the house staff was provided, and concurrent patient care responsibilities may have thus influenced diligence in filling out the questionnaire. As such, the authors' comment that “the house staff members did not see these answers as information they needed to know”1(p393) was purely speculative. The authors developed a hazards of hospitalization house staff questionnaire using a Medline literature search from January 1, 1966, through August 31, 2002. This time frame overlaps with the conduction of the actual study, which commenced on December 1, 1999, suggesting that the questionnaire may have been modified during the course of the study; no explanation was provided. Correspondence: Dr Babyatsky, Department of Medicine, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029 (mark.babyatsky@mssm.edu). References 1. Fernandez HMCallahan KELikourezos ALeipzig RM House staff member awareness of older inpatients' risks for hazards of hospitalization. Arch Intern Med 2008;168 (4) 390- 396PubMedGoogle ScholarCrossref 2. Hill AB The environment and disease: association or causation? Proc R Soc Med 1965;58295- 300PubMedGoogle Scholar 3. Vidyarthi ARAuerbach ADWachter RMKatz PP The impact of duty hours on resident self report of errors. J Gen Intern Med 2007;22 (2) 205- 209PubMedGoogle ScholarCrossref 4. Jagsi RKitch BTWeisnten DFCampbell EGHutter MWeissman JS Residents report on adverse events and their causes. Arch Intern Med 2005;165 (22) 2607- 2613PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Interpersonal Communication and the Elderly: Not Clearly House Staff Specific

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References (4)

Publisher
American Medical Association
Copyright
Copyright © 2008 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.168.19.2168-c
Publisher site
See Article on Publisher Site

Abstract

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. Just as “[t]ime demands may lead house staff members to be less compulsive in their patient interviews,”1(p393) the study required house staff to complete the questionnaires within 2 hours of the encounter; the authors did not include whether protected time for the house staff was provided, and concurrent patient care responsibilities may have thus influenced diligence in filling out the questionnaire. As such, the authors' comment that “the house staff members did not see these answers as information they needed to know”1(p393) was purely speculative. The authors developed a hazards of hospitalization house staff questionnaire using a Medline literature search from January 1, 1966, through August 31, 2002. This time frame overlaps with the conduction of the actual study, which commenced on December 1, 1999, suggesting that the questionnaire may have been modified during the course of the study; no explanation was provided. Correspondence: Dr Babyatsky, Department of Medicine, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029 (mark.babyatsky@mssm.edu). References 1. Fernandez HMCallahan KELikourezos ALeipzig RM House staff member awareness of older inpatients' risks for hazards of hospitalization. Arch Intern Med 2008;168 (4) 390- 396PubMedGoogle ScholarCrossref 2. Hill AB The environment and disease: association or causation? Proc R Soc Med 1965;58295- 300PubMedGoogle Scholar 3. Vidyarthi ARAuerbach ADWachter RMKatz PP The impact of duty hours on resident self report of errors. J Gen Intern Med 2007;22 (2) 205- 209PubMedGoogle ScholarCrossref 4. Jagsi RKitch BTWeisnten DFCampbell EGHutter MWeissman JS Residents report on adverse events and their causes. Arch Intern Med 2005;165 (22) 2607- 2613PubMedGoogle ScholarCrossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Oct 27, 2008

Keywords: older adult

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