To the Editor:
Thank you for your very informative Summer 2005 issue. It brought a few points to mind.
- The letter “PCA Presents Serious Risks” recalled an incident in my hospital. I had delivered a man after abdominal surgery to the PACU with PCA orders. After some time his nurse called me over for help. The patient’s nephew, an orthopedic resident in the hospital, was standing over his bed, pushing the PCA button while the patient was sound asleep. The nurse had tried in vain to stop him. I asked what he was doing, and his response was that he knew his uncle was in pain, but was too sleepy to push the button himself! After carefully explaining to the resident that a sleeping patient was his own safety control, I resolved to change my preoperative talk to patients. I had always told them how PCA worked, but since then I have also emphasized to the families that helping their loved one with the button could kill them. If doctors are unaware of the risk, certainly lay people are.
- I am genuinely surprised that health care professionals are still reusing needles and syringes. During my residency (back in the 1980s), we routinely reused needles and syringes. In fact, we replaced syringes only when the numbers wore off! But with the rise of the AIDS epidemic that practice stopped, almost instantly. Perhaps, because we’re in New York and had a huge awareness of the problem, it was easier for us. There is really no excuse for the practice continuing 20 years later. Needles and syringes cannot cost that much!
- I wholeheartedly support Drs. Lee and Parker who talked about fatigue in practitioners. As a resident I was aware of being extremely tired after call and have never supported the theory that there is now poor care continuity because of the 80-hour work week, and the "if I did it, you can" mentality with respect to working ridiculous hours. Finances really are at the root of these opinions. My response is get more people on the job to help spread the work and decrease the negative impact on everyone (yes, even in small hospitals). All you need is one lost patient due to fatigue to put it all in perspective.
Again thanks for a great issue.
Saundra E. Curry, MD
New York, NY