Differences in public belief and reality in the care of operative patients in a teaching hospital.

OBJECTIVE: The accreditation Council for Graduate Medical Education (ACGME) restricts residents from working more than 80 hours per week averaged over a 4-week period. No such restriction exists, however, for attending surgeons. Little exploration has been done of the public's perception of the number of hours that surgeons work and how residents work with the staff surgeons at a teaching institution. METHODS: A survey was designed to study the public's belief on surgeon work hours and habits. The survey also asked their opinion on resident involvement. All patients and accompanying persons arriving through the Surgicare Center for elective procedures older than age 18 were surveyed. The overall survey responses were calculated, and the results then were stratified by sex, age, race, and education. RESULTS: Of the 1516 surveys distributed, 370 were completed and returned (24.4%). Of those responding, 91% believed that a work hour limit should be in place for surgeons, and 77% believed the limit should be 12 consecutive hours or less. Eighty-four percent of the population believed that limit should be in place on the hours/week that a surgeon works, and 68% believe that it should be 60 hours or less. Although 82% would reschedule if they knew their surgeon had less than 4 hours of sleep the night before their procedure, 79% trust their surgeon's judgment to cancel if he/she were too tired. Only 28% of those surveyed were aware whether a resident was involved in their care, and 14% were against resident involvement. Respondents also were asked if the attending surgeon deemed a resident capable, then what percent of the procedure should the resident be able to perform? Ninety-one percent of those surveyed believed that the attending should be present for the entire case, and 78% believed that they should not be able to schedule more than 1 procedure at any given time. CONCLUSIONS: These findings illustrate a difference between the public's beliefs in regard to the hours a surgeon should be permitted to work and the reality of a surgeon's work life. Although the public may not be aware of the surgeon's schedule at a given time, they do trust the surgeon would cancel if too fatigued. The majority surveyed were not aware of resident involvement, but they trusted the attending surgeon's judgment with deciding how much of the actual procedure he/she could perform. With work-hour restrictions and resident involvement continuing to evolve, keeping the public informed should be a priority.

Chronic acalculous biliary disease: cholecystokinin cholescintigraphy is useful in formulating treatment strategy and predicting success after cholecystectomy.

Patients with symptoms consistent with biliary colic who do not demonstrate calculi on routine sonography present a diagnostic dilemma for clinicians. For those patients in whom other disease entities have been excluded and in whom the history and physical examination exemplify classic signs and symptoms of biliary disease we show in this study that cholecystokinin cholescintigraphy with calculation of gallbladder ejection fraction is a predictor of pathology as well as subsequent symptom relief after cholecystectomy. The spectrum of pathology that makes up chronic acalculous biliary disease lacks a distinct definition, yet this review shows that cholecystokinin cholescintigraphy offers the surgeon the means to better counsel his or her patient with regard to surgical indications, options, and benefits. We reviewed 26 patients who had no gallstones detectable, had gallbladder ejection fraction <35 per cent, and were status postlaparoscopic cholecystectomy for suspected chronic acalculous biliary disease. Our results show histopathologic evidence of chronic cholecystitis in 100 per cent, and 92 per cent of the patients had improvement of symptoms and satisfaction with the operation to the point that they would undergo the surgery again without reservation.