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he left side of James S. Floyd's brain is responsible for most of
what comes out of his mouth, which, considering that he's the voice
of Duke's medical students, is no light function.
As an alternate delegate for the Southeast in the House of Delegates,
the legislative body of the American Medical Association, as well
as the Duke chair of the Medical Student section of the AMA, Floyd
has represented the Duke medical-student community for the past
year.
"When you're in school, you're so busy learning about how the
body works and how to treat it that you don't have much time to
learn about professional issues, what it means to run a practice,
how you make money, how the uninsured don't have access to health
care," he says. "You don't learn the political components
either, until much later on."
Floyd knows, as does anyone who has worked in the O.R. or endured
a marathon all-nighter, that, for neurosurgeons, time is relative.
The brain is delicate landscape; it's always best to tip-toe around
an aneurysm, and that can take a while. So a new policy regulating
the hours a resident can work presents some problems for a surgeon
in training.
Scaling back resident work hours arose as a patient-safety concern
and was long a major advocacy issue in the intern and resident community.
Only now, in the face of pending legislation and recently publicized
findings, has the medical community begun to act on the idea. The
Accreditation Council for Graduate Medical Education announced this
summer that it would impose strict limits on resident work hours
and the AMA quickly backed the plan.
But those moves, intended to pre-empt federal intervention, might
have come too late. Marking the first time that Congress has been
asked to address the issue, the Patient and Physician Safety and
Protection Act of 2001 proposes outside policing of hospitals and
public disclosure of violators. Floyd opposes the idea: "We
don't want the government to have the power to step in and regulate
affairs in medicine, to be able to come in, without adequate knowledge
of the circumstances, and say, 'you've violated resident work-hour
limits. We're going to disaccredit your hospital.' "
The new limit of eighty hours per week and twelve a day "is
a good thing for medicine," says Floyd, "but it's a bad
idea for surgery programs because it's just not enough time. If
you're limited to twelve hours in a day, and you have a sixteen-hour
surgery, you're not even going to see the whole thing. How are you
going to learn to do that surgery? I think residents should work
fewer hours. And the solution to that is to have guidelines, as
in 'you have to work, say, 100 hours over this time frame and we'll
provide you with the support staff.' "
At twenty-one, Floyd is three years younger than any of his classmates.
This doesn't bother him; his friends are used to it by now, and
"age is not how old you are, it's where you are in your life."
Floyd sits on the medical school's executive admissions committee,
one of two students chosen. He says it's quite an honor, but he
won't just sit there. He's planning to select the best applicants,
those who want to go into medicine for the right reasons.
"Medicine is a social profession," he says, "and
yet you see a lot of physicians who lack basic social skills. They
have poor bedside manners. They leave patients frustrated and upset.
Your job is not only to fix the physical ailment, but to be a source
of calm as well. There's a difference between treating a person
and caring for them. You might not know the proper treatment, but
you can still care for them."
You might say Floyd has a big heart, but, technically, that's his
right brain.
--Patrick Adams
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