An Accident Waiting to Happen?

When I heard last week that the National Labor Relations Board had ruled that medical students have the right to form unions, I thought of my own medical training and the night two years ago when a colleague nearly killed a patient.

It was busy that night in the emergency room and intensive-care unit of the hospital where I did my residency. I was in charge of the regular floor; my colleague, also an intern, was covering the ICU. Interns on call usually manage to grab at least a couple of hours' sleep during their 24-hr. shift, but that night we worked nonstop. Suddenly a senior resident came rushing down the hall. Emergency in the ICU!

I ran over to see what all the commotion was about. My colleague--exhausted and overworked--had misread the label on a bottle of medication and administered a drug that paralyzed a patient, stopping his breathing. Fast thinking and the quick application of an antidote saved the patient's life. But it was a close call.

Why do hospitals overwork their interns? Because they can. Why don't interns do something about it? Because for 23 years they were forbidden to organize. The NLRB ruled in 1976 that interns were not employees but students and had no right to bargain collectively. Last week's decision reverses that ruling. It covers some 90,000 residents working at privately owned hospitals across the U.S.

Don't get me wrong. I don't think organizing medical students necessarily means better medical care. But neither does asking doctors in training to work 36 consecutive hours without a break. If nothing else, a resident's union can give interns a stronger voice to negotiate more humane work schedules and can force hospitals to the bargaining table. How the negotiations unfold could have an impact on the quality of medical care for all Americans.

--By Ian K. Smith, M.D.