Can health reporting in the popular press get any worse? Every time I think it has reached a new low in accuracy and reliability, somebody comes along and blows that last new low right out of the water.

I have a dear friend who runs a news clipping service. From her base as a teacher of emergency medicine in Saginaw, Mich., she posts links to articles about issues in our health care system, some from trade publications (e.g., Health Affairs), many from the popular press. Knowing, as I do, that my friend is esteemed by her colleagues in academic emergency medicine and beloved by her trainees, when she posts something, I am much inclined to read it.

A recent article in USA Today stated that medical interns working shorter hours were making more mistakes. Citing a study published in a major medical journal, the article reported, “Most concerning: Medical errors harming patients increased 15% to 20% among residents compared with residents who worked longer shifts.”

I will admit to a dual bias here. First, I am naturally skeptical about anything that is counter-intuitive, and I was once a medical intern whose quality of decision making unquestionably deteriorated with sleep deprivation. Second, when I read something in the popular press about a medical study that doesn’t make sense, I naturally assume that the medical reporter got it wrong.

‘It only stands to reason thatin this climate, the perception of the occurrence of medical errors might increase, over time, without a change in the reality.’

In 1984 Libby Zion was a freshman at Bennington College. She got sick and was admitted to a New York hospital. A serious error was made in her medical care, and she died the next day. The error was thought to be due, at least in part, to long hours worked by medical residents. Sleep-deprived doctors are more likely to make bad decisions, or so thought the Bell Commission, whose recommendations to limit the hours of doctors in training were adopted by the state. Similar restrictions were adopted by the Accreditation Council for Graduate Medical Education (ACGME) in 2003.

Then in 2011 the ACGME further modified the work rules. One of the changes was to limit shift length for first-year residents (sometimes called interns) to 16 hours.

A study just published in the American Medical Association’s internal medicine journal examined the effects of this recent change by surveying medical interns before and after the 2011 change in the rules. Interns were asked about their work hours, how much sleep they were getting, their overall state of well-being, whether they were having symptoms of depression, and whether they thought they were making mistakes on the job.

One would expect, intuitively, that doctors who don’t have to work as many hours, and who don’t have to work more than 16 hours (which in most other lines of work is called a “double” shift), would get more rest and have an overall improved sense of well-being. If the Bell Commission was right, they would also make fewer mistakes.

So one of the findings of this study was a bit of a surprise. The interns thought they were making more mistakes after the new rules took effect.

Notice I didn’t say they actually were making more mistakes, or that they were making more mistakes that caused harm to patients. The authors of the study didn’t say that, because that isn’t what their findings showed. But that didn’t keep the writer for USA Today from saying that. [Is she mistaken? Is this all about selling newspapers? Both?]

So what did the authors find? Well, first, you have to know what they asked. Interns were asked, on a survey, whether they were concerned about having made any major medical errors in the preceding 3 months.

Before the change in work rules, 19.9% said yes; after the change, 22.3% said yes. So, first, although this change reached statistical significance, it’s a pretty small change.

Second, this is a matter of perception. They were more concerned about having made major medical errors. That doesn’t mean they actually had made more errors. It also doesn’t mean they made errors that harmed patients. No one asked them to sit down at the end of every shift and write down whether they thought they had made any serious mistakes- and what they were, so a researcher could read it and decide whether it really was a serious error. The fact that this is a perception is very important, because in recent years doctors have been hearing a lot about medical errors and the importance of identifying and reporting them in order to learn from them and reduce their incidence. It only stands to reason that in this climate, the perception of the occurrence of medical errors might increase, over time, without a change in the reality.

Let us imagine that the perception and the reality do have some connection. What might be the explanation for that? Well, first, the medical interns might be expected to complete the same amount of work in fewer hours. That is likely to increase their level of stress and contribute to error. Second, if shifts are shorter, there will be more changes of shift, meaning more handing off of responsibility for patient care from one doctor to another. Hand-offs are associated with error. We know this. It is not only intuitive, but we have abundant evidence to prove it. And we’re working on that. We are devoting a lot of time and attention to making hand-offs better.

You see, if hand-offs are of high quality, there is reason to believe they can increase, rather than decrease, the quality of care – and reduce, rather than increase, the frequency of errors. If hand-offs are well done, they provide an opportunity for two doctors to engage in a discussion of a patient’s case and learn from each other. Do you think that discussion will be more fruitful if the doctor passing the baton to her colleague is finishing a really long shift, or a shorter one? The doctor finishing the longer shift is mentally exhausted and just wants to get the heck out of the hospital and go home to sleep.

‘When a health reporter for a major news outlet gets something so completely and inexcusably wrong, I am beyond exasperated.’ What will it take for them to get the facts right?

Certainly if we are going to have hospital-based trainees working fewer hours overall, we have to recognize and deal with the consequences. Unless we want them to have to complete the same amount of work in fewer hours, we have to have more of them, and we have to have ways of limiting the quantity of work, not just the number of hours. And we are working diligently to accomplish that.

We also have to realize that if a doctor is in training for 5 years after medical school, and we say he cannot work more than 80 hours per week, he’s not going to get as much experience in those 5 years as someone who has worked 100 or 120 hours per week. There is a famous story in which the chairman of the department of surgery at a major medical school says that the disadvantage of being on call every other night is that you miss half the interesting cases. But I can tell you from my own experience as a trainee, and from many years as a teacher, that one does not learn well when one is not adequately rested. I have concluded that, in medical training, the concept of “quality time” is very real.

Part of my keen interest in this subject is that I care deeply about the future of my profession, and I want to make sure the training that future generations of doctors get is optimal for the acquisition of knowledge and skills. And part of it is paternalistic, in the sense that my current trainees are the same age as my children, and I care about their well-being as I would if they were my own.

So when a health reporter for a major news outlet gets something so completely and inexcusably wrong, I am beyond exasperated. What, I ask you what, will it take for them to do what they must to get the facts right?

Dr. Solomon teaches emergency medicine to residents at Allegheny General Hospital in Pittsburgh and is Medical Editor in Chief of ACEP News. He is a social critic and political pundit and blogs at www.bobsolomon.blogspot.com.