From Both Sides

The 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.