I am writing in response to the article "Should Residents Work 36-Hour Shifts?" {Health Forum, Sept. 22}.

I work as the secretary to the director of the Residency Training Program in Obstetrics and Gynecology at The George Washington University Medical Center. I work with the 35 residents in our program on a daily basis and am friends with many of the residents. It is my opinion that 36-hour shifts are not advantageous to the hospital, the staff, the residents, the patients or to the university. As has been mentioned in numerous articles, the physical and emotional stress of working such long hours is high. I believe such stress can make a resident more susceptible to mental and physical illness and may promote substance abuse and/or dependence. Most residents have at one time or another fallen asleep at the wheel while driving home after a 36-hour shift. Anyone who has been working such a shift is generally very tired and tempers can flare up easily, making good communication between staff and patients challenging at times.

I cannot see how having residents work 36-hour shifts benefits anyone, but I am also concerned for the personal health and well-being of the residents. The residents I work with at George Washington are great people and in my opinion have proven to be very caring and dedicated physicians. I feel very strongly that these people deserve to enjoy the careers they have worked so hard toward; they also should enjoy their personal lives; and above all, their safety and the safety of the patients is a must. If the shifts were shortened to 24 hours, everyone would benefit, and perhaps residents and fellows would not suffer from "burn out" and substance abuse as often as they have in the past.

Kimberly A. Cassis

Reston

Down the Drain

That was a very interesting article on stress in the Health section {Healthtalk, Sept. 22}.

I must point out, however, that Stuart Little was never "sucked down the drain." Rather, he volunteered to be lowered down the drain on a string in order to retrieve a ring, which he succeeded in doing.

I only know this sort of thing because I majored in English. Cornelius M. Ulman New York

Estimates on Cystitis

We would like to commend your coverage of the workshop on interstitial cystitis {Healthtalk, Sept. 8}, a truly debilitating disease. But there was one error in your report that we would like to correct. In our estimates of female prevalence of interstitial cystitis in the United States, we did not say, nor did we report, that there were "at least 150,000 more {cases} that are undiagnosed."

We did report three separate estimates of diagnosed cases that ranged from 19,000 to 91,000 with an average of 44,000. These estimates clearly represent a major uncertainty in our current understanding of the epidemiology of this disease. We did point out at the workshop that an upper bound estimate of the undiagnosed cases may be five times larger than the diagnosed cases, but this is only a boundary.

Given the serious limitations of our current knowledge regarding all aspects of interstitial cystitis, it is important to be candid about the uncertainties of these new findings.

Philip J. Held, PhD; Philip Hanno, MD;

Mark V. Pauly, PhD; Alan Wein, MD

The Urban Institute

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