Work Rules & Ethics. Today's entry has to do with the current work rules and ethics. As everyone knows the State of New York years ago imposed the 80 hour work week for residents in training. This 80 hour work week has now been expanded to the entire country by the ACGME through its power over the RRC's. Anyway, the crux of the matter is that sometimes the question of the letter of the law is sometimes difficult to keep. I had an interesting discussion with a couple of Chief residents who confided in me that they are being as careful as possible to obey the rules but that on occasion they don't; mostly they overstay the limit (particularly on the go home early day) to get to do index cases. Anyway, they are advocating a "don't ask, don't tell" approach. I was never sure where that concept came from when I first heard it with regards to homosexuals in the Armed Forces. I suppose I need to dig a little deeper in to the ethical considerations; however, when I pressed the point, the residents likened it to "a tree falling in the woods". As for my part, since it seems that the system is really like the "honor code" used in college to foster honesty in test taking, I am certainly not going to infringe on the honor of the residents. And since like many trauma attendings my work week almost always execeeds 80 hour, I can not say well follow my example. It will be interesting to see if anyone studys the long term effects of this 80 hour rule. That's all for now. JTE.