It was with much dismay that I read the recent article by Petersen and associates [1], not because of the study's results but because of the conclusions drawn by the authors that decreasing housestaff work hours is detrimental to patient care.

Several explanations account for an increase in adverse events when patients are cross-covered. This may represent insufficient background knowledge of the patient and can lead to incorrect diagnosis and therapy. Perhaps the cross-covering intern had less time to evaluate the patient. I think it is important to note that all cross-coverage in this study occurred at night, when fewer attending physicians, fellows, and residents are available to answer questions and catch mistakes. Would the results have been the same if only night-time adverse events had been included in both groups?

The number of hours that interns and residents typically work is inhumane and must be changed. I am interested to know the number of adverse events—such as automobile accidents, use of antidepressant agents, and divorce—that were secondary to sleep deprivation during the same period. Neither the public nor housestaff should allow this practice to continue. The only way to reduce hours is to implement some kind of shift-work and that will mean more cross-coverage. This has also occurred at the attending physician level, where patients can no longer call their physician at any hour and expect to reach only him or her. The issue should not be how to avoid cross-coverage but how to improve it. We need improved communication among physicians, more feedback of the cross-covering resident's performance, and more accountability.