Arising from: Hanauer S B (2006) Nat Clin Pract Gastroenterol Hepatol 3: 1 10.1038/ncpgasthep0386

I am writing to say that the points made by Stephen Hanauer in the editorial "Duty hours and guaiacs" are 'right on', as we used to say in the old days. I agree completely that the push to reduce the sleepiness of housestaff has led to many more errors, thanks to the baton passing that now takes place.

One much publicized death in New York led to this revolution in training. I wonder how many bad outcomes have occurred since house officers are no longer able to provide their inpatients with continuity of care. Continuity of care for outpatients is worshipped. How about the inpatients? Who is more ill and in need of someone who knows what is going on and what has happened in the recent past? The regulatory bodies that decide the rules on training seem to have done their best to minimize housestaff training and the house officer's sense of responsibility and ownership of patients.

Do you think the regulatory bodies realize what they have done? I am bewildered by the rotations of residents and their covering faculty now and the rules that prevent learning. It is my understanding that housestaff can't even stay in the hospital to do research during their 'time off'.

When my hepatology team rounds on subspecialty consult patients and asks the assigned house officers for details about their patients and their treatment plans, some housestaff say that they don't know anything about their patients now. The worst thing is that they freely admit it and aren't even embarrassed about knowing nothing. They can always quote the rules in their defense. The attitude is that the next shift will pick up the baton, but that doesn't seem to happen: they are also relying on the next shift.

What happened to the days of the ironmen? Can we hope to reclaim some control of our trainees' training and get some more sanity in the system?