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Why Do Hospitals Hate Sleep So Much?

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Re: Why Do Hospitals Hate Sleep So Much?

#301

Post by sxg »

jac241 wrote: post #278
gerbilly wrote: post #246

Earlier quoted context omitted.

> during pre-med training: with on-call work hours up to 120 hours a week. Can someone please tell me why they still put medical students through this institutional hazing?

In medical school, 120 hour weeks really only exist for 4th year med students who are on sub-internships in surgical specialties like neurosurgery, orthopedic surgery, general surgery, etc. Students in those fields do 3 or so month long sub-i's at hospitals they want to do residency at. They basically function as month long interviews for those programs, and are also used to get letters of recommendation from promine…

I'm currently in my 4th year of medical school, and I have to clarify your comment on the hours worked. We're held to the same hours limits as residents, which is 80 hrs/week averaged over 4 weeks and an average of 1 day off per 7 days. We most often come near these hours on surgical specialty rotations (like the ones you noted). However, these are completely voluntary rotations. I'm not interested in surgery, and I have no surgery rotations scheduled at all during this year. Most of this year is actually spent on residency interviews. I've been traveling to different cities in the US about twice per week since October, and will continue through the end of January with breaks for the holidays. I have no hospital duties from September–January.

The 3rd year of medical school is much tougher since we spend about 10 months of that year on rotations in the hospital. While some rotations are much lighter, others like surgery again get close to the hours limits. This is complicated by the shelf exams we take every 8–12 weeks. These require an additional ~2–3 hours/day of studying and most of a weekend day as well. Obviously, this study time is not counted towards the hours limits, but it definitely factors into fatigue and burn out.

Re: Why Do Hospitals Hate Sleep So Much?

#302

Post by Retra »

billfruit wrote: post #293
random878 wrote: post #288

As someone on HN who is medical, not tech, this thread is as frustrating to read as it would be for many of you to read doctor's opinions on how best to run a software engineering firm. "I'm not a software engineer, but here's my full breakdown on where you are all going wrong based on using a BBC Micro for a week back in 1993"

But in your experience is there a problem with hospitals not understanding that patients need proper sleep?

In my experience, I don't spend more than a few days in the hospital, and when I do spend my time there, my whole life is turned upside down regardless of how much sleep I'm getting.

Re: Why Do Hospitals Hate Sleep So Much?

#303

Post by throwaway5752 »

billfruit wrote: post #293
random878 wrote: post #288

As someone on HN who is medical, not tech, this thread is as frustrating to read as it would be for many of you to read doctor's opinions on how best to run a software engineering firm. "I'm not a software engineer, but here's my full breakdown on where you are all going wrong based on using a BBC Micro for a week back in 1993"

But in your experience is there a problem with hospitals not understanding that patients need proper sleep?

I am in a similar position, and the ... outright condescension is unbelievable.

The worst doctor is unbelievably educated in the US. They have had to go through a very difficult pre-med undergrad, a competitive process to get accepted to medical school (which is really tough), survive a residency, and then have continuing education requirements.

And then a bunch of assholes here are like, "don't they know that patients have to sleep???"

Of course the f--king know that. I bet that same worst doctor knows more about sleep than 90% of the internet experts on this thread.

I mean, do people heard even realize that you're not supposed to be in the hospital? It's the hospital. It's for emergent medical care, and you should leave as soon as possible. Sleep is the least of your problems, vs say, MRSA.

Re: Why Do Hospitals Hate Sleep So Much?

#304

Post by RikNieu »

dahfizz wrote: post #279
ExBritNStuff wrote: post #238

Earlier quoted context omitted.

The Elementary school comment rings so true. We have to get my seven year old up at 6:15 to get to school at 7:30. That's if we take him, if he caught the bus he would have to be AT the stop by 6:15. Every day is a battle against exhaustion. On the days that school is delayed due to weather and he can get up naturally at maybe 7:30, he is so much better. He feels better, his attitude is more positive, and he does so…

Why does the school bus pick him up more than an hour before school starts? That seems ridiculous.

Traffic? Traffic at that time of day can be crushing. Arounds here, anyway.

Re: Why Do Hospitals Hate Sleep So Much?

#305

Post by jdironman »

jyounker wrote: post #259
lbriner wrote: post #217

Earlier quoted context omitted.

Although as someone pointed out above, if the doctor gets the results in the morning because the bloods were taken overnight, they might be able to discharge the patient immediately and get a bed before lunchtime for another patient. If they wait to take bloods in the morning, the patient might be in another day for no particular reason.

Five years ago in Switzerland I could get a full blood panel from my Dr's office in the mall within twenty minutes. The blood came straight out of my arm, into the vials, and into vials went into the analysis unit. Maybe there needs to be some investment in better analysis equipment for routine draws.

Or maybe an analysis of the analysis process to see what takes so long.

Re: Why Do Hospitals Hate Sleep So Much?

#306

Post by fireflash38 »

bpyne wrote: post #285
shados wrote: post #228

I'll push this one step further: why is our entire society built around the idea that sleep literally doesn't matter? - Elementary school starting so early all the kids are half asleep in class. - College + Sleep? Not gonna happen. - 24 hour construction in certain part of NYC, check! - Most cities quiet hours are very precisely 8 hours. Hope your days start at 6:30/7:00 and you're falling asleep precisely at 11pm, a…

My wife's background is in childhood development. Her job involves keeping up with studies in the field. I remember her talking about this issue. There's evidence that school start times should be flipped for elementary and high school students: elementary going in earlier and high school later. Teenagers need more sleep due to their brains re-wiring, so the reasoning goes. Keep in mind that in our school district, e…

I would think that would be because teenagers are more likely to stay up late over elementary school kids.

Re: Why Do Hospitals Hate Sleep So Much?

#307

Post by TallGuyShort »

obastani wrote: post #261
shados wrote: post #228

I'll push this one step further: why is our entire society built around the idea that sleep literally doesn't matter? - Elementary school starting so early all the kids are half asleep in class. - College + Sleep? Not gonna happen. - 24 hour construction in certain part of NYC, check! - Most cities quiet hours are very precisely 8 hours. Hope your days start at 6:30/7:00 and you're falling asleep precisely at 11pm, a…

To add to your list, a big one for me is the ritualization of coffee. Can't focus until you've had a cup!

Which is honestly a lot like not being able to calm down until you've had a cigarette. Doesn't seem to be a problem for those who just never do it.

Re: Why Do Hospitals Hate Sleep So Much?

#308

Post by random878 »

billfruit wrote: post #293
random878 wrote: post #288

As someone on HN who is medical, not tech, this thread is as frustrating to read as it would be for many of you to read doctor's opinions on how best to run a software engineering firm. "I'm not a software engineer, but here's my full breakdown on where you are all going wrong based on using a BBC Micro for a week back in 1993"

But in your experience is there a problem with hospitals not understanding that patients need proper sleep?

I'm very junior and UK based so I can only speak on my experience...

No, there is no lack of understanding about the importance of promoting sleep. To suggest that somehow medical professionals haven't got round to working out that there are benefits to having a good sleep is, to be frank, completely ridiculous and quite insulting.

A very specific example would be the importance of sleep in relation to delirium in elderly patients. This is taken very seriously.

In a wider sense, hospital staff will try to establish a reasonable environment for sleep. There is a need to be realistic though, and accept that (for many many reason not readily apparent to the lay person) it just isn't always possible to remove all the factors that disturb sleep.

Most patients on a ward are in multi patient bays. If a patient is unwell medical staff will probably have to; talk out loud, turn on a light, move some kit around, walk in/out of the bay... and so on. This would certainly wake me up. There's just very little can be done about it. Clinical need top trumps comfort.

There will of course be room for improvement, and some staff will be forgetful of the need to be mindful of quiet hours (it's very easy to forget it's 'night time' when your brain is in 'at work' mode).

So, a more balanced summary would be: "Medical professionals try to promote a good sleeping environment, but the very nature of a hospital makes this a challenge. However, there is always room for improvement and many local issues can be solved via improved patient-staff communication". Doesn't make for such a clickbaity whinge blog though when you phrase it this way.

Re: Why Do Hospitals Hate Sleep So Much?

#309

Post by spdustin »

spdustin wrote: post #199
cstross wrote: post #182

Earlier quoted context omitted.

You were dealing with doctors and nurses, right? One group runs a gauntlet of fire by sleep deprivation during pre-med training: with on-call work hours up to 120 hours a week. And the other group are typically on shift rotas so their sleep patterns are permanently disrupted. I'm going to call it for them being oblivious to the sleep requirements of ordinary human beings, because these professions are self-selecting…

Nurses are a lot more than just shift change workers, and their nursing school requirements are a lot higher than you seem to believe.

Parent to that reply edited their post after my comment, and I can no longer edit my reply.

Re: Why Do Hospitals Hate Sleep So Much?

#310

Post by bpyne »

fireflash38 wrote: post #306
bpyne wrote: post #285

Earlier quoted context omitted.

My wife's background is in childhood development. Her job involves keeping up with studies in the field. I remember her talking about this issue. There's evidence that school start times should be flipped for elementary and high school students: elementary going in earlier and high school later. Teenagers need more sleep due to their brains re-wiring, so the reasoning goes. Keep in mind that in our school district, e…

I would think that would be because teenagers are more likely to stay up late over elementary school kids.

It's a combination of a shifted sleep schedule and teenage brains going through significant, exhausting development.
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