Why Do Hospitals Hate Sleep So Much? • Hacker News Board

Re: Why Do Hospitals Hate Sleep So Much?

#311

Post by hacym » Wed, Dec 05, 2018, 3:38 PM UTC

LargeWu wrote: post #289

snarf21 wrote: post #270

Earlier quoted context omitted.

The school thing is a challenge. If the parents have to be at work 8-5 plus time to drive there, the kids have to be up at the same time so they can be dropped off either at school or a day care setting to be put on a bus later. If the parent has a longer drive to work, the child must get up that much earlier. I don't really know how to solve this problem.

Our school district has a before school program starting as early as 7:00 so kids that need to be can be dropped off early, but most kids arrive much later. Classes don't start until 9:00 at our school.

Isn't that the same thing though? It's a very common problem without an easy solution.

Re: Why Do Hospitals Hate Sleep So Much?

#312

Post by ConceptJunkie » Wed, Dec 05, 2018, 3:38 PM UTC

kleborp wrote: post #256

darepublic wrote: post #232

Earlier quoted context omitted.

I guess on paper going without sleep gives you some kind of competitive advantage? A company that believes otherwise could bet on giving their workers more sleep and they should gain an advantage by doing so.

This can be done indirectly by reducing the work day from 8 hours to 6 hours, those who otherwise need to get up early to commute may have a bit more time to settle down in the evening.

And reducing the productivity of workers by 25% couldn't possibly have any bad effects. /s

In all seriousness, I've seen mentions of studies that suggest going from 8 hours to 6 does _not_ correlate with a 25% decrease in productivity, because most people aren't consistently productive for all 8 hours of a day. I know in my case, there's an extremely strong inverse correlation with productivity and how bored I am with a particular task. I'm sure I'm not alone.

Re: Why Do Hospitals Hate Sleep So Much?

#313

Post by en-us » Wed, Dec 05, 2018, 3:41 PM UTC

DisruptiveDave wrote: post #218

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…

To be clear, you're saying that people whose job is to - quite literally - understand, diagnose, and treat hundreds (thousands?) of medical issues that they personally haven't experienced, don't have the capacity to understand that not everyone is on their same sleep schedule?

As someone with a father and a wife who are both physicians, yes. In both cases they started working to get into medicine in high school, pushed hard in college, and then had med school and residency.

That alone is 16 straight years of normalizing sleep deprivation. Time spent studying and working is regularly 80+ hours per week, certainly from med school onward and certainly the year spent studying for the MCAT.

If they start at 16 and finish their residency at 30 or 32, that's the only life they've ever known for all of their formative years. They cannot relate to people with a normal schedule because they have not experienced it.

Re: Why Do Hospitals Hate Sleep So Much?

#314

Post by anticensor » Wed, Dec 05, 2018, 3:41 PM UTC

yen223 wrote: post #22

jeffxtreme wrote: post #14

Not only are they "designed to allow patients as little sleep as possible", but also doctors too. Residents and doctors frequently have take on 30-36 hour shifts.. How they could effectively treat patients with this level sleep deprivation is beyond me. Maybe hospitals just have a vendetta on sleep in general?

It's because doctor handovers are surprisingly dangerous.

Four shifts a day of 8 hours schedule will solve that. 2 hours is a very long overlap to hand over.

Re: Why Do Hospitals Hate Sleep So Much?

#315

Post by technofiend » Wed, Dec 05, 2018, 3:42 PM UTC

pc86 wrote: post #260

ineedasername wrote: post #240

Earlier quoted context omitted.

Yeah. I mean, I get that hospitals are 24-hour operations that need doctors & nurses available at all times. So some people are going to get the crap end of that stick and have to do night shifts. But is it really necessary for them to work 80+ hours while they're at it? It seems like there's enough people trying to be doctors that you could cut that down to a healthier 40 hours+ 15 hours on call if it's really neces…

You would likely have to extend residency based on everything that you need to learn for a given specialty. Med school graduates have an average of over $180k in student loan debt - from med school alone - and resident salaries in the 2-4 year programs are mid five figures. Given the choice, I'm not sure someone whose 4-year earning potential is capped at $60k with $200k in student loans would want to extend that to…

>You would likely have to extend residency based on everything that you need to learn for a given specialty.

I would challenge that assumption because I don't believe there's any consistent number of hours worked by residents in rotation, is there? I mean there are published schedules and then there are actually the number of hours worked which at least according to the other posters is even more than scheduled. So if there's already an element of randomness here and different doctors are getting different numbers of in-rotation hours then it's plausible hours could be made consistent and reduced, isn't it?

Re: Why Do Hospitals Hate Sleep So Much?

#316

Post by sturgill » Wed, Dec 05, 2018, 3:43 PM UTC

LargeWu wrote: post #286

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…

A lot of elementary schools start early because of parent pressure to start early, because parents need to get their kids to school so they can get to work themselves. We are lucky that our school district provides before and after school programs since my daughter's elementary school doesn't start until after 9:00 AM.

I don’t see a lot of evidence that elementary schools have started classes earlier as more households have relied on both parents working. I _have_ seen an increase in after-school programs to make up the gap between school letting out and parents getting off of work.

The battle to get up early is about as old as time. We aren’t that far removed from an agrarian-based economy, and farm work has always required very early rising (my father grew up raising dairy cows: he was fond of reminding us as children that the cows don’t care how tired you are).

“Early to bed and early to rise” is not a modern day mantra, but I fear we’ve kept the wake up call constant while continuing to push how long we stay up. I don’t know how to fix it: if your kid is in an after-school program until 6, comes home to eat dinner, and then still has to do homework... I don’t see how an early bedtime is even possible.

Re: Why Do Hospitals Hate Sleep So Much?

#317

Post by ineedasername » Wed, Dec 05, 2018, 3:44 PM UTC

cstross wrote: post #291

ineedasername wrote: post #240

Earlier quoted context omitted.

Yeah. I mean, I get that hospitals are 24-hour operations that need doctors & nurses available at all times. So some people are going to get the crap end of that stick and have to do night shifts. But is it really necessary for them to work 80+ hours while they're at it? It seems like there's enough people trying to be doctors that you could cut that down to a healthier 40 hours+ 15 hours on call if it's really neces…

Here in the UK, the way I heard it from a friend who was doing their pre-med, is that there was a built-in cost incentive: hospitals paid doctors who were on-call at one third of their regular hourly rate for out-of-hours on-call coverage. (That's not regular hourly rate plus a third; that's one third of normal wages for hours after the first 40.) So the hospital administration had a solid reason to work their intern…

I wonder how much of it is financially motivated in this way and how much is the inertia of this hazing-style culture. From what you've said, I'm sure hospitals would object to a change out of financial self-interest, but it seems the ingrained culture stops the issue from getting a big push to begin with.

I know labor unions (sometimes rightfully) get a bad rap, but it seems this is exactly the type of abuse they were designed to stop. There are some [0] but the rate is low, less than 15%, and there's a sort of self-censorship style of pressure against pushing harder for them.

[0] https://www.theatlantic.com/business/archive/2017/02/doctors...

Re: Why Do Hospitals Hate Sleep So Much?

#318

Post by bzbarsky » Wed, Dec 05, 2018, 3:45 PM UTC

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…

As a counter-anecdote, we have to get our kids up by 7:30 to get them to their elementary school on time, and it's a battle every single morning. Left to their own devices, they would sleep to at least 8:30.

Kids are different, and we really don't have very good ways of dealing with that in some ways...

Re: Why Do Hospitals Hate Sleep So Much?

#319

Post by hedora » Wed, Dec 05, 2018, 3:46 PM UTC

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…

You forgot my favorite. In California (and probably other states), the building codes for apartment sound proofing are much weaker than for condos.

If you wanted to sleep, you shouldn’t have chosen to rent. Your landlord couldn’t be expected to pay $1000’s [1] extra to build your apartment, after all.

(1) https://www.remodelingexpense.com/costs/cost-soundproof-insu...

Re: Why Do Hospitals Hate Sleep So Much?

#320

Post by anticensor » Wed, Dec 05, 2018, 3:47 PM UTC

pascalxus wrote: post #33

I would imagine patients in the hospital have much bigger problems than how much sleep they're getting. They'll probably be awake all night anyways worrying about their over-billed hospital bill and how their insurance company is going to get out of paying for it.

Only in the private hospitals.

self-induced sleep deprivation intensifies