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No Doctor Should Work 30 Hours Straight with No Sleep

theatlantic.com

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Re: No Doctor Should Work 30 Hours Straight with No Sleep

#121

Post by trome »

parenteral wrote: post #90
venomsnake wrote: post #72

Earlier quoted context omitted.

I would probably trust the worst student in a medical class when sober and well rested more than the even the best doctor after being awake for 30 hours. Mistakes will be made and people will die. After mission critical all nighter you also need 2 days at least to be able to recuperate.

I'm a doctor and I dispute this. I'm not advocating for long work hours or saying that it's healthy/OK. But the "worst students" in my assessment are people that I wouldn't trust to care for my loved ones at all and I would definitely take my weary-eyed trusted colleagues over the former any day. It's a very long discussion, but there are some really bad doctors out there who get by because most mistakes don't cause…

Working over 80 hours in a 7 day period is just insane in and of itself, unless there is a major crisis you shouldn't be working more than 40hrs a week.

People fought and died for an 8 hour workday, and here the AMA and hospitals are shitting all over it, putting everyone involved at risk. Should we bring back child labor while we're at it?

Re: No Doctor Should Work 30 Hours Straight with No Sleep

#122

Post by noskillz »

My wife was a surgery resident when we had our first child. It was tough with her working 30 hour on-call shifts. Plus the normal 80+ hour (sometimes it would be as much as 130) work weeks. She eventually decided that instead of killing herself for a job she would stop being a doctor and focus on the kids. This worked out for us but it took some guts to call it quits after 10 years of training to get where she was at. We have a ton of debt because of it as well.

Besides the tough work schedules I find it kind of crazy we require 20-something year olds to choose a speciality and stick with it. Very few people can do this and not have some regrets. On top of the insane work hours they also put up with people dying on them and delivering the bad news to family members (at least for surgeons this happens a decent amount).

Re: No Doctor Should Work 30 Hours Straight with No Sleep

#123

Post by failrate »

linkregister wrote: post #38
finid wrote: post #22

Earlier quoted context omitted.

But nurses are no different. We need to start addressing the leading cause of medical accidents - physicians/nurses sleep deprivation.

I know of no nurses that work this schedule, even voluntarily (overtime, swaps). Nursing in many states is challenged by unsafely high patient:staff ratios, excessive documentation requirements (on extremely slow user interfaces), and the need to vigorously double-check physician's orders (dangerous drug interactions, over-dosages, etc).

I used to work in a hospital laundry (where we were understaffed, of course), and I spent my lunch hour talking with nurses. Many were actually NAs and had to work second shifts at different hospitals to make a living wage. So even if the hospitals are reporting normal shifts, the personnel are actually working up to twice as many hours.

Re: No Doctor Should Work 30 Hours Straight with No Sleep

#124

Post by crpatino »

parenteral wrote: post #90
venomsnake wrote: post #72

Earlier quoted context omitted.

I would probably trust the worst student in a medical class when sober and well rested more than the even the best doctor after being awake for 30 hours. Mistakes will be made and people will die. After mission critical all nighter you also need 2 days at least to be able to recuperate.

I'm a doctor and I dispute this. I'm not advocating for long work hours or saying that it's healthy/OK. But the "worst students" in my assessment are people that I wouldn't trust to care for my loved ones at all and I would definitely take my weary-eyed trusted colleagues over the former any day. It's a very long discussion, but there are some really bad doctors out there who get by because most mistakes don't cause…

That's even worse, you know. Not only you are working people to the brink of exahustion. You are failing to cull the idiots in your midst and then work those idiots to the brink of exahustion. What could possibly go wrong.

Also, I am not convinced that the study that found there's no difference in outcomes means what your overseeing board claims it means. As mentioned in the article, they have not measured the performance of individual workerd, but of the hospital as a whole. Most likely it just means that whoever happens to be better rested in the team is catching (and covering up) the fuckups of the ones that are most tired.

Re: No Doctor Should Work 30 Hours Straight with No Sleep

#125

Post by KVFinn »

Usually this discussion is around residents' performing worse while deprived. A big problem no doubt.

But I wonder why people don't bring up another aspect: sleep is essential for actually retaining and making any learning from practice permanent. Anyone who has trained or studied anything knows this well and it's clear in the literature. How can we expect these doctors in training to be actually learning and improving if they are so often sleep deprived?

Re: No Doctor Should Work 30 Hours Straight with No Sleep

#126

Post by Fnoord »

jseliger wrote: post #11

The culture of medicine, at least at the physician level, is completely insane; it's so insane that describing its insanity is part of the reason I wrote "Why you should become a nurse or physicians assistant instead of a doctor: the underrated perils of medical school" ( https://jakeseliger.com/2012/10/20/why-you-should-become-a-n... ). Residents in particular have no power, and even physicians themselves frequently…

> The culture of medicine, at least at the physician level, is completely insane

Is this problem US specific, or global? And, isn't the real problem a scarcity of qualified doctors? Which, if people follow your advice, becomes worse?

Re: No Doctor Should Work 30 Hours Straight with No Sleep

#127

Post by maxerickson »

dougmccune wrote: post #113
parenteral wrote: post #85

Earlier quoted context omitted.

I'm a practicing hospitalist and I love it. I spend time on the hospital floor, time in the ED, and time covering patients in the ICU. Yeah, some days suck (I occasionally have to stay from 7 AM to past midnight, though that is quite rare), but overall I can't imagine doing anything else. Also, I work 7 days in a row and then have 7 days off, which I absolutely love. I have the option of working 5-days every week and…

Even if there are people like yourself who actually want to work 17 hour days for 7 days in a row (!), shouldn't we as patients be able to have doctors who are not allowed to do that insanity? Medical error is the #3 cause of death in the US. It seems entirely irresponsible to take someone's life into your hands without proper rest.

work 17 hour days for 7 days in a row (!)

They explicitly said 17 hours was rare.

Re: No Doctor Should Work 30 Hours Straight with No Sleep

#128

Post by tnecniv »

pavel_lishin wrote: post #47

Doesn't this level of overwork originate with one medical instructor, who was a habitual cocaine user and thought nothing of going without sleep? I remember reading this somewhere, but can't remember where.

Cocaine abuse was rampant around the turn of the 20th century, since it was used as an anesthetic.

Re: No Doctor Should Work 30 Hours Straight with No Sleep

#129

Post by themantalope »

rileyteige wrote: post #118
bb611 wrote: post #111

Earlier quoted context omitted.

What did ACA change about reimbursement?

Most of the changes pertain to Medicare/Medicaid. I haven't looked into it in several years, but this covers it in a nutshell as far as Medicare is concerned: https://www.medicare.gov/hospitalcompare/linking-quality-to-... Pay-For-Performance is the key term there. And while it is certainly the more patient-friendly approach, the problem as I recall is that a lot of patients re-admit for issues that are their own fau…

Yep, a big issue is the metrics that are used to determine performance. I'm at an upper tier medical school and the doctors here talk (complain) about this all the time. Not only are many within 30-day readmissions due to factors outside the control of the hospital, it also disincentivizes institutions to take on difficult and complicated cases.

If you look at the top performing hospitals, many of them are obscure hospitals or ones that only offer expensive surgical care that most doctors would __never__ go to themselves or recommend to their friends/family: http://www.usnews.com/news/articles/2015/04/17/only-251-hosp...

I know the article is a bit old now, but if I recall correctly the rankings haven't changed much since the metrics are still calculated in the same way.

Re: No Doctor Should Work 30 Hours Straight with No Sleep

#130

Post by dv_dt »

hahajk wrote: post #106
TheOneTrueKyle wrote: post #69

Earlier quoted context omitted.

I'm curious why so many people still put up with it?

I always wondered why the public puts up with it. Aviation is always provided as a contrast to the medical community: pilots have legally-mandated sleep requirements. My hunch is that when a plane crashes, everyone freaks because planes aren't supposed to crash. When someone dies at a hospital nobody notices because people die at hospitals all the time.

If the plane crashes, the pilot has a good chance of dying too, if the doctor makes a mistake, not so much.
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