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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

#141

Post by mattkrause »

adub wrote: post #24
vorotato wrote: post #9

Earlier quoted context omitted.

Who is this they?

This study [0] concluded that reduced duty hours for surgical residents actually had no significant difference in patient outcomes. [0] http://www.nejm.org/doi/full/10.1056/NEJMoa1515724#t=abstrac...

That's not really what that study says. The paper finds no difference between a "flexible" schedule and the standard duty-hour one.

Neither one of these schedules is really "reduced" compared to any sort of typical level: they're both ~80 hrs/week (and probably more).

From the paper:

"Programs assigned to the flexible-policy (intervention) group were required to adhere to ACGME duty-hour requirements of limiting work to 80 hours per week, 1 day off in 7 days, and on-call duty no more frequently than every third night, but they were granted a waiver by the ACGME to waive four duty-hour requirements (from the 2003 and 2011 reforms) concerning maximum shift length and minimum time off between shifts (to facilitate continuity of care) (Table 1)"

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

#142

Post by arikrak »

trowawee wrote: post #135
minimuffins wrote: post #51

Learning about new ways that our medical industry is totally dysfunctional is baffling and infuriating. It seems to be an inexhaustible well of misery for workers and patients alike. These conditions are like something out of a 19th century factory town. One more way the US healthcare system is a ridiculous anachronism. My first questions are 1) Is sleep deprivation and the generally toxic work culture for doctors an…

The problem is that doctors are never going to organize against this, because A) most have been thoroughly inculcated in a culture that worships that kind of work ethic and B) the limited number of physicians is the reason they make absurd amounts of money. The median ER doc in SF makes $328,047[1], and ER's a relatively low-paying specialty. The solution is regulation with teeth, similar to the rules governing pilot…

I wonder what would happen if instead of adding more regulations, they took away some of the power that medical schools have in restricting people from practicing medicine. E.g. nurse practitioners and physician assistants sound like a step in the right direction.

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

#143

Post by kelnos »

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…

> no difference in outcomes...

I find it hard to believe there's no difference in outcomes. Every study related to quantity of sleep or sleep deprivation that doesn't have to do with doctors points to severe cognitive impairment as waking hours increase and sleeping hours decrease. It's incredibly suspicious that studies that are related to doctors point the other way, especially studies conducted by the body that oversees residency programs (sure, I expect them to be unbiased, right). Either patient outcomes are indeed affected by the long hours, or being a doctor is so comically easy that a drunk monkey could do it. I doubt it's the latter.

Speaking of drunkenness, being caught drunk on the job is a firing offense for a doctor, and I believe you can also lose your medical license, right? Sleep deprivation has been shown to affect judgment, alertness, memory, and reaction time in a similar manner as alcohol. If it's fine for a doctor to be sleep deprived, why not let them be drunk while working too?

> ... or resident satisfaction when they eliminate the 80-hour restriction.

Of course not. The residents would never complain, lest they risk being viewed as slackers.

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

#144

Post by snowwrestler »

A friend of mine is a PA who works in emergency medicine, which means he pulls 30 hour shifts sometimes.

I challenged him about how, with what we now know about sleep deprivation, he could defend that schedule.

He pointed out that much of medicine, especially emergency medicine, requires deep complex analysis of a wide variety of symptoms, some of which might seem unimportant or unrelated at first. We've all seen shows like House where it takes a genius to diagnose the root cause of a set of weird symptoms. While that is obviously exaggerated, the reality is that diagnosis is often difficult and in an ER, happens continuously with treatment.

He said there is no way that a doctor or PA can fully hand that mental flow state off to another one. So the scariest thing to him is handoff--what if he forgets to document or mention some seemingly minor detail that ends up being crucial??

Long shifts give medical personnel more continuous time with each patient, reducing the chance that handoff will come too early in treatment, when mistakes or misses have a greater impact. It also permits long periods of overlap between shifts.

"Being sleep deprived is bad for care," he admitted, "but so are handoffs." He feels that as long as the total time per week does not exceed too many hours, long shifts are good for care.

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

#145

Post by zeroer »

trome wrote: post #121
parenteral wrote: post #90

Earlier quoted context omitted.

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?

There are basically no children with enough experience to be doctors.

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

#146

Post by kelnos »

diimdeep wrote: post #107

In the US alone, the Association of American Medical Colleges (AAMC) estimates a shortage of 91,500 physicians by 2020 and up to 130,600 by the year 2025. https://en.wikipedia.org/wiki/Physician_supply#Global_View

Perhaps the US health care system should be focusing more on preventative care. I hear that reduces demand for doctors.

Oh wait, that doesn't make the insurance companies as much money, so that's a bad idea.

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

#147

Post by ohwello »

wildmusings wrote: post #110
maxerickson wrote: post #105

Earlier quoted context omitted.

The medical system has billions of free cash flow. Big hospitals could fund lots more residency spots.

Exactly. The "limited federal funding" canard is a brazen excuse by the AMA to deflect attention from their own role, and to lobby for more free money. No one ever argues against more free money for themselves.

Can the AMA prevent hospitals from creating residencies with their own funds? I'm ignorant about this, but at first blush it seems like doctors must be a top expense and most companies enjoy employing workers with cheap wages and long hours. Hospitals should be happy to hire as many residents as possible (even if they got 60 hours from them instead of 100). What am I missing?

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

#148

Post by kelnos »

maxxxxx wrote: post #45
prodmerc wrote: post #8

The medical system will disagree: all doctors should work 30 hours straight with no sleep, else they're not real doctors and slacking off.

Sounds a little like startup culture. If you don't work 80 hours per week you are not a real startup.

Most startup employees aren't in a position to accidentally kill someone due to sleep deprivation, though.

(Not saying startup culture is good in that regard. Just saying it has less of a life-or-death impact on others.)

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

#149

Post by QuarterReptile »

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…

Thanks for writing that. I can't remember exactly the process we went through, but I remember your post being a significant part of the information pushing my wife from med school to PA school, a decision we're quite happy about.

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

#150

Post by kelnos »

module0000 wrote: post #103
realitygrill wrote: post #95

Earlier quoted context omitted.

You don't think that's kind of questionable?

Demanding perhaps, but not questionable. It's just the nature of the industry. Not an apples-to-apples comparison, but look at combat medics for contrast during wartime. There are limits to what humans can do, but the 120-hour workweek in a heated-and-cooled hospital does not bump into those limits. Maybe it would be 'better' if that wasn't the case, but it's simply what is.

So "simply what it is" is a reason not to strive for something better?
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