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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

#151

Post by michaelmachine »

snowwrestler wrote: post #144

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 sho…

Yeah there is lots of literature on this issue and some ongoing studies trying to determine how to reduce medical error during the hand-off. For example: http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD...

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

#152

Post by amorphid »

snowwrestler wrote: post #144

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 sho…

That's a really interesting point. I wonder if it'd be practical to address the handoff problem with rolling start times. So if average ER patient takes 3 hours to treat from start to finish, for an 8 hour shift, you stop taking new patients at the 5 or 6 hour mark. That being said, if an ER doc is in the "graceful shutdown" part of their shift, and a spike in patients rolls in the door, it'd be hard to say no to helping out.

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

#153

Post by mjevans »

amorphid wrote: post #152
snowwrestler wrote: post #144

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 sho…

That's a really interesting point. I wonder if it'd be practical to address the handoff problem with rolling start times. So if average ER patient takes 3 hours to treat from start to finish, for an 8 hour shift, you stop taking new patients at the 5 or 6 hour mark. That being said, if an ER doc is in the "graceful shutdown" part of their shift, and a spike in patients rolls in the door, it'd be hard to say no to hel…

I had similar thoughts, except with 4s.

For the first 4 hours they take patients (and shadow some of the persisting cases from other doctors).

For the next 4 hours, they're purely cleanup/handoff... EXCEPT in the case that a major crisis happens. Things extend 4 hours at a time in that case.

This would, however, mean staggering the doctors in 6 different shifts that could each handle the ingress load for their ramp up period.

Naturally doctors that are 'morning' or 'evening' people should be binned in to shifts compatible with their biological schedules.

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

#154

Post by kelnos »

mcv wrote: post #139
kelnos wrote: post #137

Earlier quoted context omitted.

A doctor friend of mine claims that the benefits of doctor-patient continuity outweigh any downsides of sleep deprivation. That sounded like a rationalization or cop-out to me, though. I can't imagine how that could be true, or that they're aren't other ways to solve the continuity problem that don't involve zombie doctors.

Even then, finishing with your current patient and then going home should still not lead to regular 12 hour shifts.

Different patients need differing amount of times. We're not talking about doctors who work in private practice and have business hours. We're talking about doctors who work in hospitals and work prearranged shifts and have on-call time.

A doctor can't necessarily predict how much time a patient will need. If a doc is on an 8-hour shift (hypothetical; I doubt any docs are so lucky!), and gets a new patient at the 6 hour mark, it might not be known if the patient will only be in the hospital for an hour, which would be fine, or 4 hours, which would push the doc to 10 hours.

As the argument goes, that patient is safer staying with the doc into his/her 10th hour on the job, versus being transferred to a different, fresher doctor midway through. I think there's enough truth there for it to be persuasive, but 1) there are limits to how effective a doctor is going to be after a certain amount of time, and the benefits of patient continuity must start dropping as the doctor has been working longer, and 2) there seems to be little attention paid to improving the process of handing a patient off between two doctors, which could further reduce problems related to lack of continuity to the point where a doctor who has been working 10 hours will cause more bad outcomes than shifting patients to fresher doctors would.

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

#155

Post by finid »

kelnos wrote: post #143
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…

> 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 ov…

And sleep deprivation is a well-known torture technique.

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

#156

Post by pmoleri »

snowwrestler wrote: post #144

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 sho…

I experienced this twice, when my baby daughter was in observation after two episodes a week apart.

She recovered quickly so she was released from ER to observation for 48 hours. In those 48 hours we would see new doctors and nurses every 8 hours, explain everything again, so they wouldn't miss any details from the history, and every now and then a doctor would come up with a new theory and order studies without first consluting with a specialist in that area.

One of this theories was epilepsy, after that we went to see a neuropediatric and dismissed the theory inmediatly, even before seeing the study.

All of this was in a stable condition, I can't imagine going through the same in critical condition. So, altough I think 30 hour shifts are excesive, I can understand why long shifts are important.

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

#157

Post by Spooky23 »

mjevans wrote: post #153
amorphid wrote: post #152

Earlier quoted context omitted.

That's a really interesting point. I wonder if it'd be practical to address the handoff problem with rolling start times. So if average ER patient takes 3 hours to treat from start to finish, for an 8 hour shift, you stop taking new patients at the 5 or 6 hour mark. That being said, if an ER doc is in the "graceful shutdown" part of their shift, and a spike in patients rolls in the door, it'd be hard to say no to hel…

I had similar thoughts, except with 4s. For the first 4 hours they take patients (and shadow some of the persisting cases from other doctors). For the next 4 hours, they're purely cleanup/handoff... EXCEPT in the case that a major crisis happens. Things extend 4 hours at a time in that case. This would, however, mean staggering the doctors in 6 different shifts that could each handle the ingress load for their ramp u…

Where do you get the 5-6 doctors to make up the difference since you're working a short shift plus pairing with another doctor for half your shift?

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

#158

Post by [deleted] »

mjevans wrote: post #153
amorphid wrote: post #152

Earlier quoted context omitted.

That's a really interesting point. I wonder if it'd be practical to address the handoff problem with rolling start times. So if average ER patient takes 3 hours to treat from start to finish, for an 8 hour shift, you stop taking new patients at the 5 or 6 hour mark. That being said, if an ER doc is in the "graceful shutdown" part of their shift, and a spike in patients rolls in the door, it'd be hard to say no to hel…

I had similar thoughts, except with 4s. For the first 4 hours they take patients (and shadow some of the persisting cases from other doctors). For the next 4 hours, they're purely cleanup/handoff... EXCEPT in the case that a major crisis happens. Things extend 4 hours at a time in that case. This would, however, mean staggering the doctors in 6 different shifts that could each handle the ingress load for their ramp u…

[deleted]

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

#159

Post by Spooky23 »

ohwello wrote: post #147
wildmusings wrote: post #110

Earlier quoted context omitted.

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?

They can encourage their members to avoid those hospitals.

Most doctors don't work for the hospital. That's one of the many reasons behind the strong opposition to Obamacare the creation and consolidation of regional medical systems is making more doctors salaries employees and reduces their bargaining power.

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

#160

Post by Spooky23 »

kelnos wrote: post #137
mcv wrote: post #92

Earlier quoted context omitted.

So what happened? Was there a massive disaster that created an overwhelming flood of patients, that everybody needs to work overtime? Because under normal circumstances, a competently run hospital should be able to function with normal 8-hour shifts. If that's not possible, then management fucked up. Accepting these kind of hours as standard is completely unreasonable and dangerous, especially in hospital, where live…

A doctor friend of mine claims that the benefits of doctor-patient continuity outweigh any downsides of sleep deprivation. That sounded like a rationalization or cop-out to me, though. I can't imagine how that could be true, or that they're aren't other ways to solve the continuity problem that don't involve zombie doctors.

I would agree. In extended hospital sessions that my wife and I have experienced, having continuity was huge, especially as the nurses swap out every 8-12 hours.

In my case, I suffered from this issue after a back surgery when some dumbass hospitalist read my chart wrong and told the nurse to cut off pain medication 10 hours after a spinal fusion. I asked the nurse for meds after she woke me up at 3 AM (to take my blood pressure and ask if my birthday had changed) and she refused and essentially accused me of shopping for narcotics.

When my surgeon checked in on me at the start of his day (5AM), he was shocked and got things fixed.

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