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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

#161

Post by parenteral »

dougmccune wrote: post #140
maxerickson wrote: post #127

Earlier quoted context omitted.

work 17 hour days for 7 days in a row (!) They explicitly said 17 hours was rare.

Ah, I probably misread the comment a bit. I read it as working 7am to past midnight is rare, making 7am to midnight (or just before) normal. But you're probably right in that what was meant was that there are other, more sane working hours (not defined in the comment) that are the normal conditions. But yes, to agree with the sibling comment, I'd prefer to never have any doctor in any hospital seeing a patient after…

I'm usually in around 0800-0830 and out by 1700-1800

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

#162

Post by Spooky23 »

Moshe_Silnorin wrote: post #73
pdxandi wrote: post #34

Earlier quoted context omitted.

My wife's a second-year resident and it's pretty unbelievable how hard and how much they work. She's on her 18th straight day of working long days during the week and long nights during the weekend. Legally there's an 80-hour per week cap, but no resident would ever complain. They do 24 hour shifts, but never 30 hour ones, though other programs at her hospital do. I felt upset about her hours all through medical scho…

If you're worried about the effects of your age on your child, why not freeze her eggs and your sperm?

IVF is no walk in the park.

If you don't have the time to have sex and give birth, you sure as hell don't have time to go through IVF retrieval cycles!

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

#163

Post by Spooky23 »

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).

Nurses cannot leave until relieved. My mom routinely had 12 hour shifts extended when she worked in NYC.

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

#164

Post by wildmusings »

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?

My understanding is that their control to the end of limiting the number of doctors is exerted way back in the part where they have to approve new medical school seats.

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

#165

Post by [deleted] »

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.

[deleted]

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

#166

Post by rajacombinator »

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…

The kind of doctors who are working 30 hours straight probably have a degree of difficulty level in what they're doing approaching the drunken monkey.

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

#167

Post by snowwrestler »

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 think that is how it works, but with longer periods of time. Instead of an 8 hour shift with overlap of 2, it's a 24 to 30 hour shift with overlap of 8 to 10.

On rounds, a doc might only see each patient every hour or two... even longer for specialists.

ER docs also work some shorter shifts. So in a week he might work one 24 or 30 hour shift, and one or two 8-hour shifts. The shorter shifts provide arms and legs for simple cases, and the longer shifts provide continuity for more serious cases. The docs take turns holding down the long shift.

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

#168

Post by wott »

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…

> 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?

Unfortunately, it's not just a rhetorical argument, but it is a true problem with hospital doctors: alcoholism, drunk at work, and of course abuse of all drugs that are easily available for them. And everyone covers it up, as long as there is not a major accident.

There are of course the same reasons as in the general population, but there are extra ones: the pressure; the stupid work organisation with stupidly long shifts; the fact that most of the medicine studies are also insanely organised and insanely competitive (in my country, this is where you find the shittiest mood and mentality of all studies, except perhaps a few business studies), thus the habit is taken early to use alcohol and drugs to "perform" or to "put up with the workload", except that it is 'fine' when you are young, but when you get older and keep the same habit, you don't recover and the effects accumulate.

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

#169

Post by mattkrause »

jrowley wrote: post #17
vorotato wrote: post #9

Earlier quoted context omitted.

Who is this they?

Here is a bit of survey on the topic from April of 2013: https://psnet.ahrq.gov/perspectives/perspective/140/are-resi... Key finding: "In summary, the literature still does not definitively tell us whether limiting duty hours improves patient safety."

I would argue that the literature is basically worthless here, because they're mostly looking at modulations around an absolutely ridiculous baseline. The 2003 changes dropped hours DOWN to 80/week and 16 or 28 per shift.

As an analogy, imagine reducing your cheeseburger intake from 60 per week to 40 per week: it probably won't have a huge impact on physical fitness.

The hand-off issue is also weird because it's at least theoretically improvable, whereas there's no real way (barring go-pills) to reduce sleep-related issues.

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

#170

Post by maxerickson »

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…

Did he have statistics on the typical amount of time he spent caring for patients?

Like, how many people are in the care of an ER for 10 hour stretches in a given week.

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