No Doctor Should Work 30 Hours Straight with No Sleep • Hacker News Board

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

#171

Post by llimllib » Wed, Dec 21, 2016, 2:36 AM UTC

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…

1. That's weird, what the heck ED do they do 30 hour shifts in? Non-US? My wife is an ED physician in the US and that does not ever happen in any ED she's been in.

2. She's also boarded in internal medicine, where she did have to do 30 hour shifts. They are terrible for patients and physicians, and I've been in heated arguments with physicians because I think the primary reason they exist is as hazing.

3. Handoffs are a legit problem; much more in other fields than in the ED. (Though handoffs do exist in the ED). It is a balancing act for that reason, though physicians could do a lot better with the handoff process IMO.

4. http://mef.med.ufl.edu/files/2010/01/Resident-and-Attending-... :

> Handoffs, the transfer of patient care from one health care provider to another, are known to be vulnerable to communication failures8 and have been called “remarkably haphazard.”

and

> When looking specifically at malpractice cases with communication breakdowns, 43% involved handoffs.

5. It's my belief that patient-centric design and communication could eliminate nearly all of these issues while reducing the need for long shifts, but there's a big [evidence needed] tag on that

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

#172

Post by llimllib » Wed, Dec 21, 2016, 2:39 AM UTC

pdxandi wrote: post #74

matrix wrote: post #57

Earlier quoted context omitted.

If she is pursuing a demanding specialty, consider having your kids while she's a resident; I've known a few people that did it and while it's hard, it can be the lesser of evils. Fellowship is just as hard - maybe even harder - than residency, and when you're practicing she likely won't be eligible for maternity leave initially and can face pressure from the group to keep on working (otherwise someone else might end…

She's sub-specializing in intensive care, unfortunately. We've discussed having children toward the end of fellowship for the reasons you state. It's a tough decision for us because I'll likely carry the brunt of the parental workload, but we also depend on my income for living expenses and loan repayment.

We waited until my wife was done with residency and fellowship, and it has worked out well for us. We have our second child on the way shortly, feel free to message me if I can help in any way.

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

#173

Post by user837387 » Wed, Dec 21, 2016, 2:59 AM UTC

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…

General AI will make all of this irrelevant. A General AI doctor never needs to sleep and would never forget anything relevant.

That is, if the government allows it to be used in consumer products. It would make a potent military weapon. Probably more potent than any military weapon invented so far.

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

#174

Post by mjevans » Wed, Dec 21, 2016, 3:29 AM UTC

Spooky23 wrote: post #157

mjevans wrote: post #153

Earlier quoted context omitted.

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?

Think of the 'doctor slots' as cutting blades with overlap.

The first four hours (half shift) the doctors are taking in new patients. In the next four hours they aren't taking them in, they're finishing processing and starting to pass them off to the next shift if they appear to be complex cases.

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

#175

Post by eropple » Wed, Dec 21, 2016, 3:32 AM UTC

user837387 wrote: post #173

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…

General AI will make all of this irrelevant. A General AI doctor never needs to sleep and would never forget anything relevant. That is, if the government allows it to be used in consumer products. It would make a potent military weapon. Probably more potent than any military weapon invented so far.

Devices of uncertain possibility and certainly no timetable certainly will make such a thing irrelevant.

Meanwhile, we're discussing the world that exists.

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

#176

Post by braveo » Wed, Dec 21, 2016, 3:33 AM UTC

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…

overlap the shifts by 2 hours.

Why is that not an acceptable solution, outside of economics?

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

#177

Post by bigger_cheese » Wed, Dec 21, 2016, 3:46 AM UTC

AnimalMuppet wrote: post #62

edblarney wrote: post #13

You wouldn't want your airline pilot to be sleep deprived so why would you want your doctor to be? Unless you're a field medic in the army or whatever. No thanks.

Exactly. And it's not just airline pilots. Truck drivers have hours of service rules, too. So do railroad engineers.

I work in a heavy industry in Australia. There is a 16 hour shift limit - after which you are required to take an 8 hour break before you are able to operate any heavy machinery again.

We also have workplace drug and alcohol testing and there are requirements around disclosing any prescription medication you are on.

Operating heavy machinery is no joke but then again neither is being a doctor.

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

#178

Post by imesh » Wed, Dec 21, 2016, 4:15 AM UTC

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…

My brother just finished his residency. His opinion is they do it for cultural reasons and it's a terrible thing. I'm curious what percentage of doctors think the way they do it is a good idea.

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

#179

Post by tn13 » Wed, Dec 21, 2016, 4:16 AM UTC

As a rule of thumb I would not recommend anyone working that long without sleep. A truck driver with lack of sleep can kill more people than a driver.

Even a coder returning home driving might kill someone if he has not slept in 30 hours straight.

For doctor unless he is doign surgeries chances of his mistake resulting into death might be lower.

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

#180

Post by knz » Wed, Dec 21, 2016, 4:24 AM UTC

pmoleri wrote: post #156

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 firs…

My pregnant wife was bounced between clinics a few years back and subsequently spent several weeks in a hospital bed. We had the same experience of having to repeat the story every shift change (at least for the first week) and ultimately became incredibly frustrated with doctors doing rounds who would directly contradict the information provided by other medical staff or what was written in her chart.

One of the biggest lessons we took away from the whole experience was the need to be your own medical advocate (understand the health issues, pay attention to what doctors tell you, and don't be afraid to ask for clarification or challenge them if they say something that contradicts other information from a reputable source) - doctors work long hours and see many patients - it's not really surprising that they make mistakes and may miss critical information when scanning similar data sets hour after hour. Unfortunately for patients can be serious consequences to these errors.

(I hope your daughter is doing ok now!)