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No Doctor Should Work 30 Hours Straight with No Sleep

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

#201

Post by llimllib »

jblok wrote: post #190
llimllib wrote: post #171

Earlier quoted context omitted.

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 ar…

What, with your knowledge, could be done with technology to solve this problem of handoff? A notepad app probably wouldn't cut it, but is there any way to move the complex thoughts in a doctors mind into a database somehow?

I don't know what the exact process would be, but I think that the key would be to focus on process. Start treating each patient mishap like the FAA treats every airline mishap, take steps to ensure that each doesn't happen in the same way again, and I think you could improve things a great deal.

I think doctors focus on, and are very good at, doctoring. A little more focus on process and the totality of the hospital experience could bring big gains relatively quickly.

That's just an outside opinion though, my wife would probably disagree with me.

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

#202

Post by mcv »

Spooky23 wrote: post #160
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.

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 bl…

> and ask if my birthday had changed

Er, why? This reeks of a pretty serious administrative fuck-up.

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

#203

Post by mattkrause »

themantalope wrote: post #131
tjic wrote: post #114

Earlier quoted context omitted.

Note that the AMA, run by doctors, is required by US law to give their approval before a new medical school may open, or an existing medical school can expand its program. The doctors who would see their salaries fall if supply increased have complete control over supply. This is complete regulatory capture, and it's terrible.

While this is true, the real bottleneck is the availability of training positions. Other commenters have pointed out that these positions are generally increasing in number, but not nearly at a rate large enough to make up for the shortfall. One positive argument to having a body like the AMA leverage some control over medical schools is that it helps to ensure that schools only open/expand if the AMA thinks that the…

It's confusing to me that there are not more programs that "convert" biomedical PhDs/postdocs into MDs. The PhDs and postdocs have some relevant background and are clearly fairly clever and motivated.

However, I looked into this after grad school and other than a new program at Columbia, there's not much. In fact, one person told me that since it was more than 5(?) years after I took intro bio, I would need to retake those classes--despite doing bio research for the entire intervening time. It's baffling that a PhD would quality one to teach a class to medical students, but not attend it.

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

#204

Post by [deleted] »

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…

[deleted]

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

#205

Post by ezy »

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…

Uh, why would residents report dissatisfaction when it would hurt their opportunities down the road? Would you have? I don't think so. I don't think you are being skeptical enough about these "studies".

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

#206

Post by Spooky23 »

mcv wrote: post #202
Spooky23 wrote: post #160

Earlier quoted context omitted.

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 bl…

> and ask if my birthday had changed Er, why? This reeks of a pretty serious administrative fuck-up.

Around here, every interaction with a hospital employee involves a recitation of your birthdate, allergy status and other crap.

When my wife was having our baby, the nurses had to log into three different systems -- an OBstetrics system, the hospitals charting/EMR and the pharmaceutical system. That meant going through the ritual 3 times.

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

#207

Post by tdb7893 »

llimllib wrote: post #201
jblok wrote: post #190

Earlier quoted context omitted.

What, with your knowledge, could be done with technology to solve this problem of handoff? A notepad app probably wouldn't cut it, but is there any way to move the complex thoughts in a doctors mind into a database somehow?

I don't know what the exact process would be, but I think that the key would be to focus on process. Start treating each patient mishap like the FAA treats every airline mishap, take steps to ensure that each doesn't happen in the same way again, and I think you could improve things a great deal. I think doctors focus on, and are very good at, doctoring. A little more focus on process and the totality of the hospital…

I doubt it would scale. The FAA regulates one thing (flying planes) and there still are a ton of checklists and regulations, presumably if you tried the same thing with medicine it would collapse under it's own weight with all the different edge cases

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

#208

Post by kelnos »

mcv wrote: post #194
kelnos wrote: post #154

Earlier quoted context omitted.

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 h…

> If a doc is on an 8-hour shift (hypothetical; I doubt any docs are so lucky!) But that's a big part of the problem already. It shouldn't be luck to have an 8 hour shift, it should be standard. And of course there may be times when circumstances demand you deviate from that standard, but if you start with 12 hour shifts, you already start wrong, and it can only get worse.

I think we're deviating from the point I was trying to address. The length of the shift isn't relevant, what's relevant is that different patients need different amount of times, and can arrive at any time during a doctor's shift. Based on both of those variables, a single patient can easily require care beyond a single doctor's shift, so saying "getting done with your current patient and then leaving should never lead to a 12-hour shift" doesn't really make sense, since that "current patient" could have arrived during hour 6 of your shift and then required a 6 hours of attention before being discharged. If you believe that doctor-patient continuity is more important than a doctor's rest, then you can easily justify any shift length up to the point where the doctor falls over.
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