Why Do Hospitals Hate Sleep So Much? • Hacker News Board

Re: Why Do Hospitals Hate Sleep So Much?

#251

Post by babygoat » Wed, Dec 05, 2018, 2:25 PM UTC

DisruptiveDave wrote: post #218

cstross wrote: post #182

Earlier quoted context omitted.

You were dealing with doctors and nurses, right? One group runs a gauntlet of fire by sleep deprivation during pre-med training: with on-call work hours up to 120 hours a week. And the other group are typically on shift rotas so their sleep patterns are permanently disrupted. I'm going to call it for them being oblivious to the sleep requirements of ordinary human beings, because these professions are self-selecting…

To be clear, you're saying that people whose job is to - quite literally - understand, diagnose, and treat hundreds (thousands?) of medical issues that they personally haven't experienced, don't have the capacity to understand that not everyone is on their same sleep schedule?

People whose job is to treat human bodies should have enough sense not to constantly wake them up.

Re: Why Do Hospitals Hate Sleep So Much?

#252

Post by pc86 » Wed, Dec 05, 2018, 2:27 PM UTC

IB885588 wrote: post #230

technofiend wrote: post #190

Earlier quoted context omitted.

>One group runs a gauntlet of fire by sleep deprivation during pre-med training: with on-call work hours up to 120 hours a week. I would argue this is the source of injury and death to the patients that needs to be addressed rather than powered through in some sort of macho hazing ritual. Anecdotally a very tired doctor is allegedly how my wife lost her mother.

Peter Attia (MD) had a podcast episode where he talked about being a resident and how it almost killed him (asleep while driving) and was bad for patient. Also explained that the guy who created the residency program was a cocaine addict who rarely slept, and since then all doctors have to try to follow his crazy schedule for no good reason..

My girlfriend is a second-year OB/GYN resident (which is a 4 year program) and while that field's residency is less insane than some other specialties like ER, she still works 12 hour shifts Mon-Fri (6a-6p on paper but generally 6-7:30), one 24-hour weekend shift a month, and one 12-hour weekend free clinic shift a month. This is on top of the "extras" that are not work but are required to graduate the residency programs. Weekly rotating presentations to the rest of her group (4 other second-year residents so one ~45 minute presentation every 4 weeks), research, generally keeping up with the state of the art in her field, etc.

So she's only "scheduled" for ~67 hours a week averaged throughout the month, but realistically it is in the 85-90 range.

It's easy to see how a more demanding or emergent field could seriously select for folks who are more able or willing to work on less sleep.

Re: Why Do Hospitals Hate Sleep So Much?

#253

Post by Piskvorrr » Wed, Dec 05, 2018, 2:27 PM UTC

spdustin wrote: post #199

cstross wrote: post #182

Earlier quoted context omitted.

You were dealing with doctors and nurses, right? One group runs a gauntlet of fire by sleep deprivation during pre-med training: with on-call work hours up to 120 hours a week. And the other group are typically on shift rotas so their sleep patterns are permanently disrupted. I'm going to call it for them being oblivious to the sleep requirements of ordinary human beings, because these professions are self-selecting…

Nurses are a lot more than just shift change workers, and their nursing school requirements are a lot higher than you seem to believe.

"Works on a shift schedule" is a shared trait between nurses and shift workers. "Has one thing in common with" is not the same as "is the same thing as".

Re: Why Do Hospitals Hate Sleep So Much?

#254

Post by delecti » Wed, Dec 05, 2018, 2:28 PM UTC

Anecdote time. I spent ~3 weeks in the hospital with pneumonia in 6th grade (age 11 or so). For some reason the time they decided on to give me a daily dose of antibiotics was 3am. They were pills, so I had to be woken up enough to swallow them. Fortunately my mom wouldn't stand for that shit and put up a fuss and it only lasted a week. I was in bad shape, I was in the hospital after all, but not such bad shape that antibiotics were so urgent that they were worth ruining the sleep of a sick child on a nightly basis.

Re: Why Do Hospitals Hate Sleep So Much?

#255

Post by jyounker » Wed, Dec 05, 2018, 2:29 PM UTC

culot wrote: post #193

arkades wrote: post #180

Earlier quoted context omitted.

> intensive care unit (ICU) There are only two reasons for someone to be in an ICU: they require a therapy no other floor will administer, or their condition/therapy requires very frequent administration/titration/observation. These two reasons frequently overlap. Sleep isn’t optional in general. It’s optional in the ICU, because the premise is “if you don’t need this level of attention to survive, you absolutely sho…

I think it is absolutely standard in that situation to at least take vitals every couple/few hours, no way around it. It's annoying to be woken up so often, but it's done for good reasons.

So, my partner had the option of either going home directly after surgery or spending the night in the hospital. The hospital staff wanted her to go home. She wanted to stay. (She has issues with post-surgical pain.)

If the hospital staff had sent her home, she would not be woken every two hours. The medical staff were fine with that.

It would have been perfectly reasonable for them to let her sleep; it would have been no more risk than they were advocating for.

Clearly it was optional.

Re: Why Do Hospitals Hate Sleep So Much?

#256

Post by kleborp » Wed, Dec 05, 2018, 2:30 PM UTC

darepublic wrote: post #232

shados wrote: post #228

I'll push this one step further: why is our entire society built around the idea that sleep literally doesn't matter? - Elementary school starting so early all the kids are half asleep in class. - College + Sleep? Not gonna happen. - 24 hour construction in certain part of NYC, check! - Most cities quiet hours are very precisely 8 hours. Hope your days start at 6:30/7:00 and you're falling asleep precisely at 11pm, a…

I guess on paper going without sleep gives you some kind of competitive advantage? A company that believes otherwise could bet on giving their workers more sleep and they should gain an advantage by doing so.

This can be done indirectly by reducing the work day from 8 hours to 6 hours, those who otherwise need to get up early to commute may have a bit more time to settle down in the evening.

Re: Why Do Hospitals Hate Sleep So Much?

#257

Post by lphnull » Wed, Dec 05, 2018, 2:30 PM UTC

shados wrote: post #228

I'll push this one step further: why is our entire society built around the idea that sleep literally doesn't matter? - Elementary school starting so early all the kids are half asleep in class. - College + Sleep? Not gonna happen. - 24 hour construction in certain part of NYC, check! - Most cities quiet hours are very precisely 8 hours. Hope your days start at 6:30/7:00 and you're falling asleep precisely at 11pm, a…

I've had some of the best lucid dreams I've ever had while my sleep was disrupted by living in the second story of a building smack dab in the corner of a very busy street corner during broad daylight. I had a night job so my sleep schedule was from 7am to 3pm. All in all I had half a dozen lucid dreams and one mindblowingly extreme out-of-body experience which left me breathless upon waking. I think I even had a night terror or two while I was there.

I didn't hate it. Sleeping during the day has taught me how to put a pillow over my head in order to block out all light, and now I can sleep in the brightest loudest room without trouble.

I haven't had lucid dreams since then, or if I have, they've been really really rare and extremely hard to remember. Now that I think about it... Could my lucid dreams and OOB have been triggered by smog from the traffic in that area??

Re: Why Do Hospitals Hate Sleep So Much?

#258

Post by aetherson » Wed, Dec 05, 2018, 2:32 PM UTC

shados wrote: post #228

I'll push this one step further: why is our entire society built around the idea that sleep literally doesn't matter? - Elementary school starting so early all the kids are half asleep in class. - College + Sleep? Not gonna happen. - 24 hour construction in certain part of NYC, check! - Most cities quiet hours are very precisely 8 hours. Hope your days start at 6:30/7:00 and you're falling asleep precisely at 11pm, a…

School starts early because most adults have to get to work by 8:30 or 9, and they need to drop off their kids early enough to drive potentially a considerable distance to that work after the drop off.

Re: Why Do Hospitals Hate Sleep So Much?

#259

Post by jyounker » Wed, Dec 05, 2018, 2:33 PM UTC

lbriner wrote: post #217

mcv wrote: post #136

Earlier quoted context omitted.

Sure, if there's a real medical need to wake the patient up, they should absolutely do so. But waking the patient merely to draw blood in the middle of the night when that could just as easily be done in the morning or evening, is stupid and harmful.

Although as someone pointed out above, if the doctor gets the results in the morning because the bloods were taken overnight, they might be able to discharge the patient immediately and get a bed before lunchtime for another patient. If they wait to take bloods in the morning, the patient might be in another day for no particular reason.

Five years ago in Switzerland I could get a full blood panel from my Dr's office in the mall within twenty minutes. The blood came straight out of my arm, into the vials, and into vials went into the analysis unit.

Maybe there needs to be some investment in better analysis equipment for routine draws.

Re: Why Do Hospitals Hate Sleep So Much?

#260

Post by pc86 » Wed, Dec 05, 2018, 2:33 PM UTC

ineedasername wrote: post #240

IB885588 wrote: post #230

Earlier quoted context omitted.

Peter Attia (MD) had a podcast episode where he talked about being a resident and how it almost killed him (asleep while driving) and was bad for patient. Also explained that the guy who created the residency program was a cocaine addict who rarely slept, and since then all doctors have to try to follow his crazy schedule for no good reason..

Yeah. I mean, I get that hospitals are 24-hour operations that need doctors & nurses available at all times. So some people are going to get the crap end of that stick and have to do night shifts. But is it really necessary for them to work 80+ hours while they're at it? It seems like there's enough people trying to be doctors that you could cut that down to a healthier 40 hours+ 15 hours on call if it's really neces…

You would likely have to extend residency based on everything that you need to learn for a given specialty. Med school graduates have an average of over $180k in student loan debt - from med school alone - and resident salaries in the 2-4 year programs are mid five figures.

Given the choice, I'm not sure someone whose 4-year earning potential is capped at $60k with $200k in student loans would want to extend that to 5/6/7 years.