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Why Do Hospitals Hate Sleep So Much?

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Re: Why Do Hospitals Hate Sleep So Much?

#341

Post by random878 »

lovich wrote: post #327
random878 wrote: post #288

As someone on HN who is medical, not tech, this thread is as frustrating to read as it would be for many of you to read doctor's opinions on how best to run a software engineering firm. "I'm not a software engineer, but here's my full breakdown on where you are all going wrong based on using a BBC Micro for a week back in 1993"

I can imagine how that is for the specifics, but what is the response from the medical community on sleep? We know it's damaging to be sleep deprived and that hurts patients and medical staff. We also know that being sleep deprived craters ability to do _any_ job after far less than the 18-24 hour shifts that medical staff are routinely working. Why is this ok is medicine and not any other type of human endeavor?

You are conflating two separate issues. Sleep deprivation in doctors is an entirely different question to that of patients sleeping while admitted into hospital.

>what is the response from the medical community on sleep?

I can't answer such a general question.

>Why is this ok is medicine and not any other type of human endeavor?

It would be impossible to cover this without hitting a significant word count. It's also depends on the country. In the UK at least it's certainly a political hot potato.

Re: Why Do Hospitals Hate Sleep So Much?

#342

Post by unethical_ban »

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?

A lot of people don't do their job perfectly.

Re: Why Do Hospitals Hate Sleep So Much?

#343

Post by mrhappyunhappy »

ConceptJunkie wrote: post #312
kleborp wrote: post #256

Earlier quoted context omitted.

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.

And reducing the productivity of workers by 25% couldn't possibly have any bad effects. /s In all seriousness, I've seen mentions of studies that suggest going from 8 hours to 6 does _not_ correlate with a 25% decrease in productivity, because most people aren't consistently productive for all 8 hours of a day. I know in my case, there's an extremely strong inverse correlation with productivity and how bored I am wit…

Actually there was an interesting study done to show that most people in the office environment on average do 4 hours of work (actual work) and the rest is breaks, distractions, chit chat, bathroom breaks etc. I have found the 4 hour figure to be much too generous, I’d say on average people work less than 4 hours (maybe closer to 3) the other 5 are a total waste.

When I first started freelancing hourly, it was a sobering feeling to see how little of my time was actually billable for actual work. It takes random screen grabbing software to make you realize that most of the time you are not working. Of course those days have long passed for me but I’m always left to remember just how wasteful office workplaces are and how much time people waste away in their life. More than half of their working life is a total waste. Tell me, how does that make you feel? :)

Re: Why Do Hospitals Hate Sleep So Much?

#344

Post by crazygringo »

I highly recommend the 2017 book "Why We Sleep" [1]. Written by a doctor, starting at page 335 he calls exactly for ensuring hospital patients can sleep, why this is so critical for recovery, and how many things in hospitals currently work against this. (The book covers so much ground, including other reforms like school time starts, why society doesn't value sleep because sleep-deprived people don't perceive their substandard performance, and so on.)

[1] https://www.amazon.com/Why-We-Sleep-Unlocking-Dreams/dp/1501...

Re: Why Do Hospitals Hate Sleep So Much?

#345

Post by jchanimal »

mattkrause wrote: post #202
mfe5003 wrote: post #198

Earlier quoted context omitted.

I've always assumed that the failure rate for handing off care to another person and the rate because of long hours must go in favor of long hours. I don't have anything to back this up except the MCAT being designed to check how you perform when tired. Now with electronic records I've been wondering if long hours are still be necessary, assuming I'm right about the failure rates. I'm sorry about your mother in law r…

This is the claim, but if you look at the experiments supporting it, they’re all bonkers. For example, care is no worse from doctors on 28 hr shifts vs 24. I would argue that both of these are so far from a well-rested baseline that they’re meaningless. We know from lab experiments that performance craters way, way before that, which is why pilots, truck drivers, cops, and every other profession work shorter shifts.

All this talk is insane. I have like maybe 4 top-performing hours on my best days. The idea of working more than 8 in a life safety critical situation boggles the mind.

Re: Why Do Hospitals Hate Sleep So Much?

#346

Post by jchanimal »

sxg wrote: post #301
jac241 wrote: post #278

Earlier quoted context omitted.

In medical school, 120 hour weeks really only exist for 4th year med students who are on sub-internships in surgical specialties like neurosurgery, orthopedic surgery, general surgery, etc. Students in those fields do 3 or so month long sub-i's at hospitals they want to do residency at. They basically function as month long interviews for those programs, and are also used to get letters of recommendation from promine…

I'm currently in my 4th year of medical school, and I have to clarify your comment on the hours worked. We're held to the same hours limits as residents, which is 80 hrs/week averaged over 4 weeks and an average of 1 day off per 7 days. We most often come near these hours on surgical specialty rotations (like the ones you noted). However, these are completely voluntary rotations. I'm not interested in surgery, and I…

Where do we go to change that 80 to 32? This thread is making me feel unsafe.

Re: Why Do Hospitals Hate Sleep So Much?

#347

Post by Brockenstein »

jazzyjackson wrote: post #336
dahfizz wrote: post #279

Earlier quoted context omitted.

Why does the school bus pick him up more than an hour before school starts? That seems ridiculous.

more schools are consolidated these days. In some places, one large school serves 3 counties. I don't know why.

It's more expensive to run three schools. And if those three schools don't each have enough students, they're going to be underfunded as funding is largely based on the number of students.

So the problem starts multiplying.

1. Can't afford supplies, facilities, etc.

2. Can't afford to be properly staffed.

3. The school is invariably going to be under-performing and we've decided as a society that if your school isn't performing well we're going to penalize it by cutting funding, which exacerbates the funding problem.

4. You've got all sorts of people, fiscal hawks, tax payers, etc who don't really want to pay for education, let alone pay for half empty schools and all that overheard. No one really wants to subsidize a ghost town...

So the result is school districts that are too small to make sense being combined together to try and pool their resources and maintain quality and efficiency.

So if you live out in super rural or low population density areas, and families aren't churning out children like they're old school farmers or Catholics, then this is the sort of reality you'll have to deal with.

Re: Why Do Hospitals Hate Sleep So Much?

#348

Post by cowpewter »

cstross wrote: post #182
mattjaynes wrote: post #137

I recently had a family member in the intensive care unit (ICU) for over a month in Austin, Texas. I quickly learned my main contribution would be protecting her sleep when I saw she hadn't slept in days because of the constant interruptions. She went from reasonable and compliant in taking her medication, to extremely irritated and noncompliant with the doctors. Of course I could see this was due to sleep deprivatio…

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…

My mom was an ICU nurse for over 20 years, and yeah, the burnout is real. My mom always said that ICU is made up of a very small number of surgery recovery patients (who quickly get moved to a different section once they're past the critical part of their recovery), and the rest is people who are just there to die (especially here in Florida, where there are a large number of elderly).

She eventually had to switch to another position, because it became too much. She said she lost a lot of her empathy for the people who had spent 60-70 years abusing their bodies, and now were just here to slowly die under her care (regardless of how good that care was). She also hated that so many people were kept alive on machines long past the point of having any life left, just to keep the families happy. She said after a while, she could tell the difference... that whatever made a person a person (the soul or whatever you believe in) was gone, and all that was left was a pile of meat being kept "alive" by the machines.

Re: Why Do Hospitals Hate Sleep So Much?

#349

Post by mrhappyunhappy »

mattjaynes wrote: post #175
mattjaynes wrote: post #137

I recently had a family member in the intensive care unit (ICU) for over a month in Austin, Texas. I quickly learned my main contribution would be protecting her sleep when I saw she hadn't slept in days because of the constant interruptions. She went from reasonable and compliant in taking her medication, to extremely irritated and noncompliant with the doctors. Of course I could see this was due to sleep deprivatio…

To get up to speed on how dramatically sleep affects our cognitive performance, listen to this excellent interview with Matthew Walker (Professor of Neuroscience and Psychology at UC Berkeley, and Director of the Center for Human Sleep Science) https://www.youtube.com/watch?v=pwaWilO_Pig https://podtail.com/en/podcast/the-joe-rogan-experience/-110...

I’m always sleep deprived (typing this up at 1:30am) but I’ll watch that tomorrow. Just wanted to say, as a chronically sleep derived person I typically feel like crap, everything aches. One day I got 9 hours of sleep and I felt amazing. No aching, total clarity, just felt like a new person. I’ll probably drop dead soon, off to bed now but will watch the video tomorrow! Thanks.

Re: Why Do Hospitals Hate Sleep So Much?

#350

Post by ncallaway »

dotancohen wrote: post #170
kalmi10 wrote: post #162

Earlier quoted context omitted.

there is a difference between dead and dying

What do you think "dying" means, or looks like? What signs would such a "dying" awake person display, that a "dying" sleeping person wouldn't? Choking? Pulse goes up and breathing becomes shallow. Cardiac arrest? Aneurysm? Torn blood vessel? Shot in the head? Stabbed in the chest? Poisoned? Spider/Snake bite? Fell off bed and broke hip? All these "dyings" are easily detected by pulse and breathing monitors.

From earlier in the comment chain:

"and it's much easier to detect the neurological symptoms of this in a patient who is awake"

In this context, I imagine neurological symptoms would be things like cognitive function, spatial coordination, memory functions, and linguistic functions.

All of those are things that are not really possible to assess while sleeping, but would be possible to assess in a patient who is awake.

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