7 ms·

Who thought this was a good idea, and why? Aren't our medical professionals the people we least want to be dangerously fatigued? Hasn't anyone read the litera

Who thought this was a good idea, and why? Aren't our medical professionals the people we least want to be dangerously fatigued? Hasn't anyone read the literature on how sleep deprivation interferes with learning? Or how being up for 24 hours straight is equivalent to a blood alcohol level that would disqualify a person from driving? And we want people in this state while they're responsible for the health of people sick enough to be hospitalized? What the actual fuck?

princeb 10y ago
i mean, reading the article would give you several reasons why they didn't think avoiding fatigue was a good tradeoff.
- cauterized 10y ago
  I see one in the article, which is wanting a single doctor to consistently be available through a course of treatment. But I don't see how 24 hours guarantees that any more than 16. I for one would rather my doctor worked 8 hours, went to bed for 8, and returned for the third (or 4th) 8 hours than that they be on their feet trying to keep their eyes open for 24 hours straight and remember everything that I and 20 other patients have said to them or undergone in the last 24 hours. Would you rather have your surgeon hand the scalpel off to another doctor, or have them proceed while so fatigued as to be drunk? And in case you didn't notice, the article also points out the dangers of fatigue, just with the journalistic integrity that suppresses the expression of the outrage that those of us who aren't journalists should all be responding with.
  - chimeracoder 10y ago
    > I for one would rather my doctor worked 8 hours, went to bed for 8, and returned for the third (or 4th) 8 hours than that they be on their feet trying to keep their eyes open for 24 hours straight and remember everything that I and 20 other patients have said to them or undergone in the last 24 hours. According to empirical research, that is actually more dangerous for you, because the handoff points are most likely to introduce errors. It's counterintuitive, but that's something that both providers and peer-reviewed medical journals agree on.
- wwweston 10y ago
  I only see one -- a personal continuity of care argument ("Patients want to know 'you are the doctor taking care of them,' Kothari says."). If that's true, I think it's kind of fascinating. I'd certainly like to know that there is someone who is taking enough interest in me as a patient that they consider themselves ultimately accountable for providing or coordinating a professional standard of care. But I don't need that person to be the personal face of that care all the time, and frankly, it's ridiculous to assert the system behaves that way now. And I definitely want to know that person is operating without cognitive impairments, and definitely don't think "continuity" means "one person." I'm sure there's realities of actually doing the work that I don't understand, and I also know that handing off information and coordinating people is far from trivial (I know that we're really not all that good at it in software, a profession where for anything to work at all you have to pass around carefully encoded instructions). I just don't understand the given argument. Also, I see at least one professional counterargument in the article.
  - AnkhMorporkian 10y ago
    As someone who got out of the hospital recently after a couple weeks in, I see the continuity of care argument. I had a lot of doctors in my time there, and the left hand really didn't know what the right hand was doing. I spent an extra 4 days in because one of my doctors thought the other doctor was going to write the discharge order, and vice versa.
surgeryres 10y ago
I am a surgery resident. This "rule" only applied to first year residents, and was started in 2011. There in fact is a study being conducted where one arm of first year residents follows the 16 hour max and another follows the 28 hour max. It seems the results from this trial suggest the 16 hour max is detrimental to learning, hand-off logistics and scheduling. Regardless, after your first year, no matter what program or specialty, 28 hour calls become the norm. As a second year surgery resident for example, you can plan on taking a 28 hour call two or three times a week. This is just how it is. For two main reasons: 1) There are not enough of us for everyone to get 8 hours of sleep a night. People can debate why or ways we should fix this, whether it's widening scope of practice for nurse practitioners or decreasing our pay so there is more of us, but logistically there are not enough residents to keep everyone well rested. 2) There is physiological relevance to a 24 hour cycle in many diseases. For example, if a patient comes in with a bowel obstruction, the process of observation, lab evaluation, imaging, +\- surgery takes sometimes 24 hours. 12 is sometimes not enough to appreciate the full evolution of acute disease. Big topic here. My experience is anecdotal and limited. Why they did a big study to see what was best. Still, it only applies to first years.
- Retric 10y ago
  1) Is a problem with efficiency not people. If you design things for people to be horribly incompetent due to sleep deprivation, then going through the same process while awake probably produces similar results. However, a shorter work day would mean you could use different processes.
- rohansingh 10y ago
  These 28-hour shifts are unique to healthcare in the United States.
- verroq 10y ago
  Solution: allow more people to become doctors.
  - surgeryres 10y ago
    Ok, but what exactly do you propose? funding to support residents comes from the federal government, and this funding is already strained. Should we lower standards? Lower quality of care? If the answer was easy we would have already implemented something.
marze 10y ago
Any time you see a policy in the medical world (or elsewhere) that appears completely irrational and nuts, ask yourself one question: Does this policy increase medical industry revenue? With the exception of instant death to the patient, medical errors always increase revenue.

princeb 10y ago

i mean, reading the article would give you several reasons why they didn't think avoiding fatigue was a good tradeoff.

cauterized 10y ago
I see one in the article, which is wanting a single doctor to consistently be available through a course of treatment. But I don't see how 24 hours guarantees that any more than 16. I for one would rather my doctor worked 8 hours, went to bed for 8, and returned for the third (or 4th) 8 hours than that they be on their feet trying to keep their eyes open for 24 hours straight and remember everything that I and 20 other patients have said to them or undergone in the last 24 hours. Would you rather have your surgeon hand the scalpel off to another doctor, or have them proceed while so fatigued as to be drunk? And in case you didn't notice, the article also points out the dangers of fatigue, just with the journalistic integrity that suppresses the expression of the outrage that those of us who aren't journalists should all be responding with.
- chimeracoder 10y ago
  > I for one would rather my doctor worked 8 hours, went to bed for 8, and returned for the third (or 4th) 8 hours than that they be on their feet trying to keep their eyes open for 24 hours straight and remember everything that I and 20 other patients have said to them or undergone in the last 24 hours. According to empirical research, that is actually more dangerous for you, because the handoff points are most likely to introduce errors. It's counterintuitive, but that's something that both providers and peer-reviewed medical journals agree on.
wwweston 10y ago
I only see one -- a personal continuity of care argument ("Patients want to know 'you are the doctor taking care of them,' Kothari says."). If that's true, I think it's kind of fascinating. I'd certainly like to know that there is someone who is taking enough interest in me as a patient that they consider themselves ultimately accountable for providing or coordinating a professional standard of care. But I don't need that person to be the personal face of that care all the time, and frankly, it's ridiculous to assert the system behaves that way now. And I definitely want to know that person is operating without cognitive impairments, and definitely don't think "continuity" means "one person." I'm sure there's realities of actually doing the work that I don't understand, and I also know that handing off information and coordinating people is far from trivial (I know that we're really not all that good at it in software, a profession where for anything to work at all you have to pass around carefully encoded instructions). I just don't understand the given argument. Also, I see at least one professional counterargument in the article.
- AnkhMorporkian 10y ago
  As someone who got out of the hospital recently after a couple weeks in, I see the continuity of care argument. I had a lot of doctors in my time there, and the left hand really didn't know what the right hand was doing. I spent an extra 4 days in because one of my doctors thought the other doctor was going to write the discharge order, and vice versa.

surgeryres 10y ago

I am a surgery resident. This "rule" only applied to first year residents, and was started in 2011. There in fact is a study being conducted where one arm of first year residents follows the 16 hour max and another follows the 28 hour max. It seems the results from this trial suggest the 16 hour max is detrimental to learning, hand-off logistics and scheduling. Regardless, after your first year, no matter what program or specialty, 28 hour calls become the norm. As a second year surgery resident for example, you can plan on taking a 28 hour call two or three times a week. This is just how it is. For two main reasons: 1) There are not enough of us for everyone to get 8 hours of sleep a night. People can debate why or ways we should fix this, whether it's widening scope of practice for nurse practitioners or decreasing our pay so there is more of us, but logistically there are not enough residents to keep everyone well rested. 2) There is physiological relevance to a 24 hour cycle in many diseases. For example, if a patient comes in with a bowel obstruction, the process of observation, lab evaluation, imaging, +\- surgery takes sometimes 24 hours. 12 is sometimes not enough to appreciate the full evolution of acute disease. Big topic here. My experience is anecdotal and limited. Why they did a big study to see what was best. Still, it only applies to first years.

Retric 10y ago
1) Is a problem with efficiency not people. If you design things for people to be horribly incompetent due to sleep deprivation, then going through the same process while awake probably produces similar results. However, a shorter work day would mean you could use different processes.
rohansingh 10y ago
These 28-hour shifts are unique to healthcare in the United States.
verroq 10y ago
Solution: allow more people to become doctors.
- surgeryres 10y ago
  Ok, but what exactly do you propose? funding to support residents comes from the federal government, and this funding is already strained. Should we lower standards? Lower quality of care? If the answer was easy we would have already implemented something.

marze 10y ago

Any time you see a policy in the medical world (or elsewhere) that appears completely irrational and nuts, ask yourself one question: Does this policy increase medical industry revenue? With the exception of instant death to the patient, medical errors always increase revenue.