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There's a human factor here that I think cuts close to some startup practices: sleep deprivation. The watch schedules and setup for sailors is just ridiculous

There's a human factor here that I think cuts close to some startup practices: sleep deprivation. The watch schedules and setup for sailors is just ridiculous - https://np.reddit.com/r/navy/comments/6uz5hj/uss_john_mccain_collides_with_merchant_ship/dlx2esb/?context=3 https://np.reddit.com/r/navy/comments/6uz5hj/uss_john_mccain... You wouldn't let a civilian heavy equipment operator or truck driver work under that level of sleep deprivation.

mgkimsal 9y ago
don't we (for some reason) seem to demand similar schedules from medical residents, people who are operating with our very lives (let alone heavy machinery or trucks)?
- roywiggins 9y ago
  There's some evidence that shorter shifts cause errors too, because you have to hand patients off between doctors more often, and you lose information. I don't know what the state of the science is on this but it's one issue (of many). https://www.sciencedaily.com/releases/2014/05/140520123428.htm https://www.sciencedaily.com/releases/2014/05/140520123428.h...
  - GVIrish 9y ago
    Seems to me like the solution is to work on improving handoffs rather than trading the risk of handoffs for the risk introduced by sleep deprivation. From the medical professionals I know, handoff problems are partly because of missing/difficult to find/ignored information in charts and in healthcare IT systems. Improving on that front might be a way to allow a switch to more sensible schedules that don't invite bleary-eyed mistakes from doctors/residents.
    - colechristensen 9y ago
      Give everyone paper, pens, handwriting lessons, and AI powered OCR. Healthcare IT systems are a mess, and taking writing away from people makes them worse at their jobs. Every medical professional I've ever managed to get talking about healthcare IT gave me the impression that it gets in the way more than helps. The ... lets call it ergonomics of record keeping are vitally important in medicine and plenty of other disciplines. Computers have been used as a way to enforce and expand bureaucratic rules, not as a tool to make record keeping more expressive and powerful.
      - ribs 9y ago
        Doctors' handwriting is notoriously bad, even archetypally bad. It's its own genre of humor.
        deleted 9y ago
        [deleted]
  - bsder 9y ago
    > because you have to hand patients off between doctors more often, and you lose information. Unfortunately, I can't find it now, but there was also a study that part of the handoff problem is that the "new" doctor feels the need to put his "stamp" on the treatment and consequently causes action even when there doesn't need to be any change.
    - floatingatoll 9y ago
      Maybe the flak thrown at you by the hospital, press, and family of someone who dies is easier to bear when you “did something” as opposed to when you “did nothing”, and doctors unconsciously gravitate towards action as a result.
  - caycep 9y ago
    to be honest, i think this would be mitigated by better hand-off procedures. At the moment, there isn't a formal "handoff format" and its ad hoc depending on the physician. Nurses have much shorter shifts between doctors, 8-12 hrs, and they do ok.
- hkmurakami 9y ago
  This is why ER residents don't have quite as crazy shifts.

mgkimsal 9y ago

don't we (for some reason) seem to demand similar schedules from medical residents, people who are operating with our very lives (let alone heavy machinery or trucks)?

roywiggins 9y ago
There's some evidence that shorter shifts cause errors too, because you have to hand patients off between doctors more often, and you lose information. I don't know what the state of the science is on this but it's one issue (of many). https://www.sciencedaily.com/releases/2014/05/140520123428.htm https://www.sciencedaily.com/releases/2014/05/140520123428.h...
- GVIrish 9y ago
  Seems to me like the solution is to work on improving handoffs rather than trading the risk of handoffs for the risk introduced by sleep deprivation. From the medical professionals I know, handoff problems are partly because of missing/difficult to find/ignored information in charts and in healthcare IT systems. Improving on that front might be a way to allow a switch to more sensible schedules that don't invite bleary-eyed mistakes from doctors/residents.
  - colechristensen 9y ago
    Give everyone paper, pens, handwriting lessons, and AI powered OCR. Healthcare IT systems are a mess, and taking writing away from people makes them worse at their jobs. Every medical professional I've ever managed to get talking about healthcare IT gave me the impression that it gets in the way more than helps. The ... lets call it ergonomics of record keeping are vitally important in medicine and plenty of other disciplines. Computers have been used as a way to enforce and expand bureaucratic rules, not as a tool to make record keeping more expressive and powerful.
    - ribs 9y ago
      Doctors' handwriting is notoriously bad, even archetypally bad. It's its own genre of humor.
      - deleted 9y ago
        [deleted]
- bsder 9y ago
  > because you have to hand patients off between doctors more often, and you lose information. Unfortunately, I can't find it now, but there was also a study that part of the handoff problem is that the "new" doctor feels the need to put his "stamp" on the treatment and consequently causes action even when there doesn't need to be any change.
  - floatingatoll 9y ago
    Maybe the flak thrown at you by the hospital, press, and family of someone who dies is easier to bear when you “did something” as opposed to when you “did nothing”, and doctors unconsciously gravitate towards action as a result.
- caycep 9y ago
  to be honest, i think this would be mitigated by better hand-off procedures. At the moment, there isn't a formal "handoff format" and its ad hoc depending on the physician. Nurses have much shorter shifts between doctors, 8-12 hrs, and they do ok.
hkmurakami 9y ago
This is why ER residents don't have quite as crazy shifts.