49 ms·

Of course they all use stimulants. I don't know how else they could handle the workload. The scary part is that it continues into residency. There are surger

• stochastic_monk 8y ago
  These absurd hours have already been reduced. A friend of mine when I was 14 was a resident. He worked 3 35-hour shifts a week.
  • deleted 8y ago
    [deleted]
• philip1209 8y ago
  The book "Why we sleep" talks a lot about this - apparently the doctor who created the first residency program was a cocaine addict, which let him stay awake for days at a time: https://en.m.wikipedia.org/wiki/William_Stewart_Halsted https://en.m.wikipedia.org/wiki/William_Stewart_Halsted
  • EForEndeavour 8y ago
    The obvious solution is to legalize cocaine, at least in the medical profession.
• Alex3917 8y ago
  > I wonder how many of these are from lack of sleep. A lot of the deaths from lack of sleep wouldn't be counted as medical errors. E.g. medical errors includes accidentally doing surgery on the wrong person, but doesn't include fucking up a surgery that you actually need to do. C.f.: https://www.alexkrupp.com/Citevault.html#iatrogenic https://www.alexkrupp.com/Citevault.html#iatrogenic
  • dorchadas 8y ago
    But, what if you got the wrong patient because you were sleepy and it was affecting your judgement and clarity of thinking? I'd say there's a decent amount that could still fall under that.
    • Alex3917 8y ago
      Yeah my point was more that the JHU estimates are purposely a lower bound. E.g. they are using only data from hospitals, even though most procedures are happen in outpatient or nursing home settings. So whatever the real number of accidental injuries and deaths from sleep deprivation, you can't get it as just a percentage of the JHU estimate.
    • rscho 8y ago
      That's why there are multiple pre-op Checkpoints with nurses involved. One doctor cannot "get the wrong patient" all by him/herself. It takes a 5 people team fuck up for that to happen.
  • hopler 8y ago
    What does your link gave to do with your comment?
    • deleted 8y ago
      [deleted]
    • Alex3917 8y ago
      The bullet points from the JAMA article about the JHU study the author is talking about.
• wpietri 8y ago
  A friend runs a residency program and I've talked with them about it a few times. This is definitely getting better, but the number of hours still seems high to me. As a developer, I'm strongly against extended hours because I know how quickly the error rate creeps up. (And I probably wouldn't know that if I weren't doing TDD and pair programming, because the first thing that goes for me is ability to notice my poor performance.) My basic question was: shouldn't doctors work 8 hours and then go home? The big difference between writing code and doing medicine is that patients won't stay the same when a doctor leaves for the day. With 8-hour shifts and 40-hour weeks, covering a patient around the clock requires 4-5 people. Those people will have 21 handoffs during that week. Each one of those handoffs is an opportunity for information to get lost, for understanding to fade, for followups not to happen. If people work 12 hours, that's only 4 handoffs. 16 and it's 10. 24 and it's 7. Obviously, at some point the harm from overwork outweighs the harm from handoffs. But it's not an easy decision to make. When I'm debugging some weird, urgent problem, I know how valuable it is to stay with it, to keep all the state loaded in my head until I figure it out. And hospitals are full of weird, urgent problems.
  • travisoneill1 8y ago
    Your experience with coding for a long time is exactly like mine, but no one is going to die if I stay up late and write terrible code. Otherwise the clear answer would be to just be time inefficient and pick it up the next day. If there is an edge case where an emergency happens in hour 7 of an 8 hour scheduled shift I guess that's fine, you can go hard like that from time to time and be fine, but not constantly. And this really is an edge case since most medical care is not in an emergency setting.
    • wpietri 8y ago
      I agree that most medical care isn't urgent. But I think all doctors should be able to handle emergencies. It's similar to how I think we should work to never have urgent production issues, but that all developers should be able to debug urgent production issues.
  • albertgoeswoof 8y ago
• plaidfuji 8y ago
  It's because shortening doctors' shifts does not result in better patient outcomes: https://psnet.ahrq.gov/primers/primer/19/Duty-Hours-and-Patient-Safety https://psnet.ahrq.gov/primers/primer/19/Duty-Hours-and-Pati... The reduced fatigue is offset by the increased number of patient handoffs between shifts. More handoffs = more errors. My wife is a resident and she supports 30 hour shifts for residents for this reason. The difference between your judgement at hour 23 and hour 29 is less of a risk factor than a 20% increase in handoffs.
  • taeric 8y ago
    This seems to imply that we can't improve hand off procedures. That is, what about the hand off is so risky? Are we fixing that?
    • rscho 8y ago
      No, we're not. Clinical software is the 9th circle of hell for every healthcare worker, as it was made not for patients, but for billing efficiency. As a result, handoffs get no benefits from tech. Computers make it even worse by increasing administrative loads.
    • bookofjoe 8y ago
      Retired neurosurgical anesthesiologist here (38 years experience in top-tier academic centers: UCLA/USC/UVA). It was always my practice — from my first year of residency in 1977 until I retired as an attending faculty anesthesiologist in 2015 — to refuse relief at 3-4 pm when the night crew came on duty IF I had a patient who'd been unstable or whose management was especially complex. I didn't believe I could fully read the relieving anesthesiologist into the case because so much of what I'd been through with the patient had been idiosyncratic and it had taken me hours to get a "feel" for what worked and what their safe parameters were. Relief teams loved me, you can be sure. Oh, one more thing: when I did hand over a relatively straightforward case, rather than quickly dress and get the heck out of Dodge, I'd go down to the cafeteria, get a snack, come back to the anesthesia ready room, shmooze a bit, and then go back to the OR I'd left and quietly enter, saying to the relief doc, "Did I leave anything out, or is there anything on the anesthesia record that isn't clear?" Quite often there WAS a question or three whose answer(s) helped orient the relief anesthesiologist.
• emsal 8y ago
  How many deaths were reported per 100,000 patients admitted? Not to shed doubt; I just think that'd be important to know.
  • travisoneill1 8y ago
    Not sure but this is huge even on the scale of the entire population. Compare to the other top causes of death: Heart disease: 635,260 Cancer: 598,038 Accidents (unintentional injuries): 161,374 Chronic lower respiratory diseases: 154,596 Stroke (cerebrovascular diseases): 142,142 Alzheimer’s disease: 116,103 Diabetes: 80,058 Influenza and pneumonia: 51,537 Nephritis, nephrotic syndrome, and nephrosis: 50,046 Intentional self-harm (suicide): 44,965 https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
• krylon 8y ago
  > There are surgery residents working 24h+ shifts. We have laws against overworking truck drivers, but somehow the medical profession gets a pass. That is so true. During my Zivildienst[0], for nurses were required either by law or by collective agreement to have at least ten hours of free time / rest between two shifts. The morning shift was 06:00 to 14:00, the late shift was 13:00 to 21:00, so if somebody worked the shift one day and the early shift the next day, they could either leave an hour earlier on the first day or come in an hour later on the second day. But Doctors working 24 hour shifts were not seen as a problem. In Germany, this is weirdly intertwined with the pay structure of medical doctors, so any attempt to improve working conditions would also result in lower wages, which the medical doctors do not like, either, so the whole situation is somewhat stuck. EDIT: [0] When we had a military draft in Germany, one could become a conscientious objector and serve in a civilian institution instead, for example Hospitals or nursing homes.
• ajross 8y ago
  > We have laws against overworking truck drivers, but somehow the medical profession gets a pass. It's a feedback loop. Those residents are working themselves to the bone aiming for a big payoff in a high prestige, high income profession. The fix you want is isomorphic to just hiring a bunch more doctors to handle the workload, which will dilute the existing pool making it both lower income and lower prestige. Basically, Residents are willing to work hard because they want to be part of a profession where residents have to work hard. That's not really an issue of regulatory structure (though I totally agree that work hour limits are a common sense thing that should absolutely be enforced by some authority).
  • EamonnMR 8y ago
    > hiring a bunch more doctors to handle the workload, which will dilute the existing pool making it both lower income and lower prestige. This is a very good idea and we should do this.
    • rscho 8y ago
      On paper yes. In fact, this is a social dilemma and your point of view will hold until you yourself will end up in the hospital and complain because your doctor does not know his/her job. I don't mean that aggressively. I unfortunately get that from first hand experience.
      • EamonnMR 8y ago
        If it lowers the barrier of entry such that I actually go and see a doctor, I'd call that acceptable.
        • rscho 8y ago
          Yes, of course. In fact, the problem is that when we make major changes to the healthcare system, the truth is that no one has any idea of where we'll end up a few years later. That's why there is a lot of posturing on both sides. I can judge how extreme opinions will impact my immediate professional surroundings, but besides that your judgement is as valid as mine.
• SkyPuncher 8y ago
  > There are surgery residents working 24h+ shifts. We have laws against overworking truck drivers, but somehow the medical profession gets a pass. Actually, residents have them too. They can work upto 24 hours straight plus 4 more hours for "transition". Yeah, the that's right. The residency governing organization said 28 hours straight is completely acceptable - and preferred in some situations.
  • ams6110 8y ago
    It's like a firefighter shift. They can grab sleep during that time if there is a lull in activity. But it's not guaranteed.
    • SkyPuncher 8y ago
      That's not correct. These rules are for normal shifts where residents are caring for patients. There might be "down time" to grab lunch or catch up on notes, but it's not enough to go take a nap.
    • rscho 8y ago
      There are no lulls in activity in a resident's life. The term "resident" has not been defined randomly. It's a literal depiction of what the job is.
• billfruit 8y ago
  Perhaps other fields better manage their manpower, like airline pilots and crew, I think they operate under strict duty limits which is impossible to bypass without breaking rules. I think even train locomotive crews are under very strict duty limits.
  • nradov 8y ago
    Airline pilots are not really comparable. They don't routinely hand off control of the airplane to another set of pilots in the middle of an in-flight emergency. Every intensive care patient is essentially a non-stop crisis.
    • billfruit 8y ago
      But they do handover/takeover the control of a complex aircraft, while it is flying. They are also subject to a Fatigue Risk Management System(FRMS).
      • nradov 8y ago
        But they don't hand over control to the relief crew in the middle of an ongoing emergency. That's the point.
• momentmaker 8y ago
  Near the end of the book Why We Sleep, the author specifically talked about this. The lack of sleep contribute to 170% likely more cause an error during surgery. Scary to ponder... He mentioned the guy that started the residency program, Halstead, in John Hopkin turned out to be a cocaine addict. He stressed that a doctor needs to work all the time. No one knew about his drug addiction until he had passed away. He even tried to get rid of the addiction by checking into a rehab up north but came away in addition to the cocaine addiction but also a morphine addiction as well.
• StreamBright 8y ago
  And you think the solution is drugs instead of reasonable working hours?