8 ms·

> He was tall and lean, ran six miles a day, and was a strict vegetarian. “I believe a physician should provide exemplary motivation to patients,” he once wrote

by carlob 8y ago

> He was tall and lean, ran six miles a day, and was a strict vegetarian. “I believe a physician should provide exemplary motivation to patients,” he once wrote. “I don’t smoke and have cut out all alcohol.” > “Sometimes I worked from 6 a.m. to 3 a.m.,” he recalled, adding that the pressures had cost him his first marriage. I don't understand how a medical doctor can fail to consider sleep deprivation and overworking not to be a health threat. There is just so much evidence out there that sleep deprivation has similar health effects as alcohol consumption, both in terms of impaired cognitive abilities and long term health effects.

tw1010 8y ago
It's probably exaggeration for effect.
kitcar 8y ago
Many experts feel they have the right to ignore other experts in their field. It's scary how some doctors pick and choose the research findings to reinforce their perspectives, regardless if it's fact based.
- pfranz 8y ago
  I very much agree with this from what I've seen. I do think it's a bit of an odd situation (I'm not trying to defend sleep deprivation here). Patients often choose doctors because of things specific to them and generally seem to reject the commoditization of things (seeing whichever doctor your insurance tells you or whoever is on call that day). Me, being fairly young and only really seeing a doctor when I need a physical or have an annual exam, I don't care. My mom, who sees a doctor more regularly and has a closer relationships with her specialists has more strong opinions. I also remember hearing from a vet student that their mentor used older techniques, medications, and practices for certain things, but because he had used them for decades were way more comfortable using them than newer techniques (which can some times be more idiot proof, but less nuanced). That student was convinced it was better than if he had stayed up to date and used modern practices. Similarly, I remember hearing about aviators relying on automated controls so much that they're less capable in emergency situations. I'm not sure what you can do about that. Ideally, in aggregate passengers are safer overall.
leesec 8y ago
Some doctors don't have a choice. My brother was on call this weekend and got called in Friday night at 10 P.M. and Saturday night at 2 A.M., then had to be back to work at 7 A.M. Sunday. Obviously sleep deprived, but there's nothing he specifically could do. This needs to change at an institutional level.
- pbhjpbhj 8y ago
  Under EU legislation (Working Time Directive?) you have to be allowed an 11 hour break period in each 24 hours, not sure how that works with doctors?
- pfranz 8y ago
  I know there are some huge culture differences from surgeons, doctors, and nurses so I don't mean to conflate them. But I remember hearing that longer nurse shifts had better patient outcomes because so much was lost in handoffs between shifts. There was a study formalizing shift handoffs and patient outcomes improved significantly (I think it did beat out longer shifts, but I'm not sure). I've been to specialists offices who had a rotating practice where you saw whoever was in that day. You still usually had a primary person you saw for scheduled appointments. I still think patients prefer dealing with a single person and am sure things get lost in doctor's notes or even if you make a phone call to the original doctor. Medical training seems to promote normalizing very long work ours and sleep deprivation. I know I've heard about law suits trying to point out the egregiousness of it. Long shifts and being on call 24/7 definitely simplifies staffing. I was in a tech support department that went from 40hr support to 24/7 and it was significantly more challenging to manage. I hope we can improve things because it seems almost inhumane in how we treat medical professionals as well as patients.
- unknownkadath 8y ago
  Coming from the nuclear industry, this sounds crazy, even compared to our outage culture. NRC says that you can work up to 16 hours, then you MUST go home for 8. It takes some paperwork to get a one-time exception.
  - 8y ago
klyrs 8y ago
I swear, a surgeon killed my dad. My dad's surgery was scheduled immediately after the surgeon returned from Australia -- he drove straight from a 30-hour flight to the surgery ward. His scalpel slipped and nicked a chyle duct, which took another half-dozen surgeries to correct. Sure, the cancer was gonna kill him, but spending 3 months in ICU probably took years away from us. I can't imagine the surgeon's hubris in that -- the medical profession seems to know so much, but individual practitioners think they're immune to sleep deprivation, exhaustion, and other simple well-understood aspects of the human condition. It's appalling and tragic
- scarejunba 8y ago
  Surgeons are cowboys. They know it and take pride in it. It's a cultural thing that will take work. This macho culture thing is so common it makes me wonder.
- geoka9 8y ago
  I suspect in some professions hubris is so important that people who tend to be humble simply don't make it in them. For example, Chuck Yeager complained about the arrogance of test pilots and I've heard a couple of times surgeons comparing themselves to fighter pilots. The difference, of course, is pilots kill themselves while surgeons kill their patients. I'm so sorry about your dad.
  - kurtisc 8y ago
    To drag this conversation into further despair; an airshow pilot in the UK is currently being charged for manslaughter for when he, allegedly, negligently performed a risky manoeuvre and survived a crash that killed 11 people.
  - hinkley 8y ago
    I wonder if the humble ones are the ones that will adapt best to robotic surgery. If that ends up being case then 'choosing a human' may quickly become a Market for Lemons situation - you might have gotten better outcomes from human surgeons except the only ones still doing it by hand are full of themselves and too proud to admit they are human and make mistakes.
breitling 8y ago
Sounds like this was in the 1960's or 70's. That's a whole different world. Knowledge of sleep may not have been as pervasive as it is today.
Mikeb85 8y ago
A lot of people think you can overcome sleep deprivation and stress by being 'healthy'. They overestimate the effects of diet and drinking and underestimate the effects of stress.
nwallin 8y ago
Doctors are trained to believe that sleep deprivation isn't something that affects good doctors. During their residency, doctors routinely work 24 hour shifts. This goes back to William Halsted, who for all intents and purposes invented modern medical training at Hopkins. Halsted managed his always-on work ethic with his cocaine addiction, and drove his residents to the same extremes. https://www.nytimes.com/2011/08/07/magazine/the-phantom-menace-of-sleep-deprived-doctors.html https://www.nytimes.com/2011/08/07/magazine/the-phantom-mena... > Of course, the overworked, sleep-deprived doctor valiantly saving lives is an archetype that is deeply rooted in the culture of physician training, not to mention television hospital dramas. William Halsted, the first chief of surgery at Johns Hopkins in the 1890s and a founder of modern medical training, required his residents to be on call 362 days a year (only later was it revealed that Halsted fueled his manic work ethic with cocaine), and for the next 100 years the attitude of the medical establishment was more or less the same. Doctors, influenced by their own residency experiences, often see hospital hazing as the most effective way to learn the practice of medicine. It's bullshit, it's killing patients, it's ruining lives, everyone knows about it, yet no one does anything, because "it's the way we've always done it". If a doctor has been awake longer than 18 hours, and a patient dies on the table, they should be charged with manslaughter, traditions be damned.
- ameister14 8y ago
  I don't really agree about the manslaughter charge - if a doctor has been awake longer than 18 hours and there is no other doctor available, should they not attempt to treat the patient? Personally, I don't think it's a doctor issue, I think it's a Medical Practice and Hospital Group issue. MD's don't really want to take call, but if they can take call for the entirety of one weekend and then have the next 3-5 off, they'd rather do that than take call for 12 hours 2 weekends in 4.
  - pavel_lishin 8y ago
    > if a doctor has been awake longer than 18 hours and there is no other doctor available, should they not attempt to treat the patient? What lead to the systemic disaster that causes this situation to come up in the first place? The scenario is presumably a hospital in a major city in peacetime; doctors shouldn't be working those hours to begin with.
Bjorkbat 8y ago
One other thing to consider is that a vitamin B12 deficiency is associated with elevated stroke risk. We get most of our vitamin B12 from animal products, namely meats.
darkerside 8y ago
Just to share another perspective, doctors, and especially surgeons, save lives by the hour. Every minute they're not working, they forsake compensation of course, but more saliently, they are letting people die. Wouldn't you feel at least a bit compelled to work the extra odd hours here and there?
- antidesitter 8y ago
  > Wouldn't you feel at least a bit compelled to work the extra odd hours here and there? Not if doing so raises the risk to patients to an unacceptable level.
  - darkerside 8y ago
    It's probably easier to say that when your hands aren't literally saving lives on a regular basis. There must be a certain level of guilt that sets in when you take time to relax. I'm not saying doctors shouldn't take it easy, just that it's human nature for them not to want to.
- Terr_ 8y ago
  "Penny-wise, pound-foolish."
  - darkerside 8y ago
    I don't disagree, but I can empathize with the pressure they put themselves under

by carlob 8y ago

tw1010 8y ago

It's probably exaggeration for effect.

kitcar 8y ago

Many experts feel they have the right to ignore other experts in their field. It's scary how some doctors pick and choose the research findings to reinforce their perspectives, regardless if it's fact based.

pfranz 8y ago
I very much agree with this from what I've seen. I do think it's a bit of an odd situation (I'm not trying to defend sleep deprivation here). Patients often choose doctors because of things specific to them and generally seem to reject the commoditization of things (seeing whichever doctor your insurance tells you or whoever is on call that day). Me, being fairly young and only really seeing a doctor when I need a physical or have an annual exam, I don't care. My mom, who sees a doctor more regularly and has a closer relationships with her specialists has more strong opinions. I also remember hearing from a vet student that their mentor used older techniques, medications, and practices for certain things, but because he had used them for decades were way more comfortable using them than newer techniques (which can some times be more idiot proof, but less nuanced). That student was convinced it was better than if he had stayed up to date and used modern practices. Similarly, I remember hearing about aviators relying on automated controls so much that they're less capable in emergency situations. I'm not sure what you can do about that. Ideally, in aggregate passengers are safer overall.

leesec 8y ago

Some doctors don't have a choice. My brother was on call this weekend and got called in Friday night at 10 P.M. and Saturday night at 2 A.M., then had to be back to work at 7 A.M. Sunday. Obviously sleep deprived, but there's nothing he specifically could do. This needs to change at an institutional level.

pbhjpbhj 8y ago
Under EU legislation (Working Time Directive?) you have to be allowed an 11 hour break period in each 24 hours, not sure how that works with doctors?
pfranz 8y ago
I know there are some huge culture differences from surgeons, doctors, and nurses so I don't mean to conflate them. But I remember hearing that longer nurse shifts had better patient outcomes because so much was lost in handoffs between shifts. There was a study formalizing shift handoffs and patient outcomes improved significantly (I think it did beat out longer shifts, but I'm not sure). I've been to specialists offices who had a rotating practice where you saw whoever was in that day. You still usually had a primary person you saw for scheduled appointments. I still think patients prefer dealing with a single person and am sure things get lost in doctor's notes or even if you make a phone call to the original doctor. Medical training seems to promote normalizing very long work ours and sleep deprivation. I know I've heard about law suits trying to point out the egregiousness of it. Long shifts and being on call 24/7 definitely simplifies staffing. I was in a tech support department that went from 40hr support to 24/7 and it was significantly more challenging to manage. I hope we can improve things because it seems almost inhumane in how we treat medical professionals as well as patients.
unknownkadath 8y ago
Coming from the nuclear industry, this sounds crazy, even compared to our outage culture. NRC says that you can work up to 16 hours, then you MUST go home for 8. It takes some paperwork to get a one-time exception.
- 8y ago

klyrs 8y ago

I swear, a surgeon killed my dad. My dad's surgery was scheduled immediately after the surgeon returned from Australia -- he drove straight from a 30-hour flight to the surgery ward. His scalpel slipped and nicked a chyle duct, which took another half-dozen surgeries to correct. Sure, the cancer was gonna kill him, but spending 3 months in ICU probably took years away from us. I can't imagine the surgeon's hubris in that -- the medical profession seems to know so much, but individual practitioners think they're immune to sleep deprivation, exhaustion, and other simple well-understood aspects of the human condition. It's appalling and tragic

scarejunba 8y ago
Surgeons are cowboys. They know it and take pride in it. It's a cultural thing that will take work. This macho culture thing is so common it makes me wonder.
geoka9 8y ago
I suspect in some professions hubris is so important that people who tend to be humble simply don't make it in them. For example, Chuck Yeager complained about the arrogance of test pilots and I've heard a couple of times surgeons comparing themselves to fighter pilots. The difference, of course, is pilots kill themselves while surgeons kill their patients. I'm so sorry about your dad.
- kurtisc 8y ago
  To drag this conversation into further despair; an airshow pilot in the UK is currently being charged for manslaughter for when he, allegedly, negligently performed a risky manoeuvre and survived a crash that killed 11 people.
- hinkley 8y ago
  I wonder if the humble ones are the ones that will adapt best to robotic surgery. If that ends up being case then 'choosing a human' may quickly become a Market for Lemons situation - you might have gotten better outcomes from human surgeons except the only ones still doing it by hand are full of themselves and too proud to admit they are human and make mistakes.

breitling 8y ago

Sounds like this was in the 1960's or 70's. That's a whole different world. Knowledge of sleep may not have been as pervasive as it is today.

Mikeb85 8y ago

A lot of people think you can overcome sleep deprivation and stress by being 'healthy'. They overestimate the effects of diet and drinking and underestimate the effects of stress.

nwallin 8y ago

Doctors are trained to believe that sleep deprivation isn't something that affects good doctors. During their residency, doctors routinely work 24 hour shifts. This goes back to William Halsted, who for all intents and purposes invented modern medical training at Hopkins. Halsted managed his always-on work ethic with his cocaine addiction, and drove his residents to the same extremes. https://www.nytimes.com/2011/08/07/magazine/the-phantom-menace-of-sleep-deprived-doctors.html https://www.nytimes.com/2011/08/07/magazine/the-phantom-mena... > Of course, the overworked, sleep-deprived doctor valiantly saving lives is an archetype that is deeply rooted in the culture of physician training, not to mention television hospital dramas. William Halsted, the first chief of surgery at Johns Hopkins in the 1890s and a founder of modern medical training, required his residents to be on call 362 days a year (only later was it revealed that Halsted fueled his manic work ethic with cocaine), and for the next 100 years the attitude of the medical establishment was more or less the same. Doctors, influenced by their own residency experiences, often see hospital hazing as the most effective way to learn the practice of medicine. It's bullshit, it's killing patients, it's ruining lives, everyone knows about it, yet no one does anything, because "it's the way we've always done it". If a doctor has been awake longer than 18 hours, and a patient dies on the table, they should be charged with manslaughter, traditions be damned.

ameister14 8y ago
I don't really agree about the manslaughter charge - if a doctor has been awake longer than 18 hours and there is no other doctor available, should they not attempt to treat the patient? Personally, I don't think it's a doctor issue, I think it's a Medical Practice and Hospital Group issue. MD's don't really want to take call, but if they can take call for the entirety of one weekend and then have the next 3-5 off, they'd rather do that than take call for 12 hours 2 weekends in 4.
- pavel_lishin 8y ago
  > if a doctor has been awake longer than 18 hours and there is no other doctor available, should they not attempt to treat the patient? What lead to the systemic disaster that causes this situation to come up in the first place? The scenario is presumably a hospital in a major city in peacetime; doctors shouldn't be working those hours to begin with.

Bjorkbat 8y ago

One other thing to consider is that a vitamin B12 deficiency is associated with elevated stroke risk. We get most of our vitamin B12 from animal products, namely meats.

darkerside 8y ago

Just to share another perspective, doctors, and especially surgeons, save lives by the hour. Every minute they're not working, they forsake compensation of course, but more saliently, they are letting people die. Wouldn't you feel at least a bit compelled to work the extra odd hours here and there?

antidesitter 8y ago
> Wouldn't you feel at least a bit compelled to work the extra odd hours here and there? Not if doing so raises the risk to patients to an unacceptable level.
- darkerside 8y ago
  It's probably easier to say that when your hands aren't literally saving lives on a regular basis. There must be a certain level of guilt that sets in when you take time to relax. I'm not saying doctors shouldn't take it easy, just that it's human nature for them not to want to.
Terr_ 8y ago
"Penny-wise, pound-foolish."
- darkerside 8y ago
  I don't disagree, but I can empathize with the pressure they put themselves under