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I find it absurd that we allow medical staff to work 24 hour shifts. We don't let pilots do that. We don't let truckers do that.
by MattGaiser 5y ago
I find it absurd that we allow medical staff to work 24 hour shifts. We don't let pilots do that. We don't let truckers do that.
- someguydave 5y agoThere seems to be a strong hazing culture in the medical industry.
- nradov 5y agoIt's a complicated problem. Tired healthcare providers make more errors. But the majority of harmful errors happen in handing over patient care from one provider to another. Shorter shifts mean more care transitions. A patient in the ICU isn't like a truck that you can park and leave alone for 8 hours.
- TheFreim 5y agoThat's a really interesting point I'd never thought of before. Do you know of any discussions/articles on this topic? Would be interested to learn more, I always just assumed long doctor shifts was a combination of lack of workers and stinginess.
- skeeter2020 5y agoAlso, unlike say a trucker, the work of doctors and nurses is very reactive to environmental conditions (feast or famine), so it allows for limited downtime where you might sneak in a nap between 20-60 minutes, or might be 100% your entire shift. It might make scheduling slightly easier is some regard, but it's actually a very expensive way to staff.
- NineStarPoint 5y agoAs a follow up question, I know I’ve read a lot about the handover issue in the general sense. Does anyone know of any research that has been done to see if the long shifts exacerbate the issue? It wouldn’t surprise me if handover would go more smoothly if the people weren’t at the end of such massive shifts, but it’s equally possible that intuition is wrong. What I don’t know is if there exist places where they tried shorter shifts in recent memory for us to even have the data on.
- TheFreim 5y agoYeah, what specifically is causing the issues with handover? Lack of information transfer seems like the obvious issue which being very exhausted could be responsible for.
- nradov 5y agoThis article has pretty good data on the patient safety impacts of doctor shift length. https://www.nejm.org/doi/full/10.1056/NEJMoa1900669 https://www.nejm.org/doi/full/10.1056/NEJMoa1900669
- Minor49er 5y agoThe comment reminds me of an old joke: A mechanic sits down next to a doctor at the bar. They get to talking. Before long, the mechanic says, "hey, you and I aren't so different. We both open things up and fix 'em. How come you get so much more credit than I do?" The doctor says, "You get to turn the cars off before working on them."
- tjalfi 5y agoThis reminded me of an old quip. “The doctor can bury his mistakes, but an architect can only advise his clients to plant vines.”[0] [0] https://quoteinvestigator.com/2011/05/03/architect-vines/ https://quoteinvestigator.com/2011/05/03/architect-vines/
- thearn4 5y ago> But the majority of harmful errors happen in handing over patient care from one provider to another I've heard this claim before, but this seems like a communication problem more than anything else. Keeping insane work schedules as a means to address it seems really suspect to me.
- nradov 5y agoCommunication is certainly part of the problem. But nothing comes for free. It takes time to properly update the patient chart and brief the relief shift. Plus there are things that can't really be communicated effectively. After monitoring a given patient for a while, an experienced provider will start to pick up subtle cues about their condition. How would you even communicate that?
- 908B64B197 5y agoKeep this in mind when dealing with the medical field: They won't learn from anyone. The culture of medical education in the west places doctors in a bubble where 48 hours exhaustion marathons are glorified and considered a rite of passage. Other fields have found ways to do handovers with minimal to no impact on the continuity of operations.
- Ancalagon 5y agoAnyway you slice this problem it just sounds like hospitals aren’t hiring enough employees. Sure maybe transitions produce errors but then I’d argue you had overlapping shifts where your prior carer was transitioned to a new one over a period of hours.
- e40 5y ago> Anyway you slice this problem it just sounds like hospitals aren’t hiring enough employees. Over the decades hospital administration has grown (because health insurance is complex). Seems obvious that money would be better spent on people that provide healthcare to ease the pain of those currently providing it.
- newsclues 5y agoCentury old standard set by drug addicted doctor, continues to this day despite the evidence proving it foolish and dangerous. Funny tradition that refuses to die.
- pempem 5y agoI'm not sure what this comment is steeped in beyond a lack of reading on the topic.
- Frondo 5y agoHe's referring to William Halstead, whose cocaine habit let him work long hours without sleep, and who was one of the instrumental figures in developing the modern medical residency system (with its brutally long hours): https://en.wikipedia.org/wiki/William_Stewart_Halsted https://en.wikipedia.org/wiki/William_Stewart_Halsted
- newsclues 5y agoYeah, it took me slightly too long that he was a founder of but not John Hopkins, so it was hard to drop the wiki link, thanks. Great show called “the Knick” where I learned about this.
- newsclues 5y agoI don’t think I’ve failed to read up on this topic, if you look at the link from the other user, you may be shocked…
- skeeter2020 5y agoMost mistakes happen on the hand-offs, known as "continuity of care", which is both shift-to-shift and phase of care back to health. Longer shifts help with the former at the cost of fatigue-based mistakes, so it is a balancing act, but not as simple as "shorter shifts". The challenge is unlike pilots and truckers the process points when you can naturally terminate a shift are far less defined and predictable. Ex: a pilot who's forced to divert and enter a holding pattern will extend his shift, regardless of the number of hours flown; every hospital shift in an ER is like this.
- NohatCoder 5y agoThis may vary by region, but I believe that the original idea of the 24 hour shift is that a physician is present, but only working as necessary depending on patients. A slippery slope if the hospital is generally understaffed.
- FireBeyond 5y ago24? Try being in EMS. 24... 36... 48. The private ambulance company I used to work for allowed you to work 60 hours straight, and then required an 8-12 hour break, if you wanted to work up to another 60.