5 ms·

I feel like the patient desires should matter here. Personally, as someone with complex medical needs that entails spending a lot of time with doctors and healt

I feel like the patient desires should matter here. Personally, as someone with complex medical needs that entails spending a lot of time with doctors and healthcare professionals, I want the best care possible. The best care possible does not come from people who are sleep deprived and chronically stressed. (I do see the argument that doctors should be trained to handle stress spikes, but that's different than running on empty for months/years). I wouldn't want a lawyer handling my case that has only slept 4-5 hours a night at best for months or whose body is constantly full of adrenaline and cortisol: That lawyer is going to do a shitty job. It shouldn't be on us as patients to memorize the change over times between shifts to choose when to go in based on getting a rested doctor (actual advice that's traded around). The medical hazing culture is directly harmful to patients and is, in my opinion, a violation of the Hippocratic Oath. If you want to work yourself to death in order to make a ton of money, go into fintech or join a hedge fund instead of playing with peoples' lives. If you can get into and through med school, odds are you could pick up another just as high paying profession.

jordanb 2y ago
It's really amazing how it's illegal to drive a truck without mandatory rest periods but it's not just allowed but expected that doctors will administer medical care under shiftwork conditions guaranteed to create extreme fatigue.
- nradov 2y ago
  It's a trade-off. I won't defend abusive working conditions or forced sleep deprivation. But research has shown that the risk of serious medical errors greatly increases when a hospitalized patient is handed off from one doctor to another. This is a real phenomenon which has been extensively studied. So, when doctors work long hours it does improve patient outcomes, up to a point.
  - sibeliuss 2y ago
    Thank you for answering a long standing question of mine.
  - mech987876 2y ago
    As far as I understand, the most common achievable choice is between staffing a hospital with 3 8 hour shifts per day or 2 1w hour shifts per day. Studies have shown the 12 hour shift system has better outcomes.
    - qazxcvbnmlp 2y ago
      There is a difference in human performance between working 3 or 4 12 hour shifts and 6/7 12 hour shifts a week.
  - lurking_swe 2y ago
    how is this relevant though? One could conceive of a schedule where doctors and nurses work 12 hours shifts 3 days a week, and give them every other day off. Then nobody is sleep deprived and handoffs are reduced. Just hire double the doctors and nurses, this way there are no gaps in the work week! Logically this is a very obvious and simple solution. But there are a few problems. 1. doctors and nurses expect to be paid a lot of money. Especially doctors, because they go into a lot of debt to get their education. 2. there IS money in the system to hire double the amount of doctors and nurses, but there’s an artificial shortage of doctors 3. there are many administrators with their hand in the cookie jar. More money should go to the people working directly with patients. The status quo isn’t a good trade off. It’s probably the best outcome in our currently broken system though.
    - red-iron-pine 2y ago
      > how is this relevant though? most serious errors crop up during shift changes. nurses forget to check a box, or get distracted and leave something out, doctors don't do a follow up, etc. over millions of hospital hours across the US -- the 3rd most populous country in the world -- each shift change causes dozens of errors, and people sometimes die from that. increasing them to 12 or 24 hour shifts does increase the likelihood of fatigue-based poor decisions and errors, but at a lesser amount than shift change-related errors.
- potato3732842 2y ago
  That says more about the relative positions of doctors and truck drivers in society than it does about the relative hazards of the jobs.
  - aleph_minus_one 2y ago
    > That says more about the relative positions of doctors and truck drivers in society than it does about the relative hazards of the jobs. Also about the availability of truck drivers and doctors: If - there is a constant demand for these services, - and people are willing to pay a sufficiently large amount for the services, - and the supply of qualified people to do the job is lower than the demand, the salaries will go up, but also the amount of work hours that are expected will increase.
    - jordanb 2y ago
      Rules apply to all transportation jobs: truck drivers, airplane pilots, railroad engineers, etc. The affect of fatigue on attention and decision making is very well studied.
- deleted 2y ago
  [deleted]
thatfrenchguy 2y ago
> It shouldn't be on us as patients to memorize the change over times between shifts to choose when to go in based on getting a rested doctor (actual advice that's traded around). The medical hazing culture is directly harmful to patients and is, in my opinion, a violation of the Hippocratic Oath. I mean that's really easy, don't be sick after 7pm, the night shift people are always worse!
- red-iron-pine 2y ago
  nah. they're usually the better ones. because that's where all of the worst cases tend to happen. and if they're not good yet, a couple years in the trenches at night, esp. Friday-Sunday, where the worst tends to come out, will make them good.
nradov 2y ago
Regardless of how you feel, patients aren't the ones paying most of the bills so their desires are way down on the list of priorities for the healthcare system. If you want your desires to matter, and you have the money, then you can pay extra for a concierge medicine service. Otherwise since we have increasing demand for healthcare with flat supply you can expect longer waits and less personalized attention from increasingly stressed out doctors. I'm not trying to be mean to you, just explaining the reality of the situation.
- matthewmcg 2y ago
  The reality is created by policy. The AMA zealously protects MDs and (Medicare-funded) fellowships as a cartel exempt from antitrust laws. Any they fight PAs and NPs tooth and nail.
- mezzie2 2y ago
  I understand that. I think it's morally repugnant and a sign of an ethically bankrupt society. I also have very strong feelings about the amount of debt we place doctors into as well as the fact that we place all the burden for malpractice on them vs. putting some of that burden on the insurance companies and administrative overhead that create the policies that make malpractice more likely. Doctors wouldn't have to be artificially scarce in order to make giant salaries if they weren't almost all in exorbitant amounts of educational debt. The lack of political will the US has to take care of sick people is a disgusting symptom of our infrastructural and institutional collapse. Is a healthcare system where nobody cares about the desires and will of the patients a healthcare system or a sinecure producing machine for people who know anatomy and physiology? I personally will likely be fine. I did a stint in a medical library and am literate in medical research (and can therefore take on a lot of the work that doctors previously did when they had more time with patients - I can show up to appointments/procedures with very clear recommendations and advocate for them in a way that is respected as I have the credentials to be taken seriously by medical professionals). I also have a medical doctor + several NPs in my family and can be tended to outside the system if it does collapse. I'm worried about everyone else and the society in which we're raising our children and grandchildren.
Shawnj2 2y ago
We run the software industry on the expectation devs should constantly be crunching and we’re surprised when software is broken and people leave after 6 months so nobody has any legacy knowledge Although I think this has been getting better as big companies “grew up” and mostly stopped now

jordanb 2y ago

It's really amazing how it's illegal to drive a truck without mandatory rest periods but it's not just allowed but expected that doctors will administer medical care under shiftwork conditions guaranteed to create extreme fatigue.

nradov 2y ago
It's a trade-off. I won't defend abusive working conditions or forced sleep deprivation. But research has shown that the risk of serious medical errors greatly increases when a hospitalized patient is handed off from one doctor to another. This is a real phenomenon which has been extensively studied. So, when doctors work long hours it does improve patient outcomes, up to a point.
- sibeliuss 2y ago
  Thank you for answering a long standing question of mine.
- mech987876 2y ago
  As far as I understand, the most common achievable choice is between staffing a hospital with 3 8 hour shifts per day or 2 1w hour shifts per day. Studies have shown the 12 hour shift system has better outcomes.
  - qazxcvbnmlp 2y ago
    There is a difference in human performance between working 3 or 4 12 hour shifts and 6/7 12 hour shifts a week.
- lurking_swe 2y ago
  how is this relevant though? One could conceive of a schedule where doctors and nurses work 12 hours shifts 3 days a week, and give them every other day off. Then nobody is sleep deprived and handoffs are reduced. Just hire double the doctors and nurses, this way there are no gaps in the work week! Logically this is a very obvious and simple solution. But there are a few problems. 1. doctors and nurses expect to be paid a lot of money. Especially doctors, because they go into a lot of debt to get their education. 2. there IS money in the system to hire double the amount of doctors and nurses, but there’s an artificial shortage of doctors 3. there are many administrators with their hand in the cookie jar. More money should go to the people working directly with patients. The status quo isn’t a good trade off. It’s probably the best outcome in our currently broken system though.
  - red-iron-pine 2y ago
    > how is this relevant though? most serious errors crop up during shift changes. nurses forget to check a box, or get distracted and leave something out, doctors don't do a follow up, etc. over millions of hospital hours across the US -- the 3rd most populous country in the world -- each shift change causes dozens of errors, and people sometimes die from that. increasing them to 12 or 24 hour shifts does increase the likelihood of fatigue-based poor decisions and errors, but at a lesser amount than shift change-related errors.
potato3732842 2y ago
That says more about the relative positions of doctors and truck drivers in society than it does about the relative hazards of the jobs.
- aleph_minus_one 2y ago
  > That says more about the relative positions of doctors and truck drivers in society than it does about the relative hazards of the jobs. Also about the availability of truck drivers and doctors: If - there is a constant demand for these services, - and people are willing to pay a sufficiently large amount for the services, - and the supply of qualified people to do the job is lower than the demand, the salaries will go up, but also the amount of work hours that are expected will increase.
  - jordanb 2y ago
    Rules apply to all transportation jobs: truck drivers, airplane pilots, railroad engineers, etc. The affect of fatigue on attention and decision making is very well studied.
deleted 2y ago
[deleted]

thatfrenchguy 2y ago

> It shouldn't be on us as patients to memorize the change over times between shifts to choose when to go in based on getting a rested doctor (actual advice that's traded around). The medical hazing culture is directly harmful to patients and is, in my opinion, a violation of the Hippocratic Oath. I mean that's really easy, don't be sick after 7pm, the night shift people are always worse!

red-iron-pine 2y ago
nah. they're usually the better ones. because that's where all of the worst cases tend to happen. and if they're not good yet, a couple years in the trenches at night, esp. Friday-Sunday, where the worst tends to come out, will make them good.

nradov 2y ago

Regardless of how you feel, patients aren't the ones paying most of the bills so their desires are way down on the list of priorities for the healthcare system. If you want your desires to matter, and you have the money, then you can pay extra for a concierge medicine service. Otherwise since we have increasing demand for healthcare with flat supply you can expect longer waits and less personalized attention from increasingly stressed out doctors. I'm not trying to be mean to you, just explaining the reality of the situation.

matthewmcg 2y ago
The reality is created by policy. The AMA zealously protects MDs and (Medicare-funded) fellowships as a cartel exempt from antitrust laws. Any they fight PAs and NPs tooth and nail.
mezzie2 2y ago
I understand that. I think it's morally repugnant and a sign of an ethically bankrupt society. I also have very strong feelings about the amount of debt we place doctors into as well as the fact that we place all the burden for malpractice on them vs. putting some of that burden on the insurance companies and administrative overhead that create the policies that make malpractice more likely. Doctors wouldn't have to be artificially scarce in order to make giant salaries if they weren't almost all in exorbitant amounts of educational debt. The lack of political will the US has to take care of sick people is a disgusting symptom of our infrastructural and institutional collapse. Is a healthcare system where nobody cares about the desires and will of the patients a healthcare system or a sinecure producing machine for people who know anatomy and physiology? I personally will likely be fine. I did a stint in a medical library and am literate in medical research (and can therefore take on a lot of the work that doctors previously did when they had more time with patients - I can show up to appointments/procedures with very clear recommendations and advocate for them in a way that is respected as I have the credentials to be taken seriously by medical professionals). I also have a medical doctor + several NPs in my family and can be tended to outside the system if it does collapse. I'm worried about everyone else and the society in which we're raising our children and grandchildren.

Shawnj2 2y ago

We run the software industry on the expectation devs should constantly be crunching and we’re surprised when software is broken and people leave after 6 months so nobody has any legacy knowledge Although I think this has been getting better as big companies “grew up” and mostly stopped now