4 ms·

Your comment sounds reasonable, but it doesn't allow for nuance. If a hellish residency improves patient outcomes by 0.1%, at the expense of every single resid

Your comment sounds reasonable, but it doesn't allow for nuance. If a hellish residency improves patient outcomes by 0.1%, at the expense of every single resident suffering twice as much as they need to (and likely leading to some stimulant addictions and deaths among the resident/doctor population), that's not a fair tradeoff. Medical workers don't exist solely to sacrifice themselves for others; they are humans also and their needs should be weighed as important like everyone else's. As it so happens I think some of the strain of medical residency is related to supply shortages in the health care industry. If it's not crystal clear that working 80+ hours per week is necessary to significantly improve patient outcomes, and it is clear that working 80+ hours per week makes a lot of people choose other careers (limiting supply artificially), then reform here is imperative.

ioblomov 2y ago
Am I missing something here? How could a hellish residency—with all the stress and sleep deprivation that implies—possibly improve patient outcome? Apart from the bad real-time cognitive effects, long-term memory retention is dependent on regular, sustained sleep.
- polio 2y ago
  The idea is that the stress and sleep deprivation are not sources of permanent impairment (even though they are), but rather a filter that selects the strongest candidates.
- pcthrowaway 2y ago
  Oh I'm not saying it does, the person above seemed to be suggesting that we should focus on figuring out the residency conditions that lead to the best patient outcomes, rather than improve the conditions for residents, which suggests they believe worse conditions for residents may be better for patients. Just to point out the obvious, people doing 80 hrs/week for 2 years (lower end of residency term I believe) are going to have twice as much 'experience' as people doing 40hrs/week for 2 years. I suspect most of us here know more hours worked doesn't directly correlate with more retention of information and best practices, but that's the thinking. I'm arguing that even if 80hrs/week residencies was the optimal amount of pressure to turn our fledgling residents into battle-hardened physicians, if you can get 99% of the effect with 40hrs/week, maybe do that instead. And again, I'm not even suggesting this is actually the case.
- thijson 2y ago
  One of the guys that founded the modern medical education system was a coke head: https://magazine.columbia.edu/article/cocaine-addict-who-changed-medicine-forever https://magazine.columbia.edu/article/cocaine-addict-who-cha... The Mayans used coca leaves to get more work out of their people. I guess medical residency is kind of like a hazing ritual. Today's doctor's are like I went though it, why can't you?

ioblomov 2y ago

Am I missing something here? How could a hellish residency—with all the stress and sleep deprivation that implies—possibly improve patient outcome? Apart from the bad real-time cognitive effects, long-term memory retention is dependent on regular, sustained sleep.

polio 2y ago
The idea is that the stress and sleep deprivation are not sources of permanent impairment (even though they are), but rather a filter that selects the strongest candidates.
pcthrowaway 2y ago
Oh I'm not saying it does, the person above seemed to be suggesting that we should focus on figuring out the residency conditions that lead to the best patient outcomes, rather than improve the conditions for residents, which suggests they believe worse conditions for residents may be better for patients. Just to point out the obvious, people doing 80 hrs/week for 2 years (lower end of residency term I believe) are going to have twice as much 'experience' as people doing 40hrs/week for 2 years. I suspect most of us here know more hours worked doesn't directly correlate with more retention of information and best practices, but that's the thinking. I'm arguing that even if 80hrs/week residencies was the optimal amount of pressure to turn our fledgling residents into battle-hardened physicians, if you can get 99% of the effect with 40hrs/week, maybe do that instead. And again, I'm not even suggesting this is actually the case.
thijson 2y ago
One of the guys that founded the modern medical education system was a coke head: https://magazine.columbia.edu/article/cocaine-addict-who-changed-medicine-forever https://magazine.columbia.edu/article/cocaine-addict-who-cha... The Mayans used coca leaves to get more work out of their people. I guess medical residency is kind of like a hazing ritual. Today's doctor's are like I went though it, why can't you?